Inspiration

journal entry made January 25, 2009

I imagine that every doctor could speak volumes about particular patients that have affected her, inspired her, changed her. I encountered one such patient before I even entered medical school while I was serving with Mercy Ships. Her name was Betty. Betty was 21 when I met her in the hospital wards on the third deck of the Africa Mercy. She was about half my size but had twice my spirit and spunk. Betty had been admitted for her second attempt to repair a vesico-vaginal fistula. Three years earlier Betty had been with child, (whether she had been impregnated by choice or by force I still do not know; both are unfortunately equally likely in Liberia) and when it came time for her to have her baby she was not able to push it out - perhaps because of her size or her age or some ill position of the child. Being far from medical care, Betty was stuck in labor for 7 days. The baby died, and she was eventually able to deliver it, but the pressure that it had put on her birth canal left her with a 3cm tear between her urethra and vaginal wall, providing a passageway for constant, uncontrollable urine leakage. Thanks to this fistula, she was sent away from the city to live with her aunt in the country. And this was where she spent her next three years – in exile, unable to attend school because of “the problem” as she called it. I do not know if she had a boyfriend or husband before the problem; if so, he had evidently not stuck around after. When I met her, Betty had actually already been operated on by our surgical team once several months before. Because of the size of her fistula, Betty’s first surgery wasn’t successful, and she was back with the hope that a second one would be. I only met her briefly the night before her surgery, but it was long enough for me to be impressed by her resiliency. That’s why I was surprised to learn the next day that her second operation, like the first, had almost killed her. On the day of her surgery the hospital lab tech asked me if I would be willing to donate blood to one of the patients who needed an A-positive transfusion – it was Betty. She had lost so much blood during the operation that she actually needed transfusions from two additional crew members after me, and she spend the next few days in isolation in the ICU while I spend the next few days violently ill with the worst fever I would have while on the ship. By the time I was well enough to visit her Betty was still in isolation, which meant that we were able to have more personal time than when she was back in the ward in the company of a dozen other fistula patients. I was able to talk with her more about her history, her faith, her ambitions. She told me that she hoped that God would make her dry so that she could go to school. I told her that we were sisters two times over – because of our shared faith, we were both connected by the blood of Jesus, and because of the transfusion we had the same physical blood running through our veins too. Eventually Betty was transferred back to the regular wards, and I enjoyed visiting her daily as she healed. One of the things that she seemed to value most was physical contact. She always wanted me to plait her hair, rub her back, or paint her nails. I can only imagine how starved her isolating condition had made her for human touch. After several weeks had allowed our friendship to deepen, Betty was well enough to be sent home. Unfortunately, her second surgery had failed – she was still leaking. Betty was told that she could come back to the ship for a third surgery. Before she left Betty and I exchanged telephone numbers so that we could keep in touch when I went back to the States. I told her that she could call me after her third surgery when she was dry so that we could say “Praise God!” together. Then she left with a small paper appointment slip and more hope than I could honestly muster.

Last fall I read an autobiography by Dr. Catherin Hamlin called “Hospital by the River.” It’s the story of how she and her husband, both Australian obstetricians, left their homeland in 1958 and set up a fistula hospital in Addis Abba, the capital city of Ethiopia. Dr. Hamlin writes in her book that upon arriving in Ethiopia she was warned by another missionary that “the fistula patients will break your heart.” I concur. I need only reflect upon the thousands of women with stories like Betty’s, and my own problems seem at once petty and insignificant. The lives of these women are just so tragic on so many levels that they would threaten to drive one to despair. In her autobiography Dr. Hamlin divulges her source of hope, which drives her onward. She shares,

"I have sometimes been asked if these tragic cases ever test my faith. I can truly say that, if anything, my faith has been strengthened and my soul more firmly anchored to Jesus as the only one to whom we can turn. Jesus never promised us a smooth or trouble-free passage through life, but he did promise to be with us to share the sorrow and the pain."

This same sentiment was engendered in me as I naively worked for only a short time in Liberia, and I am glad to know that such a confidence is confirmed by one much more seasoned than myself. Dr. Hamlin speaks with the wisdom of a woman who, though her husband and partner passed away decades ago, though she has already donated 51 years to her cause, though she is 84 years old, is still working with diligence and with joy to bring hope and healing to the women of Ethiopia.

Several months ago I received a call on my cell phone at 6:30am on a Saturday morning. I stumbled out of bed and across the room to tell unknown caller that they had dialed the wrong number. It was Betty. She was calling to tell me that she had been healed. She was dry. And we cried “praise God!” together.

The thought that I might one day be able to repair fistulas is the primary driving force behind my interest in obstetrics and gynecology. I know that I am just a first year medical student, and I know that most students change their chosen specialty throughout the course of their studies. I cannot say if my interests will weather the semesters of shadowing and rotations. I’ve recently learned of other pathways that could train me to repair fistulas; I could, for example, specialized in family medicine and choose a residency that permits me to take a year to focus on women’s health. Whatever my course, may I remember that I have been called to serve. I can only hope to achieve and maintain the resolve of Dr. Catherine Hamlin, who concluded her autobiography at age 77 with the following:

"There is still so much to be done for thousands of women who every year suffer the agony of obstructed labour and its horrific consequences. I could never imagine just living here and not working, it would be unthinkable. Unthinkable, too, to walk away when I know the problems would be even worse. I have therefore made no plans for retirement."

May my calling coincide with my life’s work and result in the same passion.