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| A Day in the PICUI walked into the PICU (Pediatrics Intensive Care Unit) at 7:04AM, digging through the pile of papers I stored in my white coat pocket to find the progress notes I had written yesterday for my two patients. Having left immediately after rounds the day before (post-call), I needed to find out if there were any updates on my two patients. I skimmed quickly through their charts, looked up the labs/radiology results on Cerner, and recorded the vital signs/ventilator settings before putting on a respiratory mask to see my first patient, who was on droplet precaution. E- was a 9 mo. old little girl in cardiogenic shock secondary to viral myocarditis requiring mechanical ventilation, with concurrent Staph bacteremia (blood infection) and fungal UTI (urinary infection), and as I looked at her little form laying on the bed taking each breath with the assistance of the ventilator, and at least 2-3 other lines/tubes coming out of her, I could relate to the Gospels describing Jesus being "filled with compassion" Mark 1:41. Despite all the medicines we had been giving her, and the aggressive diuresis we were attempting, her heart function remained impaired. I finished examining her, eyed the current ventilator settings, and walked over to my next patient's room. Little D-, a 2 mo. old male admitted for electrolyte imbalances and failure to thrive secondary to severe malnutrition and neglect, opened his eyes to look at me as I approached his bed. He tracked my motions as I walked to the other side of his bed to start examining him. I was so happy to see him regain energy and strength over the past couple of days as we started feeding him through TPN/lipids and enterally. As I tickled his belly, he gave me a lopsided social smile, the fat pads in his cheeks missing. I had a good feeling that D- was going to do well medically, the concern now was to find him a good family to live with, since his parents had been arrested by the police and charged with neglect/abuse and were not allowed to visit D-. Lacking an earthly father now, I breathed a quick prayer asking God to intercede for him as His Heavenly Father...
I finished my progress notes of the day, went to morning report, and came back to meet up with my team for morning rounds. Rounds were going to start later again this morning, and as we waited for our attending, I stood chatting with my two other classmates on the team. Here came our attending, and rounds began. But before we finished with our first patient, our attending was quickly whisked away by one of the nurses taking care of one of our patients who unfortunately developed a tension pneumothorax (collapsed lung) last night. Her chest tube was leaking and needed to be replaced. Ten minutes later rounds resumed, but after two more patients were presented our attending again had to go take care of another unstable patient. This time we were told that rounds would have to resume at a later time.
Around that time, the fellow grabbed me to go down to the ER to admit a patient. This was a baby that had possibly coded and was being resuscitated, he told me. As we walked into the Peds ED, my attention was immediately drawn to the young woman worriedly hovering over her little baby in room 6, mascara stains running down her cheeks. After introductions, she slowly started telling us the history, that her baby girl K- was a 3 mo. old born with genetic abnormalities and Tetralogy of Fallot (a congenital heart defect), spent weeks in the NICU after birth, and mom and baby had driven to the hospital for a follow-up genetics appointment this morning. When the mom took baby out of the car, she thought K- was sleeping, and carried her up to clinic, and it was until they were upstairs that it was discovered that K- was blue and not breathing. She was rushed to the ER, where it was discovered that her heart had stopped beating, and resuscitation efforts began immediately. Anesthesia had a difficult time intubating her (due to some webs/scars/obstruction in the trachea), and numerous Epi drips were given, and unfortunately it took close to an hour before she was properly intubated. By the time we saw K-, she was not taking any spontaneous breaths despite not being on any sedation (all breaths were initiated by the ventilator), and when we examined her, her pupils were fixed and dilated. Her blood pressure was within the low normal range for her age even with all the Epi that we had given her. None of this was good news for K-, and as we were making arrangements to admit her upstairs to our unit, the fellow turned to me solemnly and quietly said, "Honestly I think she's braindead because she was without oxygen for too long, but only time can tell how she will do."
It was not even noon, and I was already feeling overwhelmed. My heart filled with incredible sadness. How do you tell a mother that her baby may never wake up again, that the baby that she had put into the car this morning may not be the same baby that is laying on the bed in front of her? A feeling of helplessness washed over me. I couldn't stop thinking about K- and her family during noon conference, or when we resumed and finished up rounds after lunch. I watched the transport team settle K- in her room, the fellow and the nurses attempt numerous sites for a central line (finally succeeded in the R IJ), the peds cards fellow and tech look at K's heart with the echo, and I knew that "the talk" was coming soon. K's dad had arrived from work, and within a few minutes, the fellow told me that he and our attending are going to talk with the parents, and asked if I wanted to come with them. I nodded and followed, though I felt unworthy to take part in this extremely difficult and private conversation. After we all sat down in the conference room, our attending and fellow began to share about that status of K-, and when our attending said "I'm sorry, there's no easy way to say this, but it seems unlikely that K- will ever wake up again", both parents started sobbing uncontrollably.
