What I'm Learning

Hope, Gratitude & Goodbyes

I don’t like goodbyes. I don’t like change. I told myself I'd wait til the last couple weeks at work start facing the transition. 

So here I am. Today is my last day at work.

I’ve been freaking out on the inside and occasionally freaking out on the outside. There’s been this big ol’ bundle of sadness that wells up from the pit of my stomach when I've thought about moving. When I let it, it rose up in my body until it caught in my throat and caused my eyes to leak and my nose to run.

I don’t think I’ll ever get used to transitions. I don’t think I’ll ever like change. I don’t know that goodbyes will ever get easier.

What I do know is that change is inevitable. I know that transitions are part of life, whether I like it or not. I know that there are things we can do to make transitions easier…and apparently ignoring the entire situation isn’t one of those things. So even though it’s tempting to binge watch Netflix and continue denying that change is occurring (I may have had a Netflix tab open at this very moment for that very purpose), I am taking a moment to focus on the things I’m learning about transition.

The “goodbye” matters. 

Transitioning doesn’t just involve adjusting to something new; it also involves adjusting from the old. 

A few weeks ago a friend was helping me process the move to Cambodia when I realized I really liked Waco. That’s when it hit me: I am going to grieve leaving Waco. It’s not just the transition to Cambodia that will be hard; it’s also the transition from Waco.

I’ve been watching the TV show “White Collar,” and at one point, two of the main characters are moving to another city. Elizabeth and Peter are packing up their house when Elizabeth pauses and comments (I’m paraphrasing), “We have a lot of memories here.” Peter immediately jumps in, “But we’ll make new memories.” The rest of the episode continues like that. Every time one of them mentions how sad it is that they’re leaving, the other pipes up about all the new things they can look forward to. When I watched that, it didn’t seem natural or healthy. Sometimes we need to be intentional about giving myself permission to grieve leaving the life we've built in a place.

Adjusting to Waco involved countless steps outside my comfort zone (new job, new home, new roommates, new church, new friends, etc.). It took a lot of work to build a life here, and it’s sad to leave just as I’m getting established. There’s much to look forward to, yes, but there’s also value in acknowledging that there’s a lot to leave behind.

Happiness isn’t a place.

I have been happier this past year in Waco than I have been in a long time. Not because it’s a magical place (I know that’s your first thought when you hear “Waco”…) and not because it was the easiest place to settle, but because of what I have learned here. I have wrestled through fears and shed many tears, and I have come to have a clearer view of who God is. And the more I know the Lord, the more content I become. 

Contentment, I believe, breeds happiness. I have learned to be happy here in Waco, and it was a process; it didn’t instantly appear. I will learn to be happy in Cambodia too, even if it is another long process, and then I will learn to be happy the next place I move, and the next place, and the next place.

I’m not leaving everything.

I happened upon Hebrews 13:5 recently, which reads, “Keep your life free from love of money, and be content with what you have, for He has said, ‘I will never leave you nor forsake you.’” This reminded me: God’s presence is a big deal.

Out of all the things I value most—my church, friends, family, community—there is not one thing I can take with me. I have nothing…except Jesus. But, Be content!, the author of Hebrews urges, because you have God’s presence

I’m leaving a lot. But I’m not leaving everything. He promises He will be with me. I will have Jesus, and His presence is enough.

Hope and gratitude change the game.

I can—and will—be sad about all that I am leaving. I will let myself grieve. Yet grief and gratitude are not mutually exclusive. I can be sad to leave new friendships and be grateful for them, too.

Grief with gratitude cultivates hope. (I’m still not really sure how, but if you’ve figured out how this works, let me know.) There is a next step.

All I know is gratitude focuses on the good, and grief acknowledges the sad, and somehow in the end, hope is born.

And hope makes any transition a little bit easier.
 

Whatever transition you’re facing in life—and we’re all about to be in some transition because we’re about to enter a new year—I pray it’s softened by hope and marked by His presence.

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The HCAHPS Approach

Adobe stock photo

Adobe stock photo

There is a problem on the floor. Not the literal floor. I mean the medical-surgical hospital floor that I work on. And every hospital floor, for that matter.

