Not So Black and White



Before I knew it, I was waist deep in notecards and PowerPoint slides for health assessment, nursing research and pharmacology. One day per week was spent on campus attending lectures. It was a full day with little time for breaks. As much I enjoyed my schooling (and truly, I did), I found by the end of each Tuesday, my legs, involuntarily and ever so wildly, bobbed through the last ninety minutes of lecture- a likely consequence of having consumed three cups of coffee, knowing full well my body was done a long time ago. But a girl had to do what a girl had to do to get through.

Two full days per week were still spent at the hospital working as a nurse. I had been on my own in an apartment for some time, and I wasn’t willing to move back home just to complete school if I didn’t truly need to. More, I knew my experiences at the hospital would certainly enrich my growing knowledge base. It also didn’t hurt being in close proximity to those whose careers mimicked exactly what I had been striving toward. And I made certain to capitalize on such opportunities with many seemingly spontaneous (yet previously considered) questions about various roles in the profession.

Two additional days per week were spent at various clinical locations, oddly left to our own choosing and our own finding. The idea of trying different specialties on for size was invigorating. I was getting closer to actually living out what I had been dreaming of for so long. And now I could taste it.

Even still, a smart part of me couldn’t help but acknowledge the nagging thoughts that had been smoldering below the surface. I half wondered if this was all going to be too much. Full time graduate school and part time nursing. I secretly wondered if the deck of cards I had been building was going to come crashing down on me at any given moment. I didn’t know if I could do it. I wasn’t sure it would all work. After all, my body hadn’t tolerated working full time as a nurse. And truly, it was all I could do to work the hours I had been assigned. Now, to add on full time schooling. I couldn’t be sure.

But I also knew there was only one way to find out.

I began my rotations in a primary care setting, an area of particular interest, where I cared for patients with a variety of health concerns, young and old alike. As a novice, I was comforted by the idea that a challenging patient would often be referred on to a specialist. There wasn’t pressure to be the ‘know all be all’ for any given patient. Or so I thought. More, I liked the idea of building rapport with patients and being afforded the opportunity to cultivate deeper relationships over time.

I knew I would never be the practitioner to run head first into a burning building. I wasn’t leading the charge when a patient coded, nor was I the first to straddle a patient to perform lifesaving CPR. I did, however, know when to get help and when to ask for it; and I wasn’t too prideful to do so. Emergency medicine was not in the cards for me, and I was okay with that. As a nurse, I had always found emergent situations to be somewhat draining and rattling, and the last thing I needed was some external stressor to trigger a flare.

And so, I eagerly focused my efforts toward outpatient medicine. I spent my first rotation working with a young primary care physician with short brown hair and worn brown dress shoes. He wore a white coat and a warm smile. His patients liked him, and I could see why. Eager to teach as we went through the day, I found myself vigorously jotting down notes between cases, knowing I was gaining precious knowledge that I wouldn’t have otherwise extrapolated from my textbooks. Some things were just better learned in person. A lot of things actually.

My second rotation was also in a primary care setting with a physician who happened to be very aware of his appearance, frequently discussing his food intake as well as salsa dancing after work. Patient interactions felt rushed and insincere as we raced through the day, seeing upwards of forty patients per day (nearly double what I had seen in my prior rotation). I was afforded little time for questions but was instead handed several medical books to read and memorize. My workload had already reached a staggering level, and it frustrated me that he would add to that. The volume of knowledge we were expected to learn and retain was bordering ridiculous. Doctors had four years to learn what we were expected to crank out in two! Nonetheless, I sat in the back room of his office, book in hand, feebly wondering where I would fall as things shook out over the next few years.

My rotations continued. Gynecology, orthopedics and gastroenterology. As time passed I came to see the primary care glove was not the perfect fit to my hand as I had once imagined. Instead, I found myself drawn to specialty medicine, namely gastroenterology. I was intrigued by the diversity of the field in caring for everything from autoimmune conditions to gallbladder and pancreatic diseases to irritable bowel syndrome to the screening and discovery of various forms of cancer. More, I had seen and cared for a good number of GI patients on the infectious disease unit at the hospital as a nurse. Somehow, it seemed to be an area of medicine that just made sense to me. I knew I would require much on the job training, as I had been in an adult medicine program geared at nurse practitioners working in the field of primary care. More, I hadn’t attended a GI fellowship like that of my physician colleagues. Even still, something in me was up for the challenge.

A few months passed, and before I knew it my clinical rotations were drawing to a close. I couldn’t help but pause for a moment, noting there was far more gray to the medical field than I had originally anticipated. Sure, certain things would always be black and white. A hematocrit of eight would always mean anemia, and a platelet count of 75,000 would always signify thrombocytopenia (low platelets). But there seemed to be quite a bit of gray in the profession as well. This gray area transcended personality types and social skills. It included big things like decision making. There were nuances. Moments of judgment requiring critical thinking, often left to the discretion of the provider based on a given patient’s particular case. I had come to see firsthand that lines weren’t always clearly etched which was both riveting and terrifying.

See, I was always more of a rules girl. I excelled in boundaries. I liked clear-cut solutions and believed hard work should always pay off. “A” plus “B” should always equal “C” and never “D”, “E” or “Z”. But, it turns out, like many things in life, medicine just wasn’t always so black and white.

Black and white, it seems, had been the goggles I had unknowingly worn for as long as I could remember. It was how I saw my profession and even more, it was how I saw my life. This lens of cause and effect was how I, at times (too many times if we’re being honest), judgmentally viewed my friends and family. More, it was how I viewed my faith. It was why I anguished over my rejection from medical school. All the pieces fit, or so I had thought. Why wouldn’t God help me so that I could help him? I was going to be a medical missionary after all. I had been a good Christian, why wouldn’t God make me healthy? Why wouldn’t he make my father healthy? I had turned my life back to him, why wouldn’t God bring a man into my life?

But it wasn’t about me. A lesson I fear I needed on repeat for many years to come. I had much to learn regarding the sovereignty of God. Regarding his power. Regarding grace. And love.

These dreadful short-sighted goggles it turns out, revealed only what was directly in front of me, completely handicapping my vision of God and what he was doing unknowingly all around me.

Maybe, just maybe, it was time to take the goggles off. Maybe it was time to see through a different lens.

Sure seemed scary to me. And with the changes occurring in grad school coming to a close and things at church feeling less settled, I found myself clinging harder than ever to my frail illusion of control. And so I stubbornly duct- taped those bent goggles of mine and adorned them as I had so many times before.

It was going to be a while before I would come to understand what it meant to really see.

And really live free.