I had rarely felt so helpless before. From a medical standpoint, our attending, with her many years of experience, had little left to offer K-, not to say me, a mere medical student. All I could do was to offer the tissue box to the parents... and suddenly it hit me. Whole person care. What had I spent a whole month learning last summer? Yes, it might be true that we had little left to offer for the physical needs of the patient except to keep her comfortable, but we certainly could do what we could to offer support, comfort, and care to the parents. The soul and mind are as much a part of a person as the body, and at a time like this, needed healing just as much. The simple act of offering a cup of water, asking if we can contact family members, or asking if it would be helpful to pray can mean alot during stressful times like these. We asked if they would like to speak with a chaplain, and mom shook her head, they just needed some alone time right now. We respected their decision and left the room, after the promise to call them into K's room when the nurses are ready.
As I gowned up to help my fellow put in another chest tube for our other patient with the pneumothorax, I reflected on Pastor Harold's sermon last Sunday on suffering. This was a classic example of a "perfect storm" for this family, and though we might not understand why this was happening, we could receive some encouragement from Paul's example: "We do not want you to be
uninformed, brothers, about the hardships we suffered in the province
of Asia. We were under great pressure, far beyond our ability to
endure, so that we despaired even of life. Indeed,
in our hearts we felt the sentence of death. But this happened that we
might not rely on ourselves but on God, who raises the dead. He
has delivered us from such a deadly peril, and he will deliver us. On
him we have set our hope that he will continue to deliver us, as you help us by your prayers. Then many will give thanks on our behalf for the gracious favor granted us in answer to the prayers of many." 2 Cor 1:8-11.
It was 5:30, the other students had already left, and it was past time for me to leave for the day. As I walked past K's room, I took one last look inside to see the parents at K's bedside, mom stroking K's hair. God of all comfort, I prayed silently, may you fill this family with your love, comfort, and peace today.
As I walked outside from the hospital, God gave me this verse: "I have told you these things, so that in me you may have peace. In this
world you will have trouble. But take heart! I have overcome the world." John 16:33.
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| Whole Person Care Post-METSJust wanted to share with you guys how God has been faithful to me practicing Whole Person Care post-METS. Hopefully this will encourage you to be used by God whereever He has placed you. :)
Family Medicine (1st week post-METS)
I had made a commitment during the Preceptorship (per Bob's prompting) to ask at least one
spiritual care question per patient I see, if not go further per Holy
Spirit's prompting. I was a little nervous going in on Monday, not
knowing how best to incorporate spiritual care, but as the day went on,
I found that it was not as difficult as I had previously thought. I
was able to ask my patients about "their sources of strength", if they
consider themselves "persons of faith", "what their faith means to
them", etc. God even opened the doors to pray with three of my
patients on Monday. :) The only problem became that instead of taking
15 min to see each patient (the time alloted to each pt), I was taking
30 min to see each patient, and so my preceptor (who is Christian) ran
behind on her schedule. She was very patient with me at first, but I
could tell as the day went on that her frustration started to build,
and when I left Monday at 5pm she still had 4 pts left to see. I went
home that day confused and frustrated as well, as I was thankful that I
had those spiritual care experiences that day, and I could see that my
patients were encouraged through them, but at the same time I didn't
want to slow my preceptor down and become a burden to her. I prayed
for God's guidance that night. When I went in on Tuesday, the first
thing my preceptor said to me was to thank me for being a big help to
her. She said that instead of slowing her down, she realized that I
was helping her by seeing half of her patients and writing the notes
for her, which ended up saving her a lot of time that day. When I went
in on Wednesday, she repeated the same thing to me, and thanked me for
helping her this week.
I
was completely blown away by my preceptor's reaction. And then I
realized God's plan in all of this, that when we're faithful to Him to
do the things that glorify Him, He is completely faithful back to us
beyond our imagination. Not only was I able to continue to practice
whole person care (and my speed improved throughout the week), I was
able to help my preceptor to get her work done, and God helped me to
build a great relationship with my preceptor as well. I even had a
chance to share with her a bit about METS and gave her a copy of our
newsletter. Isn't God simply so awesome? :) 
Neurology (~5 weeks post-METS)
It was 5:23pm on Monday of the last week of my neurology rotation, and
I picked up my bag and walked out of our team room. The long hallway
of the VA hospital loomed before me, and as I started my trek down the
hall, I was looking forward to a breath of fresh air and a glimpse of
the sunshine outside after a long day of work. But something was
tugging at my heart, and instead of walking to the elevators I turned
down another hallway and found myself standing outside of Mr. C's
door. During rounds this morning, our attending physician had told Mr.
