I had cared for an unending stream of children suffering from severe malaria and all other sorts of tropical diseases common to Africa; still I had not adjusted to seeing so much death.

One weekend involved performing ten c-sections, with only two surviving babies.

During one particularly memorable night, I admitted twenty-five children; five died before morning.  I vividly remember hearing the last heartbeat of one child as I examined him for admission, knowing that nothing could be done to save him.

They have a word for such suffering in Hausa, the local language, wahalla.  I once jokingly used this term and was met with stern looks by the local hospital staff; I think it was because they knew I had never personally known true wahalla.  I certainly had never experienced the type of grief that many people encounter there daily.  Medically, at least, it is orders of magnitude above what is encountered in the West.

In this midst of this wahalla around me, it was here that I found myself dizzy, exhausted and unable to stop crying in the wee-sma’s (wee small hours) of the morning.  I called the OR team back and asked that they inform the surgeon instead.  They hesitated but agreed; I had temporarily forgotten that he himself took surgical call every other night and was far more exhausted than me.

He was naturally a bit terse from the wake-up call because the c-section, by rights, fell to me unless there was some severe surgical complication.  Embarrassed, with no explanation to give, I pulled myself off the bathroom floor and stumbled over the dark dirt paths to the OR building.  Arriving home several hours later and just before the light of morning, I simply could not imagine going through another 12 hour-day.  I crafted an email to my program director, asking to be sent home.

But I never clicked send.

I think it was partly due to shame and the fear of failure that was staring back at me in the teary-eyed mirror; mostly it was a practical realization that there was no one else to replace me. The other physicians were just as exhausted, just as overwhelmed with the workload and emotional burden.  No one could take call any more often and they were working even harder than I was.  On top of all this grim reality, we were already turning away some patients who probably should have been admitted.

But what else could we do? We had already crammed three children to every one bed, with some having to sleep on mats on the floor.  IVs hung at every nook and cranny, giving lifesaving blood for the severe anemia from malaria.  Nurses could not keep up with the number of children seizing from cerebral malaria.   It was, in fact, one of the worst malaria seasons the hospital had seen.

I have since come to believe that experiencing this grief is also a gift, for it gives us the ability to accompany our suffering patients in their wahalla, even when we reach the end of all that we have to offer or maybe because of it.

Now, almost five years later, I still vividly recall that profound moment of being faced with an immense void of despair and defeat, and the apparent meaninglessness of human suffering.  I even briefly wondered if I had entered into the wrong profession.

Being a devout Christian, I naturally turned to my faith during the remaining few months of my overseas service.  I remember finding solace in the Psalms, in verses that speak eloquently of the depths of grief inflicted within a broken world; these lines often provided the words that I lacked at the time.  I think it is in this space of lament that we properly encounter and understand our own profound frailty and weakness, our own emptiness.

I have since come to believe that experiencing this grief is also a gift, for it gives us the ability to accompany our suffering patients in their wahalla, even when we reach the end of all that we have to offer or maybe because of it.  It is here in the great void of helplessness that we truly bear each other’s burdens.  It is here that we meet God once more and begin to see His image reflected in everyone we meet. It is here that we begin to truly encounter others, to love them, to experience the love of Christ for each person poured out through us.

There is a word for this emptiness in Greek, kenosis, a path of being emptied of self – of our will, our strength, our ability, our ego – in order to be filled with the presence of God, and, in so doing, become a vessel of His love for others.   Even the incorrigible Mother Teresa, in the slums of Calcutta, often experienced this “Dark Night of the Soul” as she tended to dying beggars and outcasts, “It is only when you realize your nothingness, your emptiness, that God can fill you with Himself.”  Indeed, the path of medicine demands kenosis, for, sooner or later, more will be required of you than you alone will have to give.   Such is the sacred nature of our calling.

Finally, I have come to see how that it is often the sorrow, the wahalla, that makes the news headlines, that motivates fund-raising campaigns, and even determines the stories we remember in our own heads.  It is wahalla that continues to pull us to respond to the call to medical service, to enter into the world’s lament against the injustices and unnecessary suffering.

But someone once told me that “happiness writes white” meaning that what is good and true and beautiful is often invisible or left out of the stories we remember and tell.  Yet this “white,” this expression of hope, punctuates the final lines of most Psalms, as the psalmist expresses his confidence in the goodness of the Lord in the land of the living.  This “white” is essential, for it is also true and truth must be told.

Someone once told me that “happiness writes white” meaning that what is good and true and beautiful is often left out of the stories we remember and tell.

We who are further along the path of medicine must also tell the “white” stories to those who follow behind us in this noble vocation.  In an age where endless discouraging news is just a click away, we must speak of smallpox’s defeat, of the near eradication of polio and of the drastic worldwide reduction in diphtheria, measles, rubella, guinea worm, bacterial meningitis and pneumonia, made possible by a litany of scientists who discovered vaccines and antibiotics.

We must continue to recount the incredible decline of maternal and childhood mortality over the last century, of the lengthening life expectancies all over the world.  But most important of all, each of us must learn to recall the joyful smiles of every child who returns home cured of malaria, of every mother who delivers a healthy newborn, of each father who receives antiretrovirals and is able to provide for his family.  We must remember our patients, each face and story, which will sustain us in times of discouragement and remind us of the goodness being poured out through us.

In the field of medicine, we will always encounter those who suffer and may sometimes find ourselves empty under the weight of their sorrow. We will reach out with compassion to comfort and heal, but not always succeed, and these stories will break our hearts, as they should.  But other stories, written in white, will allow us to enter more fully into this broken world with hearts filled with hope.  For my part, I have continued to practice medicine here in the U.S. and have even served in Africa on four additional occasions.  And whether empty or full, I can truly say that it is a privilege, a joy, and a gift to be a physician.

“Weeping may last through the night, but joy comes with the morning.”  Psalms 30:5