When patients come to the clinic, they have to give the medical assistants a reason for their visit. One of the most common complaints they give is, “Tout les corps fait mal,” which means, “The whole body feels ill,” or, “Whole body pain.”
I see at least a dozen patients a day who say that. “Tout les corps fait mal.”
Often it’s people who are 50 and older who have spent their life doing manual labor. The women carry buckets of water or bundles of firewood on their head. They go through sometimes as many as eight, nine, ten pregnancies in their lifetime. Then they carry their babies on their backs until the children are about two years old.
The men hoe large fields with a small, hand-held tool that requires them to be stooped over all day. They chop firewood, mix cement, and carry heavy loads of building materials.
The Togolese people who aren’t lucky enough to have a bicycle or a motorcycle have walked for hours upon hours. And at night, they sleep on the ground without a mattress or a pillow. They get malaria over and over and over again.
It’s no wonder their bodies hurt.
There’s not usually anything I can do for them, except to give them Tylenol and Ibuprofen and tell them to rest whenever they can.
On Friday I was in clinic when a woman came in with that complaint: “Tout les corps fait mal.”
When she walked in the room, I learned that she wasn’t actually talking about whole body pain; she had really bad back and hip pain, and she was so stiff, she shuffled when she walked, and her upper body was tipped forward about 20 degrees.
She was only 35, but she walked with the gait and posture of an 80-year-old woman.
She told me her back had gotten progressively stiff over the past two years, and now her pain was debilitating.
I examined her, and isolated the problem. Her sacroiliac (SI joint), the place where your back meets your hips, was nearly frozen.
I had a lot of other patients waiting. The quick solution would’ve been to write her for pain meds and send her out, but that wouldn’t solve the problem, and this woman would be suffering for many years. Or, I could take an extra fifteen minutes with her to explain the problem and show her some stretching exercises that would help more than meds.
I decided to take an extra fifteen minutes with her so she could (hopefully) spend the next few decades of her life without this pain.
I had my translator explain the problem, and then I told her I could show her exercises to do. I warned her that the exercises would be painful at first, but they would help.
“Is that okay?” I asked her.
She nodded eagerly.
First, I had her lay on her back, and hug her knees to her chest. As she drew her knees in, she felt sharp pain, and sucked her breath in quickly. Then she started to hyperventilate.
“No, like this,” I said, as I pointed to my face and took a deep, slow breath in through my nose and then gently, slowly blew it out through my mouth. “Breathe like this until the pain goes away.”
And God bless her, she did. She laid there breathing slowly and calmly, letting the pain and stiffness leave her back. Finally, her face relaxed. The pain had passed.
Next I had her rock her knees side to side, then hold her knees to her chest one at a time. The last exercise was to lay on her stomach with her hands palms-down next to her shoulders. I showed her how to straighten her elbows until her upper torso was off the floor (in yoga, it’s called the Dolphin Pose.) As she held the pose, tears sprang to her eyes as her back extended farther and her hips stretched more than they had in two years.
“Keep breathing,” I said. “Keep breathing, and the pain will pass.”
She kept breathing, until a few minutes later, her face relaxed into a smile. “It’s better! It’s better! It’s better!” she said and looked at me with surprise, as if I’d just worked a miracle.
But all the credit went to her, because she had endured longer than the stiffness, longer than the pain, and that’s what healed her.
That night I was thinking about the tears in the woman’s eyes as she was learning to take deep, slow breathes — and the joy on her face at the end of the visit.
I thought about the times in my life where I felt like that woman, wanting suffering to end quickly, wanting God to magically make it go away.
And then God doesn’t make it go away. Instead, he gently whispers, “Stay.”
I’ve made up a word for how I feel when God asks me to stay in painful places. I call it Heresick.
I’m not homesick, suffering because I’m absent from home. I’m heresick, suffering because I’m present in a difficult situation.
As children, we often outgrow homesickness. But as adults, we often encounter heresickness, trapped in rocky marriages or stressful jobs or financial crises or family conflicts or boring towns or difficult classes or emotional pain.
Heresick people are the ones who pray, “God anywhere but here.” “Anything but this.” Or, “If you just get me out of here, I’ll….”
The quick solutions to heresickness are to either numb out or get out.
The hard alternative is to stay. (***A quick but important caveat: I’m not talking about staying in violent/abusive relationships or physically unsafe places. If you’re in that kind of situation, please reach out for help, and do whatever it takes to get out.)
Many times in our lives, we are faced with this choice. We can leave, we can use our drug of choice to numb out, or we can stay.
The problem is, if we shortcut the pain, it stays with us.
If we endure the pain, if we stay, if we calmly breathe in and breathe out while we let the waves of discomfort wash over us, the pain is transformed.
We are transformed.
Because pain drives us deeper.
When we stop resisting pain and submit to it, we sink into it. At first, it feels like drowning. And then we realize that we’re not sinking deeper into death; we are sinking into a deeper life. Into a deeper way of being, a deeper way of knowing, a deeper stillness, a deeper trust in our Abba Father.
If you’re feeling heresick today, my heart goes out to you. I’m so sorry for the pain you’re experiencing.
But my prayer for you is not that God would provide an instant ejection button to get you out of the situation you’re in.
My prayer is that you would breathe, that you would trust, that you would stay. That you would let God transform your numbness into knowing, your running into rest, your desperation into deepness.
It’s been a long week.
I was in clinic on Thursday and Friday. Then I worked in the hospital from Saturday morning until Sunday afternoon. I took a short nap, then spoke at a church service on Sunday night. I was in clinic on Monday, and again on Tuesday (yesterday.) Today I’m heading back to the hospital to work another 30-hour shift.