C. and his wife that they may possibly have to stay for another week,
which added to the three weeks of their inpatient stay. Their
disappointed faces filled my mind as I breathed a quick prayer and
knocked on the door. After an invitation to enter, I walked into the
room and saw that a nurse was changing Mr. C's IV. Oh no, I thought,
as I had hoped that I would have the opportunity to encourage and pray
with Mr. C and his wife privately.
Having another person in the room had been completely unexpected. As
Mrs. C came to greet me, I asked some formalities about how Mr. C. is
doing, saying I came to check up on him before I left for the day.
After the formalities were over, there was an awkward pause as Mrs. C.
looked at me in a puzzling manner wondering why I was still standing in
the room. Well God, I prayed silently, I guess I can practice whole
person care in any setting You have put me into, with Your help. I
took out the little bookmark with an encouraging Bible verse and gave
it to her, saying, "I just wanted to give you guys this. I know how
difficult the past weeks have been for you in the hospital, and I was
wondering if it would be helpful to pray with you and your husband?"
She stared at me for a second, and then gave me the biggest smile I had
seen all day. "You don't know what a huge blessing this is. We now
know where you stand spiritually! We had been praying for awhile that
God will place Christian health care workers in this hospital. God has
just answered our prayers!". Then, as the nurse left the room to grab
more supplies, the three of us held hands, and I prayed for both Mr.
& Mrs. C. They both thanked me, and Mrs. C. promised to pray for
me as well. The next two days, as I went to pre-round on Mr. C. in the
mornings, they both greeted me with friendly smiles and told me that
they had been praying for me the previous night. On Wednesday, the
last day of the clinical part of my rotation, I went to say my goodbyes
after work. After thanking me profusely again for my "help" (despite
me feeling like there was so little I could contribute), Mrs. C. wrote
down their address and phone number and made me promise that I would
call them if I ever pass through their town. I was completely floored
by their genuine gestures of faith and thankfulness. Despite my
original expectations of serving them through spiritual care, instead I
had been greatly blessed by them in return. I had never expected them
to pray for me, nor to treat me like a trusted friend. But as I walked
away from the room that day, I was filled with a heart of thankfulness,
understanding that only God can bind anyone together in His love,
despite coming from completely different backgrounds and cultures. In
God's love, we can truly be one voice, one family, one body in unity
learning how to love others the way Jesus loves them.
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| METS Whole Person Care Preceptorship 2007METS - Medical Evangelism Training & Strategies, a summer preceptorship program for Christian health care students organized by the Medical Strategic Network (branch of Campus Crusade for Christ). Thirty-five students spent a month together learning how to incorporate spiritual care into medicine.
Have you ever had a doctor rush into the room, asked for some symptoms in a detached and uninterested manner, listened quickly to your heart/lungs, hurriedly wrote a prescription, then rushed out of the room as quickly as he entered? And you were left feeling unsatisfied like you still had questions he didn't answer, and wondering if he even cared at all about you as a person? Well, we learned how not to do that this summer... but instead reach out to patient's physical, emotional, and spiritual needs - - in other words, how to practice whole person care.
Here're two pictures of our group - the guys and the gals. The guys trying to look cool with their upturned collars, and the gals looking beautiful, like always :)
Here's a picture of Kristen and I at the METS conference at the start of our preceptorship. We had just learned the basics about how to obtain a spiritual history from a patient we had never met before, and we partnered up to try it out at Loma Linda Medical Center. We got into our first patient's room, and we made the introductions to him and his mom about who we were, and as we were about to go ahead with the interview, the patient suddenly said "espanol?", and I was completely taken aback. I have some background in Spanish, but had never used "spiritual" Spanish before, and Kristen has no background in Spanish. How is this going to work? I said a quick prayer, then decided to go for it by faith. We all started chatting, and then started reading the "Four Spiritual Laws" together. We found out that they were of Catholic background, but mom responded that she believed "being saved" means to pray three times a day and do good works. We talked about the redeeming salvation through Jesus Christ, and when we asked if they wanted to dedicate/rededicate their faith, they said yes, and we all held hands and prayed the prayer together. Though we didn't exactly know their salvation status before, as of that afternoon, they could have an assurance of their salvation. :)
Here's us at the Shu's house. Stan and Esther are two of our leaders, and they are some of the most generous people I have ever met. They opened up their house to us the whole month. Here's us in one of our talks/lectures, and one of us hanging out in their pool
Here's my small group whom I love dearly. We started out the month with our "Soul to Soul" session, where we all took an hour to share our life stories with each other. My first thought was, "who can talk about themselves for a whole hour?", and then "who would share their deep dark secrets with people they had just met for a week?". Well our leaders Sharon and Diana set the tone, and shared their personal stories with us, and then the next day, we spent eight hours sharing stories with each other. I was surprised at how open and vulnerable we were all willing to be with each other, and each person shared something(s) that we normally would not share with just anybody, and I realized that no matter how perfect people appear on the inside, that everyone has wounds/weaknesses/challenges that they're dealing with. This helped to open us up for deep and honest relationships with one another, where we can be affirming, yet accountable to one another. We read "Search for Significance", a wonderful book talking about many of the "traps" people fall into, like seeking for approval from people instead of God, being caught in a performance trap, etc. We also had the chance to go deep into God's Word through the month, and I really valued the time we spent together. I pray that our relationships will continue beyond the preceptorship. Christina, I'm praying for you and your CMDA group in Worchester!
