Morris Family Webpage

Reflections

The Bible says a lot about how to live.  
Churches say a lot about how to live.  
So do most other religions.
Therefore, living right must mean that if the God of the Bible is real, then I am in good standing.
 If religions are multiple choice, I will probably still meet the requirements.
 And even though I am not particularly religious, I have my bases covered.

The Crusades were pretty bad.  But if I were to rank the church's greatest sin, it would be one of ommision, not commision:  that she has not separated herself clearly from faulty thinking about doing good stuff to get in good with God.  

I am part of the church.  The church is not some other entity.  This has been my ommision.  I like hanging out with generally good people.  I click with people who enjoy serving, who seem to have compassion for the poor, the weak, and the dirty.  I like working with people who are considerate, flexible, conscientous, and gracious.  If anyone is at risk for being good enough to fool themselves into false eternal security, I probably like them and respect them.  And the rest of the church probably does as well.  So, these are the people we are least likely to say anything to about salvation.  After all, it sounds really fanatical, doesn't it, "SALVATION."  Just writing it in capital letters conjures up images of people with bad reputations.  I don't get so self-conscious about my faith when I am sharing  about Jesus with someone who obviously needs it.  What convict or alcoholic guilty of leaving his kids destitute is going to point a finger at us and say, "Well what about you?"   I diverge.

I think that the majority of people in the world who classify themselves as Christians believe that they will go to heaven if they are mostly good.  Even though this is not said in the pulpit, we (the church) probably condone it, because we (I) are not likely to tell good people that they need Jesus.  I mean, most good people have it together moreso than I.

Ephesians 2:8-9   

For by grace are you saved through faith, and that not of yourselves, it is a gift from God, not by works, that no man should boast.

There is plenty more, but Ephesians says it succinctly.  

Works show our faith real, but they are not the currency of our transaction with God.  Faith in Christ's death on the cross is the only currency accepted for our sin that guarantees salvation.  And this is hardest for those who can present other forms of payment.  It is the truth, and I need to say it.

-andy
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Resources and Medical Decisions    Reprinted from Medical Journal 1/31/2007

She came in 3 hours post-partum, still bleeding, with a retained placenta, easily removed with traction and pushing.  Her BP was 88/75, Pulse 160 lying down, conjunctiva white as snow, skin cold and pale.  Two liters of NS and a shot of Oxytocin later, she was 100/70, pulse 130, still unable to stand for more than a few seconds on her own.  I have seen one just like her approximately every 3 weeks.  They come in the backs of pick-up trucks or riding in hammocks swinging from a long bamboo pole (aka bambulance), complete with cotton in their ears (they keep in for 1 month to prevent bad air from getting in) and a towel around their head, often holding their newborns who are sporting a piece of fabric tied around the midsection, which they believe prevents them from having an "outie.".

I presented them with two options:  1.  My preference - go to the hospital now for blood products and quit scaring me.   2.  Stay here in the clinic overnight, so we can send her if she continues to hemorrhage.  I was only presenting option 2, because she was otherwise healthy and they were obviously poor.  The hospital is 3 hours away on a very rough unpaved road in back of our USAID sponsored ambulance, otherwise known as a Dodge Ram 4x4 with a gurney and a camper top. The gas costs 2,000 Lempiras, approximately $110.  They were unable to make a decision.  The patient did not have any say  the matter, as the sick are often not included medical decision making.  This was up to her husband and her step-daughter, who was the only one with clean clothes and likely the one who would foot the bill.  They couldn't decide, because they wanted to go home. They didn't come to stay.  They came to get the placenta out and that was done.  To prove my point, I stood her up for a minute and let her start to pass out before catching her and laying her back on the gurney.  I thought it was rather clever and convincing, but they were not impressed.  These are the times I rely on Dr. Ruben Martinez to put his command of Honduran expressions to use in convincing people that their lives really are in danger, but he was gone.  There was no convincing them.

In the US, physicians do make choices about treatment according to a patient's resources, but we are also obliged by our oath to treat people with life-threatening conditions without consideration of their ability to pay.  Honduras is becoming more affluent.  It is indeed "developing" at lightening speed, but their are still people who have to decide between years of debt and medical care for life-threatening conditions.  Do they pay now and subject their extended family to months or years of resource shortage or do they take their chances and pray that God will have mercy on them once again?  "Fatalismo" is a word used to describe the worldview that "what will happen will happen, and my actions will not change that."  It is a survival mechanism that is part of the psyche in impoverished areas everywhere, from Bangladesh to inner-city slums in America.  Fatalismo allows the poor to escape from feeling responsible for bad consequences of decisions that they are forced to make in order to meet basic needs.

