Big Enough

I had my pediatric rotation during the third year of medical school. My first assignment was in the Newborn Intensive Care Unit of St. Paul-Ramsey County Hospital.  The NICU in those days was a new idea, and our unit was modest–a mere eight incubators with monitors and respirators.  My first patient: a premature baby boy weighing 500 grams (about 17 ounces).

The NICU director taught me how to intubate a premie struggling to breath, how to take advantage of the umbilical artery and veins during the first day of life, how to start an IV in a scalp vein. I learned to calculate fluids and nutrition within very narrow margins of error by the barest of guidance from limited labs, weight and physical examination. I learned about respirator settings for tiny human beings, the perils of too little and too much oxygen. I worked hard and learned a lot. The NICU director gave me great autonomy and an experienced nurse gave me lots of help. And I believed my little patient would live.

Then, forty-eight hours later, the baby died.

I was shocked. I had done everything right, done everything I could, and he died anyway. My knowledge and skill and willingness to work were not enough. The baby was too fragile.

The NICU staff was not surprised. Because the one thing I didn’t know, and everybody else did, was that a 500 gram baby had never survived. They had worked with me treating the baby because they hoped he would survive. I didn’t know any better; I believed he would.

Though we failed with that child, there now are a few babies who have survived, even thrived, from sub-500 gram birth weights because another generation of doctors not only hoped, but believed, the most fragile could survive.

I learned three things: babies are fragile, hope is good, belief is better.

This Christmas season I’ve found myself wondering about the baby Jesus and remembering that baby in the NICU.

History tell us that about two thousand years ago, the creator of the universe gave up being God and chose to become the frailest of human creatures, a baby. A very fragile baby. We know what happened next: The baby survived, grew in wisdom and strength, sacrificed himself thirty years later for the salvation of mankind.

But babies are frail. Did God risk the salvation of mankind by coming as a baby? Did He have an alternative plan if the baby Jesus had not survived? I don’t know. I feel that with the alignment of the stars, the signs in the heavens, the specific prophecies about Jesus going back several centuries, Jesus’ birth and life were planned since the beginning of time.

Maybe part of God’s message is about fragility. The nation of Israel had been hoping for a Messiah for hundreds of years, expecting some kind of celestial Superman who could save them from their enemies and restore their political and religious dominance.

Then Jesus arrived as a fragile baby, someone who needed constant care simply to survive, and a message from angels to keep him from being slaughtered with the other infants in Bethlehem by the evil King Herod. I mean, really, if you were there–say, a shepherd who had heard about this miracle from angels in the field–and you had to change a diaper, would you really believe this little guy was the Son of God?

I don’t know why God does things the way He does. The story we have about Jesus is so much more beautiful than the stories we have about the great political and military saviors in the Bible–Moses, Joshua, David, for example. But though the Jesus story is beautiful, it remains puzzling.

This Christmas season, I am thinking of Jesus as a metaphor. A baby Jesus is born into my heart. He represents all those beliefs that are beautiful and true: that I am a beloved child God, that my current experience only touches a true and deeper reality, that my life is not limited by time and space, that order reigns over chaos, that good triumphs over evil, that mercy is better than justice, that true wealth is in the heart, and love is real and stronger than fear and hate.

But He is small and frail.

I have moments, maybe many moments, when I can believe that reality is limited to the cold facts demonstrable by science, that life is limited to a short time on this small planet, that human law is the best we can expect out of justice, that mercy is weakness, fear is self-preservation, forgiveness is foolish, success is getting more, and that love is an illusion based on hormones and reproductive drive.

These are easy beliefs in our secular age. As a flinty-eyed realist, I should be able accept them and dismiss my hope for Jesus as sentimental foolishness.

But I can’t.

When Jesus was born in the stable at Bethlehem, He was small, fragile. Maybe He only weighed 500 grams. But by the grace and love of His Father, our Father, He survived.

He was big enough.

