Walking Slower

Ironic. And if I can be so forward, poorly timed. In the final week before the return of a couple full-time hospital workers, I still had a lot on my plate. The busier I get, the more I lean on To-Do lists. Post-it notes are one of my most enduring friends, and their presence in my pocket is ridiculously calming. You can roughly approximate my busyness by the number of lists I'm carrying around with me. If I have one master list—no matter the number of things I've crammed onto it—then life is at a steady pace but overall very manageable. If I've got multiple lists that are well organized, life is busy but I'm still on top. When I pull multiple, crumpled shreds of paper out of my pocket, covered in chicken-scratch and 'X' marks, life has officially become chaotic. This past week, I've been carrying around a clipboard full of such paper shreds.

But I'm doing my best to keep my heart in a listening mode so that I catch what the Lord is trying to teach me in a somewhat quicker, less painful fashion. Call me what you will, but I sometimes find these lessons to be a little less than convenient. I'm not saying that I want them to stop or that I don't want to enact wisdom in my life, I just wish I could choose the timing. This week, in the midst of my chaos, the Lord decided to spring on me a simple, but inconvenient truth (thank you Al Gore for creating the internet and making that a cliché). "Walk Slower," He (God, not Gore) says.

It started Monday when I was walking between two buildings with one of my Malian friends. About mid-way, he said, "Jacob, you need to slow down. You walk too fast; I can't keep up." I'll admit it—I walk fast. At my natural pace, I walk about twice as fast as the average Malian professional or city-dweller, and roughly 6.5 times faster than the average Malian villager. In college, I used to run to all my classes, even when I wasn't late (which, admittedly, wasn't often). The busier I get—you guessed it—the faster I walk. I also tend to write notes on my lists while I walk fast. (This has roughly the same effect as texting while driving.)

This isn't the first time I've tried to slow down. Starting out in the ICU, I used to walk faster and faster if I was getting behind in my work, but I soon learned that I needed to keep my pace in check. Seasoned ICU nurses are trained to react to odd noises, bodily fluids, scribbly lines on a TV screen, and any sudden movements from their coworkers (doctors excepted). On several occasions, I had a crowd of nurses rush into my patient's room behind me, perceiving my fast walk as an indication of something urgent. At the same time, I started working with Somali refugees and quickly learned that walking through the city with them was to march to the beat of your own, very slow drum. We used to joke that if they walked any slower they would be standing still, which was especially true when you were late for some appointment. But well before that, in my youth, my grandparents tried to slow me down whenever we were in nature. They delighted in showing me interesting things that I had missed alongside the trail because I was rushing.

So I began to do my best to walk slower this week. I tried to keep pace with the person I was walking with, instead of leaving them behind. I knew there had to be more to this than just the speed I move my legs. I figured it had something to do with stress management or maybe with not having tasks as the object of my attention. As it turns out, God was trying to help me realize what I was missing alongside the trail.

Adama arrived late in the afternoon last Friday. I vaguely remembering looking him over, but I didn't investigate his case much once the other pediatric nurses said he was a malaria case. They prescribed the normal cocktail of treatments for malaria, and I took off for the weekend. Monday morning I got pulled into handling some issues down in maternity, and by the time I got to pediatrics, the other nurses had almost completed rounds. As I walked into the room, they were in the middle of demonstrating Adama's continued need for oxygen. Turning off his oxygen dropped his saturation levels from 100% to 50% in a hurry and it took him a long time to recover. (90-100% is normal for all you non-medical people.) We immediately shifted our thinking from malaria to some type of lung infection. We transferred him to an isolation room, ordered x-rays, and began to carefully monitor his lungs. The x-rays didn't turn out that great, but they also didn't seem to show anything horrible either. I wrote Brett, our friendly neighborhood phone-a-pediatrician-friend (soon to be the back-in-Mali-so-Jake-doesn't-have-to-play-remote-diagnosis-anymore pediatrician), who with my descriptions advised treatment for asthma. The initial treatments seemed promising.

However, the next day, Adama didn't seem much better, and worse, he looked absolutely exhausted. We puzzled over what to do with him, but nothing seemed clear. In the later morning, I was walking by his room headed to my office to complete some tasks. I made it to my office door, which is just past Adama's room, but was too troubled by his case to enter. So I turned around and walked back into his room. I sat at the edge of his bed. He sat there breathing hard and looking like he could pass out at any time. Brenda, a nurse who normally works in another part of Mali, but who has been down at the hospital helping us during these past couple months, walked in the room asking me if I had any new thoughts on his case. I admitted that I was clueless. She too sat on the bed, put Adama in her lap, and allowed him to lay his head on her chest. She began telling me that during the x-rays she would hold him like this to get him to calm down. I looked at the monitoring machine and saw that indeed his pulse had slowed and his oxygen level had risen. His little hand dangled at his side. I grabbed it and while holding it, I saw that the ends of his little fingers were oddly puffy. (Finger clubbing we like to say)

It suddenly all began to click…the finger clubbing, the sudden drops in oxygen saturations, and Brenda's calming position. I practically ran out of the room and into my office (so much for walking slower…). I grabbed the monster pediatric textbook off the shelf and paged through it until I found the title Tetralogy of Fallot. Reading through it, the description fit so well. Tetralogy of Fallot is a congenital heart malformation. Depending on the severity, children can live with the malformation, but the best treatment is surgery. Of course there isn't such surgery in all of West Africa. The only option is to get him to the capital to see a cardiologist who can hook him up with some charity groups that take kids like him to Europe for such operations.

Though treatment options are certainly limited, we did have some options, which we started immediately. And Adama is slowly but surely getting better. On a number of occasions, I've had to leave my office in the middle of trying to get paperwork done, go into his room, and cradle him in that special position. (With Tetralogy of Fallot, a knees to chest position helps redirect blood flow in the body, which helps the heart work like it should.) To be honest, like most of the pediatric patients I've grown attached to, Adama is a bit of a brat. Sometimes he likes to fight instead of assuming his position, which makes this a time consuming task. He sits there panting, ready to pass out, slapping your hands away instead of just allowing you to help. But as the week progressed, he began to accept our help more and more. His crises decreased in frequency, and we are looking to send him to Bamako in the middle of the coming week with Brenda.

In slowing down, we seem better able to take in the whole picture. With all our fancy machines and lab tests in the States, medical professionals don't have to spend as much time at the beside of the patient (which we all complain about), but here in Mali, correct diagnosis still largely depends on sitting in the room, examining every square inch of the patient, and putting all the details together. It takes time, and it is time you have to put in regardless of how busy you are.

I wonder, in life and in ministry how often I've misdiagnosed people because I've haven't taken the time to slow down. How many times have I rushed past someone because I was busy, when that was exactly where the Lord wanted me to be? How many times have I made some false assumption about a person and their condition, when, if I had slowed down and walked their pace, I would have seen their world with more clarity? I shudder to think of all the important things I've missed alongside the trail.

In a world and culture that gives us every reason to rush, we are called to lives of listening better, looking more thoroughly, taking time to sit on the bed, and walking slower.