Yesterday was my first day back at work, post-malaria. When I got malaria, I was in the hospital for three days, and then I spent a week after that lying in bed, sleeping, reading, taking short walks, drinking lots of water, and trying to keep my mind off the nausea and joint pain that just.won't.go away.  (I lost 6 pounds in 10 days, if that tells you anything about how lousy I felt.)

I showed up at the hospital yesterday to work a 28 hour on-call shift with one of the doctors.  We split up the patient list and started rounding on patients. The hospital's pretty full right now with lots of sick patients, so I had a lot of exams to do, a lot of notes to write, a lot of thinking to do about complex medical conditions that we just don't ever see in the U.S.

A patient in pediatrics died of cerebral malaria early yesterday morning, just before my shift started.

Then, mid-morning,  a 40 year-old man with a brain abscess started to decompensate. Even though the surgeons had taken him to the O.R. the night before to take some of the pressure off his brain and evacuate the infection, even though he was on every antibiotic we could think of, even though he was on multiple medications to decrease the swelling in his brain, the infection was taking over his brain and making it swell until it herniated down into his brain stem because it had nowhere else to go.

Even though we had done everything we could possibly do for him, this man was (still) dying.

The doctor told the man's brothers that there was nothing else we could do.  I stood there and watched the monitor above the patient's head.  I watched the oxygen level drop to 70%, then 54%, then 35%.  I watched the heart rate as it went from being a regular 100 beats per minute to erratically swinging from bradycardia, in the 30's and 40's, to tachycardia, in the 170's.  After a few minutes of an erratic heart rate and an oxygen level so low the monitor couldn't register it any more, the heartbeat turned into a flat line on the monitor, and it started blinking 0.  "ASYSTOLE" the monitor alarmed, until the nurse reached up and silenced it.  As I stood there watching, the man's soul left his body.  And just like that, he was gone.

An hour later, I was sitting at the nurses station charting when I heard a loud commotion at the front of the hospital. Nurses were running towards a gurney with a crash cart and an Ambu bag.  And then, a second later, all the nurses slowly walked away.  As the crowd dispersed, I saw a 3 year-old girl's limp body on the gurney.  The doctor had her hand on the girl's chest, and was slowly shaking her head as she spoke to the girl's father.

"She was already gone," the doctor said to the father in French.  "When you brought your little girl to us, she was already gone."

The father began to cry.  The little girl had vomited a few times the night before, he said, but it didn't seem to be anything serious.  He had told the mother that if the girl was still sick in the morning, they would bring her to the hospital.  The little girl had vomited twice that morning, so the father carried her to the hospital.  Sometime between when he left the house and when he arrived at the hospital, his little girl had passed away in his arms.

Her body was still warm when she arrived, but she had no heartbeat and her pupils were blown -- her brain had already stopped working from the lack of oxygen.

The chaplains came to pray with the father, and a few minutes later, he wrapped the little girl in a panya of fabric.  I held the door open for him as he carried her body out.  The mother was outside, sobbing, holding herself up against the wall.  The father strapped the dead little girl to the mother's back and, weeping, they slowly walked towards the main road.

After that, we admitted a 5 year-old boy who came in with fevers and a nosebleed.  At first we thought maybe he had leukemia, but his white blood cell count was normal.  Then he vomited blood. Then he passed bloody stools.  We ordered all the tests we could think of, and they all came back normal.

"I hope he doesn't have Ebola," the doctor murmured as we looked over his labs, trying to find an explanation for why this boy was bleeding out of every orifice.

When the boy first came in, he was tired but awake, lying on the gurney, asking for his mom.

"She's coming," the father said to him.  "She's coming."  The boy seemed content with that, and he fell asleep for a while.

In the middle of the night, he started seizing.  Then he stopped breathing.

He got medicine to stop the seizures, and his breathing went back to normal, but he never regained consciousness.

"I'm afraid your son is bleeding into his brain," the doctor told the father.  "And there's nothing more we can do."

He nodded his understanding as tears filled his eyes.

He spent the night in his son's small bed in pediatrics, sitting up against the headboard, cradling his son's head in his lap.  The boy will probably not live to see the sun set tonight.

When my shift ended, I came back to my room, sat on the floor with my head in my hands, and cried.

I cried because my heart aches for the families who lost their loved ones.  I cried because I'm spent -- I don't feel well, and after being up on my feet working all day, I feel even worse.  I cried because so much has gone into building and running this hospital, and yet some days, it doesn't seem to matter.

Patients die anyway, at an alarming, overwhelming, heartbreaking, gut-wrenching rate.

So why does it matter that the hospital is here? Why does it matter that I'm here?

I wonder if Jesus asked these same questions when he was here on earth.

I wonder if, when he was alone, he sat down with his head in his hands and, with tears streaming down his face, asked his father the same questions I'm asking now.

Why does it matter that I'm physically present here?  Why does it matter that I've sacrificed comfort in order to be tired and sweaty and hungry and thirsty and in pain?  Why does it matter that I'm here if I can't heal every person who's sick, or resurrect every person from the grave?  Why did you send me here if, even after all the sacrifices I've made to be here, there is (still) going to be injustice and hunger and death and pain? 

What, if anything, was the point of Immanuel, of God being With Us?

If we look at everything Jesus left undone when he departed from the earth, then his presence hardly mattered at all.  People were (still) sick, they (still) died, they were (still) oppressed, they (still) suffered.

So why did it matter that Immanuel was here?

The question becomes its own answer.  Immanuel's value does not lie in what he did or didn't accomplish while he walked the earth. What mattered was that he was here.  He was here.

Jesus' presence mattered because it was a tangible reminder that we are not invisible to our Father.  We are never lost to him, we are never forgotten by him, we are never abandoned by him.

When Jesus was talking to Nicodemus, he said he was here because "God so loves the world."

So why does it matter that the other missionaries and I are here?

Maybe, the question becomes its own answer.  Though we try our hardest and do lots of good for the Togolese people, our ultimate value does not lie in what we can or cannot accomplish.  What matters most is that we're here.  

With our physical presence we remind people that they are not forgotten or lost or abandoned. They are not invisible to their loving, compassionate Father.

At some point today, I'll finish crying.  I'll find something to eat.  I'll take a long nap, and a long walk, and a lot of deep breaths.

And when it's time for my next shift, I'll return to the hospital.  Not because I can fix every problem or diagnose every illness or alleviate all the suffering that's there.  But because just by being there, I make a statement.

God (still) loves me.

God (still) loves you.

And in spite of all the dangers and toils and snares...

God (still) so loves the world.