Stacie is another person I deep value, and feel SO privileged I got to know her over the preceptorship. She is an absolutely amazing woman of God, full of wisdom and tact gifted from above. She's an ethics major at a local seminary, and has an answer to almost any question you may have on spirituality and ethics. I loved all our conversations together, especially her teaching during the "Feminar", and what it means to be a woman belonging to God. Another thing I so appreciated was her attitude about singleness. She saids that she "thrives in singleness, not just survive singleness"! This is so refreshing to hear in a society where there the social standard is to date, be engaged, and get married by a certain age... she is such an inspiration to christian single women!
We went to Disneyland and had a blast. Space Mountain was much faster than I remembered it! One of our memorable moments was when we got stuck on It's a Small World ride for ~30 minutes, with the music playing again... and again.... and again... Here's us after hearing the song about the 50th time...
Christina, Ashley and I trying out some hats... :)
We did a medical missions trip down to Ensenada, Mexico. Here's Dr. Harvey Elder and I outside our dorms in Mexico. I had the privilege of working with Harvey in Mexico... he's full of godly wisdom and experience about how to effectively do whole person care, and God has used him to touch so many patients in his life. He reports that he now prays with about 98% of his patients in his ID practice, which is an astonishing percentage, considering the number of patients he sees in his clinic!
Harvey during one of our patient visits
We decided to set up a spiritual care station for patients waiting to see the doctor, so I asked Noah if he would like to share the Four Spiritual Law with the patients. He looked at me, and he said, "but I don't speak Spanish", and I told him that he can just try reading it to them. He eventually agreed, and I later found out that he had started reading the tract with this patient (in the picture), and even though he didn't know what he was reading, or if he was pronouncing the words correctly, that the patient read along with him. When they reached the end, and he asked her if she wanted to lead a Christ-centered life, she said yes! He was able to lead her to Christ not even knowing her language! This is evidence of the power of God working even with our own human limitations, if we just allow Him to use us... :)
Our typtical triage station
We had two clinics, a kids fair, and a building project going on all at the same time that day. The building team was able to build this house for a family of four (shown here) in a day's time! Here's Phil offiically welcoming them to their new home.
So we got 17 fabulous brothers in our midst who are perfect gentlemen to us. How should we (sisters) thank them? How about by cooking them lunch, making them care packages, writiing encouragement cards, and having them play "Bigger and Better"? Here's the "booty" they picked up from their scavenger hunt. Notice the old mattress and fertilizer machine... ^_^''
One evening, our brothers cooked for the sisters a really nice dinner in the decorated lounge, gave us roses and encouragement notes, and sang a song for each one of us. Thanks guys, it was truly a "Night to Remember". :)
Then the evening continued with a trip to Universal Citiwalk
And we finished off the night with late night Chinese food at 2AM at Baccali's :)
So what's a good program without good food? Here's a bunch of us off for some good sushi... yum :P~
Allow me to introduce you to Amanda. She's the newest member of the "egg" clan. She's tried her first piece of mango, her first sushi, and now even as a cell phone keychain to go along with it too. She is truly "white on the outside, and yellow on the inside. :) Amanda, are you going to start that facebook group? :) (In picture, she's holding pocky stick, phone with Asian keychain, and Asian umbrella)
And here're the gals during our last night together in Hollywood. I miss everyone so much... till we meet again!
Check this album out for other pics: http://www.imagestation.com/album/pictures.html?id=2089639527
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| March MadnessVCU defeats Duke 79-77!!!!!!!
