December 2017 Newsletter

Then saith He to Thomas, Reach hither thy finger, and behold my hands; and reach
hither thy hand, and thrust it into my side: and be not faithless, but believing. ²⁸
And Thomas answered and said unto him, My Lord and my God.
— John 20:27-28

 Bear ye one another’s burdens, and so fulfill the law of Christ.  — Galatians 6:2

Sharing Burdens, Sharing Scars.
            Out of the house, under silently fading stars in that final half hour of the night, just enough light to see the puddles from last night’s rain, you get in the pickup, for some reason closing the truck door as quietly as you can, not wanting to disturb the still sleeping morning. You pull out slowly, without headlights, driving one-handed across the solár (barnyard) and down the accesso (driveway). You’re steering with one hand while the other hand carefully balances a cup of coffee. You’re driving slowly since the driveway down to the coast road isn’t exactly like Downton Abbey’s. It’s the rainy season, and there are more gullies and rivulets and dips and swales than there are flat stretches before you get to the bottom of the hill.

At the “T”

The challenge is to have enough coffee left in the cup for one last swallow when you get there.

But when you get there, to the “T” at the end of the drive, with a little more coffee in you than on you, God more than makes up for the lack of civilization with another of His symphonies of the dawn. To the east, the border of sky at the rim of the San Antonios is just outlined in a crimson like the light under the door to Vulcan’s forge. Straight ahead the storm has pushed out over the sea, over the Cayos Cochinos. But the sea is pushing back and holds the cobalt thunderheads on the horizon.  Sheet lightening illuminates the battle in brief brilliant flashes. To the left, to the west, the last star still burns bright.  You turn to the left.

I’m out early this morning in the pickup. Before work I have some lumber and some plans to deliver to Luis, the Ebanista, the Cabinetmaker over in Lis Lis. Funny story about how Luis got his start in the cabinet making business: he came to Balfate originally because he heard that there was a hospital there, and he had apprenticed with a Cofreador, a maker of coffins. Coffins were the only thing Luis knew how to make when he first got here. He thought that would work, because, as everybody knows (at least in Honduras), every hospital needs a coffin maker… But Luis, as he tells it, nearly starved to death because at Loma de Luz, he says, “You know, nobody ever seems to die!  So, what do they need a coffin for? … I had to learn how to make windows and cabinets. A man’s got to eat, you know.”

The turn-around with Luis in Lis Lis didn’t take long, so on the return trip the sun in my eyes was just peeking up over the San Antonios, painting everything red-gold—transforming plain old, bony Brahma-mix cattle in the road into something of immortal beauty. Their cowboy attendants, with the dawn’s light on one side of their bodies and the indigo shadow of the madrugada on the other, they weren’t just campesinos in rubber boots. They were like silent cowboy symbols moving in a slow-motion dream.

In that light, as I rounded a corner, I passed two little girls, sisters, I guess, or cousins. They couldn’t have been more than 10 and 11… carrying a 10 gallon milk can between the two of them, hauling it from the milking shed to the roadside. By the way their arms were straining it looked as if it must have been pretty full too. That would be probably 80 or 90 pounds between the two of them. Barefoot in cotton dresses, one has her hair in her face and pushes it back behind her ear… both of them are blowing their cheeks out in the way that kids do when they are straining hard. Then they looked at each other doing it at the same time and started giggling just as I passed. Still, they never set down their shared burden till they got to the edge of the road.

            As I was coming in the gate at the hospital, a little later in the morning, I passed two stolid women walking up the hill together, carrying a burden between them. Each woman had one hand on either side of the top-strap of the big day-bag that a lot of countrywomen carry when they are going to be out all day.  Sharing the carry of a load like that is so common out here that I wouldn’t have noted it at all if the picture of the little milk-girls hadn’t been so fresh in my mind.

