“Be flexible.” That was one of the exhortations most emphatically conveyed when I was preparing to go on my first short-term mission trip some years ago. In fact, I still remember vividly how a few of the team members and I were asked to ad lib a short skit demonstrating the importance of flexibility. After six months on the mission field, I would say that this admonition has served me as well as any.
Not every day requires back-breaking degrees of pliability, but at any moment I have to be able to handle a change in plans. The realities of third world medicine demand it. Let me give an example. There was one recent Thursday, which for me meant a 7-8 am surgery meeting, an 8-9 am academic meeting, and on this day three surgical cases. About 8:00 am, I received a phone call from a missionary in a nearby town who was having a urologic problem. He asked that I evaluate him and informed me that he would soon be en route to Tenwek.
After getting a brief history, I realized that managing his condition would require a small procedure and that he and his wife would need a place to stay. Tenwek has an abundance of visitors, so this request was easier said than done. But I promised to help find a room at the guest house. Still having the morning conference to finish and surgeries awaiting, I enlisted the help of my wife to investigate whether Tenwek could accommodate our visitors for a few days. Not that she had a lot of free time, being busy with homeschooling and getting kids out the door to class.
Once the missionary arrived at the hospital, I had to find a few minutes before my first case to help him get registered. Tenwek is now, believe it or not, live with an electronic medical record system, which means that I couldn’t order any tests until the registration process had been completed. Unfortunately, I was not yet facile with the system, so I had to ask yet another person to assist me with getting him registered.
Now on this morning I was hoping to start my first case a little early because I needed a special piece of equipment (a C-arm for fluoroscopy for those interested) which is generally utilized all day long by the orthopedic team. The fact that I had been granted this early start was in and of itself no small feat. But I knew I had to work quickly so that the orthopedic team could have the equipment back in time for their case. I certainly didn’t need anything else on my plate at the time.
My first case unfortunately went longer than I’d hoped, leaving me a little stressed about causing a delay for the orthopedic team. Following the case, I turned my attention toward helping the missionary get the tests done that I felt he needed. Because these tests had to be ordered on the electronic record system, I quickly found a clinical officer (similar to a physician’s assistant in the US) to put in a brief note for the patient and order the lab work and ultrasound.
Not wanting the missionary and his wife to wait around too long, I located a visiting radiologist and asked him to perform the ultrasound, which he was able to do right away. Anxiously listening for my pager to signal that the next surgical case was ready, I was thankful that it continued to remain silent. Following the ultrasound, I gave the patient a specimen cup to produce a urine sample, which needed to be evaluated. I informed him that I could drop off the sample in the lab for him, since that would actually be easier than giving directions (urologists don’t mind handling urine).
Before I could make it to the lab to drop off the sample, one of the residents tracked me down and requested that I go examine a patient in the general surgery clinic with a urologic complaint. No problem, the pager was still quiet. It turns out that this particular patient would need surgery that day, so I coordinated with the resident exactly what would have to be done and asked him to call me when the patient was in the operating room. Still no pager activity, but what about that urine sample I needed to get to the lab … I’d better head that way.
But before I could exit the general surgery clinic, another resident asked for some advice about a different patient with a urologic problem. Ok, sure. In the meantime I heard back from my wife that the guest house had a room available for the missionary and his wife. Thank goodness. Oh yea, I almost forgot about that urine sample sitting on the counter. I finally dropped it off with a sigh of relief and a feeling that I’d actually accomplished something.
As I left the lab and headed back toward the operating room to investigate the delay with my second case, I heard a voice call from behind … “Daktari!” (doctor). I turned around to see a Kenyan in a white coat that I vaguely recognized but had not officially met. He informed me that his father was in casualty (emergency department) with a urologic problem and asked me to come to evaluate him. I obliged with the permission of my still silent pager. Fortunately it was nothing too urgent, and I advised his father to come and see me in the urology clinic in two weeks.
By now it had been a while since I finished my last surgery and I was becoming concerned about why the next patient was not in the operating room yet. I tracked down the resident working with me, and to my chagrin found out that the anesthetist assigned to my room was only “scheduled” to work a half day and was now gone. What? This would have been good to know before the day began (if not earlier). With no hope for anesthesia, a rightfully upset patient who arrived the night before for today’s surgery was told that his case had to be rescheduled (since I was not available the next day for surgery and would then be out of town for the weekend). Unlike in the states, most of the patients at Tenwek don’t just come from “around the corner,” so you can understand his and my frustration.
Luckily, my third case of the day was a minor procedure and did not require anesthesia, so we would be able to do it without an anesthetist on hand. But not right now. As I’ve mentioned once before, Kenyans rarely miss lunch, and by now it was about 1:30 pm. Knowing my next case would likely start shortly after 2:00 pm, I trotted home to enjoy a quick bite to eat with my family.
I then learned that the driver who had just brought the missionary couple to Tenwek to see me was someone we had gotten to know recently. My wife, being the sensitive lady that she is, realized that he had probably not had any lunch, and so I gave him a call and asked him to join us at our place for a meal. He informed me that he’d be right down. If by “right down” he meant 30 minutes, then he was right down. Those who know Kenyan culture know that he probably did come right away, but the cordial and sometimes lengthy greetings that inevitably occur when walking more than ten yards amongst other Kenyans likely accounted for his delay.
At this point, my family and I were already done eating because the kids had class and I needed to return to the hospital any minute to finish my last scheduled case. As I was preparing to walk out the door, our driver friend arrived, ready for some food and fellowship. So I sat back down at the table and suppressed my “American” urge to race back to the hospital before I was late. We talked about his recent transport of several missionaries to the Ugandan border and the great things that they were able to see the Lord accomplish during the trip. As I walked back to the hospital I lamented at how I had almost let my “busy” schedule steal this ordained meal.
After completing my last case and pausing to catch my breath, I began my end of the day walk down the windy and rocky road that leads homeward. Only Ashleigh and Ivey were home, as the older three were on another part of the compound playing with friends. Ashleigh informed me shortly thereafter that she and Ivey were heading out to pick up our other three children before dinner time.
I decided to lie down for a brief rest, but just as quickly as deep sleep fell upon me, I was brusquely awakened by my pager. I had completely forgotten about the case that had been added on from the general surgery clinic. Pushing through my tired fog, I called Ashleigh’s cell phone to let her know that I needed to head back to the hospital. Disappointed by her ringing phone in the next room, I accepted that I would have to go on a hasty search around the compound to track her down (since I had the key to the house), inform her about my case, and quickly make it to the operating room. Thankfully, I found her at the first home I looked in and was off to surgery. After finishing the case and wondering what could possibly happen next, God’s grace allowed the urologic demands to fade away into the Tenwek sunset and I was able to call it a day.
While I wouldn’t say that this represents my “typical” day at Tenwek, these types of unexpected events do occur with surprising regularity. I’m not sure that I can offer any deep spiritual insights from my day of being flexible. But I think that flexibility can at least on some level be seen as a type of spiritual discipline. Sort of a sister fruit of the spirit to patience. After all, how many times did Jesus have to deal with interruptions? Perhaps more importantly, how did He respond? And how does the Lord use us during times of bending? What kind of witness do we offer when things don’t go the way we plan or take much longer than we hope?
It’s easy to get comfortable with the routine and anticipated patterns of life. My prayer for myself, and perhaps for you, is to embrace a posture of flexibility, realizing that God’s purposes are often found in the unanticipated more than in the expected.
“For my thoughts are not your thoughts, neither are your ways my ways,” declares the Lord. – Isaiah 55:8