I have named this problem “the HCAHPS approach.”

For those who are not in the healthcare profession, let me briefly explain. HCAHPS [pronounced H-caps] stands for Hospital Consumer Assessment of Healthcare Providers and Systems. When patients leave the hospital, they receive a 32-question survey asking them to rate various aspects of their care. Examples include how quickly their call lights were answered, whether nurses and doctors treated them courteously, and even how quiet the halls were at night. The idea is to measure quality of patient stays and not just quantity, which is a good thing in of itself.

Here’s the catch. Hospitals’ reimbursement is linked to HCAHPS scores.

I could go on and on about the flaws in the system (like have you ever noticed the people who have dissatisfied are the ones who are more likely to complete surveys?), but that’s beside the point.

Broken system or not, I can tell you the effect it has on the hospital floor. Nurses and other staff are more stressed out, feel pressure to perform, and are always trying to please everyone, even when patients' demands are unreasonable. Hospital units track scores, huddle over scores, post graphs of scores. Sometimes we even talk about which patients wouldn’t give us a high score during shift change huddle. You would be amazed at how much time, money, and effort goes into trying to improve patient satisfaction scores.

But then again, maybe we shouldn’t be amazed. 

It’s Everywhere

When I look around myself—and more importantly, when I look within myself—everything I just described is present: high stress level, pressure to perform, working to please everyone…

Toward the beginning of this year, I sat across from my therapist and told her I felt like I was on a treadmill of perfectionism. I kept running and running and running, trying to go faster and work harder and be better, but I was getting nowhere. It was only exhausting me and made me feel like a failure.

I was applying the HCAHPS approach to life—and so is a large portion of society. We pressure ourselves and others to perform, and we measure our self-worth by what other people think of us. Many of us openly admit to being “people pleasers.” (The opposite response is also dangerous—dismissing everyone’s opinion and deciding not to care about what anyone thinks, even if they have valuable feedback. But that’s a whole different topic for another day.)

Though there’s nothing inherently wrong with ensuring quality patient care and assessing how others feel about us, there is a fine line between assessing and obsessing

When satisfying others and controlling their perception of us becomes the focus, toxic environments are created. That toxic environment can exist inside ourselves, in our work places, in our homes, etc.

Why It’s Toxic

When our whole focus is on what others think, we operate from a belief that we are not enough and maybe if we try harder, are nicer to that co-worker, answer that patient’s call light faster, we will be enough. We believe we will get all top scores and everyone will love us and we will feel worthy and loved.

Yet this feeling of enough-ness will never come from others. We may feel liked and valued for a while, but striving for worth is a vicious cycle that always calls for more. A little more work. A little more makeup. A little more money. A little more studying.

The truth is, we will never be perfect in the eyes of the people around us…because we are not perfect. And they are not perfect.

We carry around invisible satisfaction surveys and, gauging everyone around us, silently (and maybe subconsciously) rate ourselves based on our perception of their perception of us. I bet that person would give me a ‘1’ on promptness. He would give me a '10’ on friendliness. She would give me a ‘5’ on fashion sense. No wonder we’re stressed out and exhausted!

Toxic environments lead to sickness and death. In my case, it led to deepened depression and anxiety. For others it may manifest in physical sickness, anorexia, addiction…

Getting Out

Ironically, it’s when we stop caring too much about what others think that our relationships improve. When we direct all our energy toward pleasing others, we forfeit the opportunity to do our best work. It takes great courage to admit that we are not enough, and great humility to admit that we can never be enough. But there is freedom if we can embrace the truth that because God is enough, we don’t have to be enough.

When we believe this, we shift from operating from a place of frantic striving to a place of confidence in God’s enough-ness. We operate from a stable place rather than from a place where success is defined by others or even by ourselves. We are able to focus on doing our best rather than exhausting ourselves attempting to achieve perfection. We are able to be instead of do, and out of just being come our gifts to the world—the gifts that so often get squelched in our efforts to please others: our compassion for our patients, our ability to motivate our students, our passion for our workplaces, our unique skills and talents for serving and creating and inspiring.