Sharing the Load

           Today is another day with both clinic and wound therapy patients and surgery. During the turnover between operations, I’ll go to see the next 3 or 4 patients waiting in wound therapy. Every exam table will have someone on it, many recovering from some grave injury, often in kind of private places. In the interest of privacy, we have curtains drawn between the exam tables. But 3/4ths of the patients will have pulled the curtains back to share with their neighbor their scars and their stories while they are waiting.   It’s the same on the wards and in the Pre-op Holding and Recovery Rooms. Unless I know the patient’s family, I often can’t tell them apart from some other patient’s family. Before surgery, they all join in for the explanations and the prayers. After surgery I routinely go out to a packed corridor, and the first thing I’ll ask is, “who is here for (Jose, or Maria, or Feliciana, or Fulano)…. Everybody in the corridor will nod to whoever is the closest family member of Jose, or Maria, or Feliciana, or Fulano, because they’ve all met each other this morning, and their own family member is next in line.  They will also listen attentively to the report regarding the outcome of the surgery, and they will all rejoice together for the common good news, or comfort each other for the uncommon bad news— because they are all in this together.

A funny, true story from just the other day: a big heavy-set woman was being so kind and solicitous of a recovering patient who we thought had come alone. He was waking up from surgery in some pain yet not awake enough to really know where he was. This nice lady had asked if she could come into the Recovery Room and now is stroking his hair and patting his hand and telling him that surgery was over and that everything was fine and he was going to be all right. Assuming the woman was her patient’s wife, Rosa Linda, our quietly compassionate and unflappable little Recovery Room nurse, was efficiently going about her job, checking and recording his vital signs. Then when the patient awoke just enough that you need to call his name to get his attention, the woman looks up to Rosa Linda and asks “What is his name?”  Rosa Linda raised both eyebrows, supplied the patients name, and then said “So…you’re not his wife?”  No, it turns out the nice heavy-set woman came to the hospital with her crippled son, the next patient to be operated on. She just had noticed that the man on the gurney had come alone and figured he needed someone to be there for him when he was waking up. This was kind of funny, but it wasn’t so surprising, because, the Poor are like that.

In preparation for writing this piece I wanted to see what other people had to say about the Poor. I read more than 100 famous quotes about The Poor.  One of the first things I noticed was that almost every single person being quoted about the Poor…was Rich… and Powerful. And, they were mostly all Famous people. That is something akin to a Man pontificating about The Pregnant. His credibility on the matter might be called into question. One of the next things I noticed was that while they were mostly all well-meaning, and a few had something important to say, most of the people didn’t seem to know much about the poor, maybe didn’t even know one, and most of them confuse and conflate “The scourge of Poverty” with “The Poor.”

With each passing year I learn there is far more that I don’t know than what I do know. But one of the few things I know something about is… the Poor. For the greater part of my adult life I have lived among them as my neighbors and patients, friends and foes, students and teachers, employees and co-workers. One of the things I can say with certainty about the Poor is that they are people. They are not a Scourge, and they are not Noble Savages, and they are not simply an Object for Charity. The Poor are People.

While Poverty is the condition of relative insufficient access to goods and services, relationships and opportunities, The Poor are the people, the sector of human society, living under the condition of poverty.

Jesus knew and understood the Poor as People far better than any of us, of course. For one thing He was one of them, one of the Poor. For another thing: well, He was Jesus. But not one website of all of the collected sayings about the Poor quoted Jesus. So, among all of those “Greater than 100 Great quotes about the Poor” collections, one of the very few that considered the Poor as people, instead of objects for charity, was John Steinbeck; well actually it was his character, Ma Joad, in The Grapes of Wrath. Ma, herself a poor woman, says, “If you’re in trouble, or hurt or need—go to the poor people. They’re the only ones that’ll help….”

Now believe me, I’m not idolizing the poor. Poverty neither makes the Poor good nor bad, neither sinners nor saints, neither clever nor dull. But there are some characteristics found much more commonly among the Poor, the people with insufficient access compared to the Rich (the people with abundant access). One of the good character traits is this: The Poor are generous.

Carrying the load

            By definition, they don’t have much money to share, but they share what they have. They share their food. They share their shelter, or their ride, or their labor. They share their time. They share their burdens. And, they share their scars.

I have a patient, a woman named Ángel. In Spanish, Ángel is pronounced A´ng- hel and, in Spanish, Ángel is a boy’s name.   I think her father named her for the son he wished he’d had. If you knew her, you’d say “Yeah, I can see that.” Angel is one of my favorite patients. I see her once a year now, and it always makes me happy to see her. Part of the reason it makes me happy to see Ángel is that she’s doing great. She’s a success. She is a 12 year survivor of breast cancer.