That was an awesome game down to the last 1.8 seconds... Go RAMS!!!
http://www.ncaasports.com/basketball/mens/gamecenter/recap/NCAAB_20070315_VACOMM@DUKE
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| A Challenging Look on PovertyI attended two awesome(though challenging) lunch lectures this week which really got me thinking (while post-call on peds night float). The first one was presented by a team that operated a community (free) clinic up in Rhode Island who subsequently has built and set up a clinic down in Honduras literally from scratch (they even had to chip away at the rocks to make a road to this clinic). Some of the audience members asked really good questions about how they were able to decide how to divide up their resources between the two projects, since the community clinic also has huge needs for funding. She responded that she doesn't really look at it as one pie that they're trying to share, but more so as as two separate pies with two different set of sources. Just because they are going down to Honduras, doesn't mean that they're taking anything away from their clinic and their patient population in Rhode Island. Then what the speaker said really struck me. She said that "Abundance builds abundance", and the example she gives are people who go to volunteer in Honduras for a few weeks go back to the States all fired up to make a difference in their own communities there. And this project has grown from a little clinic to being partnered with quite a few of the major medical schools in the States (perhaps MCV will play a part someday?), and the lives of the people who live in this little village of Honduras are changed forever (they now have access to medical care and more importantly, clean water)...
The next day, Dr. Hilfiker, a Christian family practitioner and author from DC came to speak to us. I sat down, expecting him to talk about some inner city ministry that he's been working on, but instead, he gave us a detailed history of how poverty and the segregation between blacks and whites came about. He mentioned that back in the day, many landlords would refuse to let African-Americans live in their housing, and so they are forced to live in certain areas of town together, and thus the "ghettos" and "slums" start to form. He also talked about "Margine" and her little boy. Her son, being a typical two-year old child, was actively climbing around the office looking for things to play with. Margine would grab her son, scold him, and told him to sit still. When the child started squirming and pulling his head away as Dr. Hilfiker looked into his ears (which is normal reaction for a two year old), Margine once again grabbed her son and scolded him severely. Dr. Hilfiker was fuming inside at the way that Margine was treating her son, but then he remembered that Margine is only 14 years old, a child herself. And more than likely, that was the way that she was treated when she was a child. Even though she should still be responsible for her actions and the way she raises her son, the root of the problems went way back before Margine was even born. That really struck me as I had more than a few encounters with difficult behavior or non-compliance in our patient population, and I think many of us instinctively try to blame it on the patients themselves in some way, saying that they're lazy or just don't care. But how many times, do we actually think beyond the box and actually go to the root of the problem?
So what does poverty mean for you and me? Why do we keep poverty at arms length, or worse yet, across the town? The Bible has over 300 verses on the poor, and God's concern on them. Here's a classic example:
"Is 41:17. The afflicted and needy are
seeking water, but there is none, and their tongue is parched with
thirst. I, the LORD, will answer them Myself, as the God of Israel I
will not forsake them." And as Jesus Himself was the ultimate example of serving the poor, how can we claim that we're following in our Lord's footsteps (or as some may say, being covered by the dust of our Lord) if we do not care for the poor? And where does this start? I think a huge part of it has to start within us, a willingness to be educated on the topic and not being afraid to be immersed in the world of poverty.
Dr. Hilfiker mentioned during his talk that he thinks it's spiritually detrimental for children to grow up in the suburbs. I was a little taken aback when he first made this comment (as someone who grew up in the suburbs), but as I thought about that comment, I couldn't help but agree with what he's actually saying. As someone who was extremely sheltered most of my life, my image of poverty and inner city was what was presented by the press. I was taught to walk on the opposite side of the street when someone sketchy walks by, or never walk around alone in the dark, or not to go to the wrong side of town. But coming to Richmond, living in the urban areas, working with many underserved patients, doing activities in Church Hill (an inner city area of Richmond) has opened my eyes to how people live under tremendous stress and need. Jesus himself not only worked with the poor, but He lived with the poor, laughed with them, cried with them, met their every need whereever He went. I'm always very touched when I hear about middle-class educated people moving into the inner cities (as many in my church have moved into Church Hill), and about the life-changing experiences and revivals that have resulted from them.
I'm not sure what this means for me personally, as I'm still exploring the path ahead. But as I look in front of me, the path through the "ghettos" and "slums" is narrow, scary, and covered with thorns and barriers, and the other path is open and wide and full of bright attractive lights and signs that promises riches, popularity, power, prestige, and comfort. But I know that only one way leads on to Heaven.
*Let's ask the Lord to give us a heart for the poor as He does
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