So, how do we as physicians interact with this cultural ideal when it comes to sick people in trouble?  Where and when do we press patients to adopt our values of life and risk avoidance in exchange for their acceptance of risk as necessary for survival?  If we press too much, we may be understood as imposing severe hardship in order to calm our own discomfort.  When we don't press, we have to live with the consequences - that someone may suffer and/or die as a result.  

I take refuge in my belief that life doesn't end here.  It helps me to understand fatalism a little bit.  Physicians are not trained to avoid death, or else we would all be miserable failures. Phycisians are trained to extend quantity and improve quality of life according to the patient's values, which sometimes are hard to understand.

-andy

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New Year's Resolutions                                1/8/07

As we celebrated the new year here in Santa Lucia, we explained to some of our Honduran friends and coworkers that many Americans set goals at the beginning of each new year.  The funny thing about New Year's resolutions is that I can't ever remember what my resolutions were from the year before.  So, I figured that by writing them on the website, I would be held accountable by whoever reads this, who can remind me next January 1 of what I wanted to do in 2007.

Resolution 1 : I want to hike to all the aldeas (small outlying communities) of Santa Lucia (the municipality) in order to see where most of our patients live.   Let me explain.  I am by nature not a patient person.   While I often pose as a service-oriented type, I only serve by God's grace.  When I am not relying on God, I can get short with people.  So, when people come for consultations, I want them to be sick; not sick enough to make me worried or sick enough to die but sick enough to need medicine.  And it would be nice if they had an interesting disease that I happened to read about within the last 2 weeks.   The other day, I was seeing a middle-aged lady with a cough, not pneumonia or asthma or tuberculosis or cryptospiridium from inhaling aerosolized bat guano,  just a cough. In addition to her cough, she complained of headache, pain in her knees, abdominal discomfort, infrequent dizzy spells, and itchy eyes.  I had been seeing coughs all day, the viral kind with a little runny nose that had been spreading from house to house for the last 3 weeks.  I was getting weary of my speech of why they didn't need a shot, nebulizer treatment, antibiotics, IV fluids, or injectable B vitamins (the five miracle cures that most people here believe in), so I asked her where she lived and how she came to the clinic.  "I left at dawn and walked 1 1/2 hours," she replied.  Her feet were old and dry and dirty, fitted with cheap chancletas (flip-flops).  I so wished I had a medicine to cure her cough, but we didn't .  Nobody does.   I understood a little bit more about her visit.  This was more than just a visit for a cough.  This was probably her quarterly or semi-annual trip to the pharmacy.  Her life is hard.  Imagine 10 kids, laundry by hand, husband in the states, not a thread of new clothes in years.  She could use a little Tylenol, Visine, Robitussin, Ben Gay, and Women's One-a-Days (note - brands used without permission) to make it through the day. After hearing how far she came, I wasn't so frustrated any more.  And I was more than willing to take the extra 3 minutes to write down all the things that might make her life a little easier.  One of my former family medicine faculty, Dave Mouw, used to tell us that there isn't a patient you cannot come to like if you know their story.  Though we joked about how long his office visits were, he was the one who could find that heroic trait, that redeeming quality of every person who walked in the door.  So, taking long walks this year will be part of learning the stories of my patients here.

Resolution 2:  Learn to talk about Jesus in Spanish.  Many of you know that the Spanish here has been difficult for me to understand.  While I can manage in a controlled medical context, I have trouble out on the street , and I really have trouble when talking about emotions, feelings, and nuances of relationships.  I do better with things like, "Does this hurt?"  I want to tell people why we are here.  I want to talk to them about their faith and the faith God has given me.  I want to be able to engage with people on a personal and spiritual level.   Without speaking their heart language, this is next to impossible.   I actually need to study and practice, with lists and flashcards and notebooks.  So, this is a priority for 2007, right after I finish the last brownie. Happy New Year!