My baby Jesus, born in my heart, has been small sometimes, maybe only 500 grams. Who can measure these things? Sometimes He seems frail. But, by the grace and love of our Father, He survives.

He is big enough.

Mustard Seed Medicine


Patient Number One was seven years-old and alone.  The numbered tickets had been distributed in advance of the clinic day to two hundred patients in this town in southern Haiti.  The tickets were a tool to avoid a riot at the door to the church/school, because there had been no doctor in town for years and the needs were great.  Pews and school desks had been rearranged to form a registration area, an area to measure height, weight and visual acuity, a makeshift pharmacy, and four examination stations with providers and interpreters.

Number One wended his way through the matrix and arrived at a chair in front of me, a skinny black kid in a sky-blue shirt and navy blue slacks–his school clothes.  He spoke only Creole; I spoke only English.  Benson, a Haitian interpreter, sat next to me.

I was filled with a kind of altruistic excitement.  I was prepared; I had studied the diseases of Haiti that were unfamiliar to me–malaria, typhoid, tuberculosis, AIDS, cholera.  I had knowledge, skills, and tools to do some good.  I was ready to alleviate pain and suffering.

Number One was under-sized for his age and underweight for his height, at least according to the American height and weight charts we had brought with us.  But he looked healthy.  I asked if there was anything special he was concerned about.

Benson interpreted his reply, “Sometimes he doesn’t feel like eating.”

I asked a string of questions about nausea or vomiting or abdominal pain, then examined him, looking into his ears and his eyes, gently touching his neck and his abdomen, and then listening through the stethoscope, his breath and heartbeats sounding so close.

A pretty healthy kid, I thought to myself.  I wrote a prescription for our pharmacy to give him an anti-parasite medicine and a supply of vitamins.  As a last question, I asked how long it had been since he didn’t feel like eating.

A minute or two passed as Benson and Number One exchanged words several times.  Then Benson turned to me and said with a voice and expression that indicated the story was a common one, “His parents had a very successful little grocery store here.  Their neighbors thought they should share more of their good fortune, and when they didn’t, the neighbors killed them.”

Benson shrugged.  Number One continued to fix his eyes on me with no change of expression.

And I’m giving this kid vitamin pills.

I get a patient like Number One and I am smacked out of my complacent belief that I am making a difference simply because I am practicing medicine.  I wonder if all the children got their vitamins and grew to be strong and bright, would they still kill each other?  They’ve been doing it in Haiti for a couple of hundred years; there’s no reason to think it will change now.  Why bother with the vitamin pills?

I am tempted to despair, to go home and take care of my own, and let the world take care of itself or go to hell, whatever it chooses to do.  But now I’ve heard the boy’s heartbeat, I’ve listened to him breathe, I’ve looked into his deep brown eyes, and he’s no longer an abstraction, no longer Number One but a real boy; he’s flesh and he’s blood and he’s somehow connected to me.

“Jesus told them another parable: “The Kingdom of God is like a mustard seed, which a man planted in his field.  Though it is the smallest of all seeds, yet when it grows, it is the largest of garden plants and becomes a tree, so that the birds come and nest in its branches.” (Matt. 13:31-32. NIV)

Everyone holds a mustard seed.  It’s that thought that maybe you should make a phone call, make a visit, or make some cookies for someone who needs to hear that someone else cares.  Maybe you need to enroll in that course, the one that has no practical value but gives you skills the Kingdom needs.  Maybe you have the opportunity to change from the job that pays more to the job that cares more.  It’s all a question of how we handle our mustard seed.  Do we brush it off and let it float away in the wind, because it’s a little thing and doesn’t really matter?  Or do we plant it and water it and wait years for it to grow?

So I give him the vitamins and I give him the anti-parasite medicine, and I see the next patient.  And the one after that, and the one after that.  And keep going all day long.  Because I believe that we are all children of God and we should care for each other, one mustard seed at a time.  And I find that belief easier than despair.