The Goodness of God

We returned to Ohio late September to begin our first true home assignment – a time to visit with family and friends, reconnect with our supporting churches, and share about the work God is doing in our ministries. The past few months have given me time to reflect on my work and some of the more recent experiences I have shared with my patients.

“I remain confident of this: I will see the goodness of the Lord in the land of the living. Wait for the Lord; be strong and take heart and wait for the Lord.” Psalm 27: 13 & 14

Writing about some of the stories I have been privileged to step into for a short time is one way for me to process them. In the few months leading up to our home assignment, there were a few of these stories that held me captive and that I knew I needed to put into writing to process the place they hold in my own heart. When an author I follow (KJ Ramsey – “This Too Shall Last”) shared the above verse while battling her own health crisis, I found it was the spiritual balm I was searching for in this phase of life. She shared her lament for her own suffering, while also holding claim to the promise in these words of David to see “the goodness of the Lord in the land of the living.” In the weeks leading up to our departure for our home assignment, I began meditating on this verse and using it as a prayer that God would help me to take note of his goodness amidst the struggles I see. And he did. I continued to see the suffering that is a daily part of my work, but I also took better notice of both the big and small demonstrations of his goodness in each day.

Rachel came through our emergency department bleeding heavily at 18 weeks’ gestational age. She had a history of two prior first trimester miscarriages – this was the furthest she had made it in a pregnancy yet. This baby was loved and desired and very much alive with a strong heartbeat. Presumably she was experiencing a gradually worsening placental abruption; she had no risk factors and no inciting event or trauma for this. She was simply unlucky enough to be experiencing an idiopathic abruption at 18 weeks, which is an obstetrical emergency not compatible with continuation of the pregnancy. Our limited resources mean that typically the earliest we can resuscitate a premature baby in Kudjip is 30 weeks (compared to the standard 24 weeks in the US). Mom and baby were 3 months away from this mark, and mom was bleeding badly enough to lower her hemoglobin to 6, making her vital signs unstable and necessitating multiple blood transfusions . It was a somber conversation; I remember the visible pain on her face as I told her that in order to preserve her own life, we needed to deliver her baby, who would inevitably lose his life. She understood. I wrote an order for the induction medicine and went home. It is hard to adequately describe the sorrow of being the one to make the decision that would hasten the loss of that 18 week life; it was a new, even more profound and previously unknown sorrow to my soul to be making such a decision when I was carrying my own living 16 week baby at the same time. I prayed for forgiveness. I thought about what I would do if the medicine didn’t work and mom continued to hemorrhage; what if our blood bank was out of blood for her, as we so often are? Would I have to do a more invasive procedure on a still living fetus? I prayed for her and for my own discernment. She did successfully deliver with the medicine, and, as anticipated, the baby passed shortly after due to his prematurity. My patient then suffered further hemorrhage from a retained placenta and I spent the better part of my call night caring for, praying, and worrying over her. Rachel survived, but 3 pregnancy losses later, she still had no living children. I mourned for her and I prayed that God might help me to better see his goodness in a place where it is so easy to become overwhelmed by the weight of the witnessed anguish.

Josephine had a story too similar to many of our moms – she delivered a stillborn baby at home in her village. Subsequently, she developed a common complication of an infection within her uterus that lack of treatment allowed to progress to her bloodstream and a severe sepsis. Due to any number of possible reasons (lack of education? lack of transportation? lack of funds?), she presented almost two weeks after her delivery. By this time, she was in septic shock with an altered mental status and was minimally responsive, unable to communicate or walk. Her prognosis was grim. She was admitted by one of my colleagues to the postnatal ward with what few resuscitative measures we have to offer – IV fluids, antibiotics, oxygen, blood products. The following morning when I stepped onto the maternity ward, I found her still in fairly critical condition. An ultrasound showed a high likelihood of some retained placental pieces being the etiology of her infection, and she underwent a D&C procedure to remove the infected tissue. My hopes were highly guarded. Many of the moms I have seen presenting in this condition during my short two years in Kudjip have succumbed to their illness. Often, those who don’t die end up needing a hysterectomy, losing their uterus and any potential for future children in an attempt to control their rapidly spreading infection and save their life. I have seen more of my patients die or have serious complications from illnesses like hers than I have seen those who have made full and complete recoveries. So, I rounded on Josephine each day – usually seeing her as my very first and most critical patient – and I kept my hopes guarded. Several days went by of our very basic care with a watched bed, more IV fluids, and antibiotics. Morning after morning, to my amazement, she stayed stable. Her fevers slowly subsided, her kidney function stabilized, she began to take food and water. She slowly started to walk again with the assistance of her family. However, more than two weeks had gone by since her initial presentation and she continued to be minimally verbally responsive. She had survived, but I remained guarded about her overall prognosis and I cautioned her family the damage to her brain may be permanent. Eventually, her family felt comfortable returning home with her and I was able to discharge her with instructions to return to my clinic for follow up in a couple of weeks.

When I walked into her clinic room almost two weeks later, I barely recognized the same young girl who had nearly died on bed 1 of our maternity ward. She was smiling and in her own soft, sweet way was able to hold a normal conversation with me. I told her what a miracle her life was. I went home that afternoon and couldn’t help but take note of how I had held witness to the goodness of God in the land of the living through her testimony.

In my work at Kudjip, I often find it is easy to dwell on the tragedies I see. I think of the Rachels, of the women who lose their babies, those to whom I deliver a terminal prognosis, of my patients on whom I am rounding one day and return to find their bed empty the next – too many young women and mothers who lose their babies lives or their own for reasons that are largely preventable in places with more resources. Much of that suffering will probably always be a mystery to me. But, I have also found that when I choose to open my eyes and heart to it, the goodness of God in the land of the living is also most clearly visible in a place like Kudjip. I have witnessed the miracles of the premature babies who beat the odds. I have seen the women who present critically ill, receiving such basic care that science and experience would say they shouldn’t live – and yet, they do. In this advent season, I am reminded of the weight of God’s choice to humble himself that he might be among us. This season is an opportunity to allow myself to reflect on the goodness of his presence – a presence that remains today among us through the Holy Spirit. And although the mystery remains of how and when he chooses to reveal himself, I know his goodness is present if we choose to allow our eyes and spirit to be open to seeing it.