Good News

The bad news is that we live in a society that embraces the HCAHPS approach to life. Regardless of whether or not you work in a hospital, I imagine that all of our workplaces have a tinge of the HCAHPS approach, subtle or blatant.

We may not be able to change society completely—or hospital reimbursement policy—but the good news is that we do not have to keep the HCAHPS approach as our approach to life. We can replace it with the liberating approach of recognizing our need and operating from a sufficiency outside of ourselves. Somehow, when our internal approach shifts, it doesn’t matter so much that the people around us—at work, at school, or at home—are hung up on performance and people pleasing. 

They can post it on a wall I see every day at work, but they cannot post it on my heart. I choose to leave the HCAHPS approach behind. What about you?

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Beyond the Smiles

I remember her lying there. The bare metal bed frame. Her hair pulled back behind her head. The blood on the floor. The coughing and then the bright red vomiting as her thin frame twisted and shook. And the pool of blood grew.

This woman had no family. In this Cambodian hospital, family members are the ones who bathe, clean, clothe, reposition, provide food for and feed patients. They are the ones who faithfully stand at the bedside and move plastic fans back and forth, back and forth, creating air movement in an un-air-conditioned building and preventing the ever-present flies from landing on the sick. 

This woman had no family. 

Her eyes were closed, her body weak. There was nothing with which to clean up the crimson puddle. “Wait,” they told me. “The cleaning lady will come later with the mop and bucket.”

I remember the moral dilemma when a doctor told me they had no more blood to transfuse for this woman. The need for blood, the safety concerns if I dared donate, the fact that even with several transfusions this woman may not live because we could not correct the bleed at this facility… These are the moments that pushed me to the end of my rope again and again until eventually, when I came back to the States, I felt I had completely lost the rope a long, long time ago.

Yet, as Bethany Williams writes in The Color of Grace, “when our level of desperation becomes greater than our pride, true healing can begin.”1

It has been in the pride-swallowing desperation following those experiences that I have discovered true healing. 

True healing, I found, requires courage—and learning what courage is. Courage isn’t going without water heaters and microwaves; it isn’t forcing my eyes open to watch drivers navigate the wildly crowded streets of Phnom Penh. It isn’t becoming comfortable riding on a motorbike or even eating fried crickets and silk worms.

Courage is living the story that is happening beyond the smiles, beyond the Facebook posts and beyond the Instagram snapshots. Courage is struggling—hard—and being vulnerable with others about those struggles. Courage is walking into a counselor’s office; courage is asking for help. 

Courage is learning to acknowledge grief and wrestle with suffering, being willing to embrace my humanity, and humbling myself enough to recognize I'm in over my head. In that moment in the Cambodian hospital, standing at the bedside of a dying woman, I felt helpless and defeated. What had eaten away at me for years was shoved in my face: I was not enough. This time courage meant wading through years of lies to find the truth that although I am not and never will be enough, I don’t have to be.

True healing, I found, happens in the presence of Jesus. 

I can never do enough, say enough, sacrifice enough, love enough; I can never be enough for Cambodia, for those around me, or for myself. Yet when I relive that moment in the Cambodian hospital remembering that Jesus was present, too, I find that He is enough.

As healing happens within, grace creeps into the relationships with those around us. We don’t have to be enough, for God is enough. When we believe this truth for ourselves, we can extend grace to ourselves for our imperfections and failures. When we believe this truth for others, that they don’t have to be enough either (for God is more than enough for all of us), we can extend grace to them. True healing embraces Truth, brings forgiveness, and overflows with grace.

Healing is a process, and it requires humility and perseverance and sincerity. It is not easy. But the freedom on the other side is well worth the work. For me, it has brought freedom from the pressure to please, perform, and perfect. I am free to feel and to fail and to forgive, to be the imperfect me He created me to be.

If healing happens in the presence of Jesus, what glorious news that Jesus is Immanuel, that Jesus is here with us! And He is enough. His sacrifice is enough for our sins. His love is enough for our souls’ deepest needs. His compassion is enough for our grief. His strength is enough to catch us when we fall. His presence is enough to heal. He is enough.
 