Ángel is poor, of course, like basically all of our patients. She is a quiet person, maybe a little simple, kind of shy. I remember how scared she was 12 years ago. It wasn’t even registering when I told her the biopsy results, and explained about the modified radical mastectomy that she would have to go through. She seemed to be just going through the motions like she was walking under water. But she did go through the mastectomy and the healing afterwards. She has gone through the fear and anxiety and expense of each follow-up exam.

Now, 12 years later, Ángel is still poor, though it seems a little less so. But she is no longer scared, and she is not so shy.  She has become kind of bold. Once, a couple of years ago, Ángel told Rosanne how she has a neighbor “with the same problem.”  Ángel encourages her neighbor all the time, saying that she just needs to save up for the mammogram in the city and save up for the travel expenses, a little at a time, and then go to Loma de Luz. “Go there and see my doctor,” she says. “It’s better to face it and deal with it than to just let it eat you up,”

Last time I saw Ángel was a couple of months ago in clinic. It was good to see her again. And, once again, she had a clean bill of health. I knew that the visit meant a lot to her, that she saved up all year for the trip. So, though I took a little extra time to talk about her home and family, I had a lot of other patients waiting, and in short order we had said goodbye at the door to the office, and she had another year of distance from cancer recorded in her chart.

It just so happened that morning that (a few patients later) there was another shocked and frightened woman sitting before me, just learning that she was facing breast cancer. I was certainly saddened and also surprised that this breast biopsy result showed cancer. The woman, of course, was just stunned. I talked her through the next couple of steps, but I could tell she was hardly hearing what I was saying. She needed someone, someone better than me, to talk to.

I thought of Ángel. So, I went out into the corridor, crowded with patients. They always turn their faces expectantly watching and commenting to their neighbor on “where is the Dr. going now?” I was relieved to find that Ángel was still there, seated in one of the chairs lining the wall toward the courtyard. She must have been waiting until it was time for her bus. I went over and crouched down in front of her and explained the situation and asked her if she wouldn’t mind talking with the woman. She seemed a little surprised, but nodded that she willing and followed me back to the exam room.

I introduced the two, then left them alone and walked down the corridor to see other patients in wound clinic.  Ten or fifteen minutes later I returned, tapped on the door and entered. There was Ángel, seated next to the woman. She had her shirt raised and was showing her surgical scars. The two hardly looked up as I entered. I sat across the room, with my back to them, intent on being invisible and making a bit of a show of completing paperwork and computer entries while they talked. A few minutes later, Ángel left. The woman seemed much more collected, calm, and resolute. I asked if she could do this. She told me, “With God’s help I can do this.”

Far better than anything I could have said, far more than anything one of our chaplains could have said, Ángel, poor and shy and simple, was able to minister to that woman in her shock and fear of what the future held. For Ángel had real credibility. She had walked through that particular Valley of the Shadow of Death and come out the other side. She had the scars to show for it. She was willing to share her story. She was willing to share her scars.

It’s coming on Christmas, and particularly up there in North America, you’re being bombarded with a million and one things to buy for “the Holidays.” But no matter what it looks like now, no matter how it has been desacralized and profaned, and covered up with stuff, Christmas started out as a celebration of the birth of Jesus. It is sometimes hard to remember that the Christ Child who was born in poverty, yet received the gifts of a King at the time of His birth became Christ the Man, the Messiah who gave back immeasurably greater gifts at His death; for “When he ascended on high, he led captivity captive, and gave gifts unto men.”  He bought and paid for the gifts of Salvation, Meaning, Purpose, Direction, Abilities for Ministry, “and, in the end, Life Eternal.”

              To this day He carries the scars to show for it. And He’s willing to share those scars with us. “….Behold my hands,”

       Shouldn’t we too?  Shouldn’t we share, for His sake, a gift that neither the Poor nor the Rich can buy with a credit card. Shouldn’t we share the carry of someone else’s load. Share their burdens. Share your story. Share your scars.

This Christmas, in Christ Jesus,

 Jefferson McKenney, M.D.

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