I’m tired. It’s hot. And the only caffeine around is either instant coffee or Folger’s. An iced quad venti skinny vanilla latte is at least a thousand miles away….a little too far to drive for a coffee break.
In the mornings I try to get up a little early to meditate and pray and sit with God for a while before the day gets crazy. The other morning, I was telling God how tired I was. I remembered telling him the same thing when I was going through chemo and I was completely wiped out.
When I was on chemo, I asked God, “How is it possible that your power raised Jesus from the dead, and yet most mornings I can’t even get out of bed?”
The other morning, I reminded God of the same thing, only it was more of a request than a question. “God, you can do this. You can give me a sudden, crazy, overwhelming, blinding burst of energy to make this day easy and fun. Remember the resurrection? Kinda like that. Only maybe just half the amount of power you used that Sunday morning because I’m not dead. I’m just really tired.”
Every weekday morning at 6:30 a.m., patients who want a doctor’s appointment that day line up outside the hospital gate for triage.
If there are four providers in the clinic, we can see 120 patients. Some days as many as 500 patients wait in line.
The director of the hospital triages them one at a time. All pregnant women and sick children get appointments. And then the director fills the remaining appointments with the adults who have the most urgent complaints. The rest are given appointments for a future date — right now, we’re booked three months out.
If anyone gets very ill in the meantime, they can skip the clinic and go straight to the hospital (the building behind the clinic), where we have E.R. and inpatient services.
For the first two weeks I was here in Togo, I worked in the clinic, seeing as many as 35 patients a day. And they’re not just Togolese. Other patients come from Ghana, Burkina Faso, Nigeria and Benin. Some of them drive here the day before and spend the night sleeping on the ground outside the hospital gate. Others wake up early and leave their homes at 2 a.m. to get here in time for triage.
My patient died on Thursday night. (If you missed that story, you can read it here.)
On Friday, I was in clinic for the morning, and then I had the afternoon off.
In the early evening, I did what I always do when I need to clear my head and talk to God — I took a walk.
I walked down the main dirt road that leads from the hospital into town (it’s about a mile-long walk.)
Half way between the hospital and the town, there’s a large tree along the side of the road, and I noticed three boys squatting around a small fire they’d built under the tree.
It had been 90 degrees that day, and now, it had “cooled down” to 85.
“Are you cold!?” I asked the boys in French, pointing to the fire.
The oldest boy, who looked about 12, shook his head.
“Are you bored?” I asked.
The middle boy, who looked about 8, nodded his head.
It was a busy day in clinic on Thursday morning. There were people with Hepatitis B, bone infections, corneal ulcers, uterine fibroids and malaria.
I also saw a 60-year-old woman who came to clinic with her son, because she’d had constipation for the past week. Her belly was also getting more and more distended.
I examined her. Her blood pressure was low, and her heart rate and respirations were fast. Her belly was taut and a little tender.
I sent her for an upright abdominal X-ray, which looked very abnormal.
I admitted her to the hospital and asked the surgical team to consult, thinking that maybe she had a bowel obstruction and needed surgery. If that was the case, she might be home in three or four days.
In the afternoon, the surgical team did more tests and found that the woman had metastatic cervical cancer. She had mets in her liver, and her whole belly was filled with cancer and fluid. They prescribed her diuretics to remove some of the fluid from her belly, as well as morphine and anti-nausea meds.
Last week I flew into Lome, the capitol of Togo, which is on the coast. I spent two nights at a guest house near the airport.
Two days later, a Togolese man who works for the hospital came to pick me up and drive me 9 hours north to Mango, where the Hospital of Hope is located.
I had a layover in Ethiopia on my way from Paris to Togo, so I sat on the floor with my laptop and wrote the following list:
Ten Ways To Spot an American in Paris
On my last day in Paris, I was walking toward Luxembourg Garden, composing a blog post in my head about how much I love Paris because I’ve been here four times and so I can navigate it easily without getting lost. And then I stopped daydreaming and realized I’d been so distracted writing a blog post about how I never get lost, that I’d gotten myself lost. So that was awesome.
After months of planning, praying, packing, getting vaccines and buying clothes appropriate for a Muslim culture, the day of departure is finally here.
I’m flying to Togo tonight!
I’ll land in Lome (Togo’s capital) at 1 p.m. on Tuesday, and the following day I’ll take the 9-hour cab ride north to the hospital in Mango.
I’ve been in Paris for the weekend. I love Paris and, lucky for me, they have the cheapest/shortest flights to Togo (which used to be a French colony way back when.)
Right now I’m sitting at a cafe having lunch, waiting for the airport shuttle to pick me up in a few hours.
I’m trying to decide how I feel, but I can’t narrow it down to a specific emotion.
I’m excited. Nervous. Scared. Curious. Ready. And at the same time, not ready.
I’m staying in Paris for the weekend, before flying to Togo on Monday night.
The small hotel I’m staying at here only has wifi in the lobby. I was sitting there this afternoon writing on my laptop when the hotel clerk, a 60-something-year-old man who’s shorter and thinner than me, started asking me questions about Independence Day. He asked what Americans do to celebrate, and I told him that we typically have cookouts and fireworks.
“And for dessert?” he asked.
“Well, it’s usually ice cream or watermelon or cake,” I said.
“Okay,” he said in French. “I get off work in twenty minutes. I will take you to get ice cream so you don’t have to celebrate your independence alone.”
And he did.