Deepest gratitude to my wonderful counselor, Lynette, who continually ushers me into Jesus’ presence and who walks with me in this healing process. I am truly thankful, from the bottom of my heart…

1) Williams, B. (2015). The color of grace: How one woman's brokenness brought healing and hope to child survivors of war (p. 29).

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In Over My Head

These lyrics to “In Over My Head,” a song by Bethel Music, recently caught my attention:

Then You crash over me and I’ve lost control but I’m free
I’m going under, I’m in over my head
And You crash over me, I’m where You want me to be
I’m going under, I’m in over my head
Whether I sink, whether I swim
It makes no difference when I’m beautifully in over my head1

I’m not sure there’s any better way to describe the transition in life right now. I’m preparing to leave behind a stable job with wonderful coworkers, move out of the coolest house I’ve ever lived in, and say goodbye to a city I just came to know and love. These are inevitable when it comes to the move to Cambodia.

People don’t talk about this part of missions much. It’s the part that some people point to and say is crazy or even stupid. It’s the part that the “missions-minded” (why is that even a distinction among church members, anyway?) often gloss over in their enthusiasm that the Great Commission is being fulfilled.

It’s the part that is a hundred nitty-gritty, contemplated decisions about leaving people, places, jobs, and what seems like security. It’s the part that means accepting that we aren’t in control but we’re free—we’re free when we let the Lord crash over us and our lives, stepping away from the comfort of the shore until we are way in over our heads. 

Helpless, powerless, struggling. Isn’t that what “in over our heads” means?

These are words we don’t like to talk about. In fact, these are words we as the Church often deny. To say that ministry is beyond our ability sounds like heresy to these Southern-Baptist-raised ears. Isn’t this what we were made for?! Of course it’s within our ability!

Yet the reality of missions—and ministry, and life—is this: if we think it is within our ability, we are dangerously deceived and in for deep disappointment. Interestingly, a confirmation this is the right thing to do is that every morning that I wake up and think about moving, I am driven to my knees. Thoughts of moving and ministry make me so aware of my inadequacy that I cling to Jesus more and more desperately.

For me, one of these inadequacies lies in the reality that moving involves taking a huge risk with mental health and depression. My well-oiled coping mechanisms will shift and change, and I will be challenged to find new ones in Cambodia. 

My roommate Taylor (who is also a nurse) had a patient once who was paralyzed from the neck down. Taylor came home struck by the patient’s utter dependence: if she wanted a sip of water, she had to ask; if she wanted to change the channel on the tv, she had to ask; if she wanted to turn the lights off, she had to askA discussion on the patient’s needs led me to consider: is dependence something that is learned, or is it something that is recognized? We say we want to learn to be dependent on God. But maybe we have it wrong…

Maybe we are always dependent on God. Maybe we just don’t recognize it.

In Colossians we read that Jesus “is before all things, and in Him all things hold together” and in Acts that “in Him we live and move and have our being.”2 We cannot take a breath without Jesus, for it is through Jesus that our very cells hold together. We don’t just need Him spiritually. We need Jesus to exist. 

We are all in over our heads.

It isn’t the act of moving that makes me need Jesus more. But the step of moving makes me more aware of my need, reminding me I’m already in over my head here in the States. This, I believe, is a step in the right direction.

Daunting and uncomfortable as this step is, ”whether I sink, whether I swim // It makes no difference when I’m beautifully in over my head.” Sink or swim, fail or succeed, struggle or thrive, it makes no difference when I am more overwhelmed by Jesus than ever before. Really, all is success if I find myself deeper in Christ than before. And so maybe thriving and struggling aren’t polar opposites, after all.

Whether it means moving overseas or intentionally breaking comfortable routines Stateside, may we be a people who step out in faith and recognize how helpless and incapable we are, may we live in a state of being overcome by Christ’s adequacy and love, and may we be a people who recognize that being in over our heads is truly the most beautiful place to be.


1) https://bethelmusic.com/publishing/in-over-my-head-crash-over-me/ 
2) Colossians 1:17; Acts 17:28. NIV.

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