-andy

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What does it mean to be Called?      10/12/06-12/1/06

Growing up in the church, I often heard people relay that God called them to do something or go somewhere, but they rarely explained how exactly the call happened.  Our culture has borrowed this term in our use of "vocation," or what we perceive to be our "calling."  How does call happen?

Looking to scripture, here is what I learned about specific calls from God:

    1.  God communicates with people.
    2.  God has chosen to reveal himself and his will through many avenues including scripture, the church, dreams, visions, audible voice, and messengers who may or may not be aware of their role.
    3.  God supernaturally calls very few, and these people in scripture have played pivitol roles in the history of his people (Noah, Abraham, Moses, Gideon, Jeremiah, Samuel, David, Mary, Apostles).  
    4.  The people God has called in supernatural ways were not always ready, willing, or prepared to accept this call (Jacob wrestiling with God, Moses citing his weaknesses in Exodus 3 and 4).
    5.  God's specific call may be related to a task (Mary birthing Jesus), to a role (Jeremiah as a prophet), or to both (Moses leading God's people from Egypt and then serving as their leader).
    6.  God may call a corporate body instead of an individual to accomplish his tasks, as in his calling of Israel to be his conduit of revelation in the Hebrew scriptures.
    7.  God's call is not about you but about him.  This is probably the most common misunderstanding of call.  God does not call people for their own benefit; he calls people to advance his agenda in the world.   Sometimes we are blessed and promoted in the process of responding to call and sometimes we end up ostracized or in harsh places.

So, where does that leave the rest of us, those of us who worship the God of the Bible but have never stood in front of a burning bush?

First, God's primary call on our lives involves who we are and how we live our lives, not where we are or what job we are performing.  Bussing tables with an attitude of thankfulness may be more faithful to God's primary call than preaching to thousands with a lust for fame.

Second, God has revealed more to us already than we could ever accomplish.  Just for starters, he has called all his people  to feed the poor, seek justice for the powerless, show hospitality toward those away from home, honor our parents, love our enemies, make disciples of all nations, and love the Lord our God with all of our heart, soul, mind, and strength. I often have often been so obsessed with wanting a specific call from God that I lost the big picture of what God has already called me to do.  I would much rather pray in my easy chair about what I am supposed to do than talk with the person living on the street 2 blocks from my house. If I am at all representative of the church, we have a knack for disguising apathy as spirituality.

   
Third,  "God comes to us outwardly through sensation and inwardly through intuition" (unknown).   This rings true to me, because intuition has been God's modus operandi in guiding my steps.  What is spiritual intuition?  Intuition has both a spontaneous and convictional quality.  It sometimes comes unexpectedly like revelation and resurfaces until we respond.  It grasps our feelings and our will but leaves us free to choose.  Because we have the tendency to equate our own desires with God's desires for us, we must critique our intuition before following it.  The Holy Spirit will not lead us to do something that contradicts his will as revealed in scripture or fails to edify the body of Christ.

Fourth, God often prepares us for certain roles long before we discover them.  David fought off bears and  lions with a sling and stone before God used him to deliver his people; and when Israel had a need that coincided with his talents, he was prepared to face the challenge and deliver Israel from the Philistines.  I would guess that David did not realize that his hours watching sheep was preparation for a throne until God brought the need before him.

I did not receive a supernatural call to be a doctor in Honduras, but where I am now came about more or less through the four ideas above.  First, I was called to follow Jesus.  Second, in following Jesus, I learned about the things that are important for God's people to do.  Third, ideas about international medicine, missions, and working in a poor region have been part of my interest, dreams, and vision that I  think were planted by the Holy Spirit.  And fourth, looking back, I can see how my experiences have prepared me to work in this place at this time.

So, my encouragement  to you is this:  1.  Seek God before you seek his will.  2.  If you don't sense any call or intuition about meaningful work right now, work on what you know God already wants you to do.  3.  Listen for those tugs on your soul that come in the form of passions and dreams.  4.  Pay attention to the circumstances in your life that have especially prepared you to meet one of the needs you encounter in the world.

Finally, remember that certain jobs or tasks are not sacred or secular.  It is more glamorous to write about being a missionary than taking care of your grandmother, but it may take more obedience and grace to do the latter than the former.  It is all about who gets the glory in the end and who we become in the process.  Treasures in heaven do not correllate with glamour on earth.       

-andy