Good-Bye

People come in and out of your life, sometimes just moments, sometimes longer, leaving implications that are so numbing you become mindless and are filled with despair because the moment is gone but also with un-sureful gratitude that you experienced a small touch of God's hand...something that touched you so greatly...or allowed you think about something in a different light...or showed you a piece of yourself you never knew...or opened the opportunity to experience something you would have never experienced without him or her...

You feel a sense of pain that the moment has passed you by but also of peace that you were supposed to meet that person...You want to cling to everything about them so you don't forget them...It reminds me of the quote from Peter Pan..."Never say good-bye because good-bye means going away, and going away means forgetting." How do you not forget? Do all good things come to an end? Johnny Cash sings 'Everyone I know goes away in the end'...It can be pretty damn depressing but I guess you live in the moment and do your best not to forget flashes of times that changed you, small little glimpses that are deep within...and you live to create that for another person and live to find it again...

(I am not an Optimist, probably more of a Pessimist because I have been hurt so many times...but perhaps the best way to describe my view would be that of a Realist...the pain of good-bye is real, very real- but I realize some good-byes are meant to be...no matter how painfully real they are at the time or how misunderstood they are)

Acceptance

I have come to accept that the dichotomy of religion, good versus evil, is the only black and white that exists. With people, it is only shades of grey, so we will always be disappointed when we place our faith in others. Yes there is grey area in discussing religious matters and in everyone’s faith, including denominations that believe the same fundamental truths. But when it comes down to it, we know good versus evil…we know there is good and evil in the world. And personally, I know there is a good God and there is an opposing evil as well. I think this means a lot to me because I realize that I will always be hurt by humanity-the imperfection of it all…there is good and evil in all of us.

So why do I continue to place my worth in humanity-how others feel about me, what they think, or how much they do or do not love me? It is foolish! The only think that should matter is my relationship with the only thing that is purely good-my heavenly Creator…the only one who will truly accept me for who I am, grey areas and all.

I think the term acceptance really recapitulates my growth here in Samoa. I think I have learned to accept myself and others more. I have learned that we all have good and bad in us, and at the end of the day hopefully the good outweighs the bad. I am coming also to realize we are a product of chemical reactions. Everything we do is a product of a chemical reaction---sleeping, eating, talking…our emotions so often guided by hormones. This helps me accept our humanity…we are reacting because of the reaction going on inside of us. I think we can try to help direct these reactions with our morals, ethics, and faith but we are all going to fail at some point. We are all going to let someone down and we are all going to be let down by someone more than once. We are going to be disappointed many times, but if we can remember that there is nothing black and white humanely speaking and cling to the fact that we are product of chemical reaction, perhaps we can move towards an acceptance of this inevitable disappointment.

Furthermore, disease, both physical and psychiatric will never fit into a black and white classification due to different set of individual chemical reactions. We often medicate with drugs or alcohol to calm our disease. But there are other ways to cope with these unruly reactions…through therapy, medication, family, exercise, friends, social interaction, faith. I think when we use alcohol or mind altering chemicals, this creates disrupt in the chain of reactions our body wants to produce through science and molecular biology. It can change the set of reactions to come. As a Physician Assistant, this concept helps me realize that I can not diagnose and treat two people the same because of this grey area. You can not classify people into one category, therefore not everyone can be treated the same. This must be taken into account.

Also, I believe the more aware I am of my imperfections and the more I accept them, the better healthcare provider I will be. It makes me a better practioner because I am aware of my own struggles and imperfections that make me empathize with others and accept my patients more openly. I would like for my growth here in the Pacific, personally, professionally, spiritually to be looked at as a better acceptance and I pray that acceptance continues to develop.

Ila

Named Ila because it means a defect, to hurt or feel pain in Samoan, I think my little puppy was doomed from the start. She was found with scars from either wire or a machete, someone trying to end her life from the very beginning. She was brought to Humane Society where I feel in love with her instantly. I was with her a few weeks before her short life ended when another dog attacked her. She was my baby and I loved her so much. I tried to save her but I couldn’t. The people in my village couldn’t understand why I was so hysterical over an animal but I was devastated as she laid in my blood soaked arms. I will never forget how she looked at me like ‘Mom what just happened, are you gonna help me?’ The men in the village helped me bury her. I am not sure why this had to happen, but I know she brought me a lot of happiness the short time I had her. She was a beautiful creature even with her scars. I loved her and will miss her.

Work

LBJ Tropical Medical Center, where I happen to work, is complete insanity. I love my patients dearly and they are in legitimate need of help and so very grateful; but, sometimes I come home wanting to burst into tears because of the injustice here. LBJ is the ONLY medical center on the island. Medicine is definitely lacking here and sometimes I try to take on cases only the most qualified specialist would take in the states…because I know there is no else to do it. On top of lacking resources, funds, ect…the politics of the hospital anger me so much. I am not trying to pull a race card here, but I am definitely looked down upon for being a white woman. I would say 80% of the doctors here have no US training or certification. And I know US training isn’t the end all, be all…but it is kind of scary when the doctors here have a 4 year medical officer degree. It is scary how much wrong medicine is being practiced. Patients are given NSAIDs with Renal Failure daily, people don’t show up for work on time I mean like 45 minutes + on a regular basis, people wait for an average of 3-10 hours to even be seen by a doctor, the is no accountability, the lab loses specimen, and the frustration goes on and on. I think that is why no one from off-island stays here long term. Patients do not come to the hospital because they are scared, so they wait until it is too late…I see so much End Stage Disease. American Samoa is the number 1 fattest area in the world…An estimated 93% of American Samoans are overweight or obese…the majority of my patients have Diabetes, High Blood Pressure, Cholesterol, and Gout…I think this is because of a lack of education regarding personal health. I had a patient go in for an appendicitis and came out with a colostomy bag because they nicked his bowel so bad. Today I was left in the clinic with no supervisior as a Physician Assistant…I was running Head CTs, dealing with liver masses, nystagmus, broken toes, polycythemia vera, just absolute craziness. I am so overwhelmed when I come home that I am numb, overwhelmed, and exhausted. I do not regret my decision for coming here, but it seems like it is a little too much to handle. I became a Physician Assistant because I wanted to practice medicine…I liked the idea of autonomy and the supervision at the same time. My training was intense...the hardest thing I have ever done, but I am not a Physician. I practice as a Physician under the supervision of a Physician which I don’t feel like I always have here. When my boss Dr.Bouslough leaves, I don’t know what I am going to do. I know this is great training for when I go back to the states. But is this fair for the people here? Honestly, I have more training than the ‘doctors’ here, no vanity involved…just plain not right, not cool. I can’t believe I am actually writing this but I am frustrated! I leave to go home in 3 weeks for my best friend’s wedding and I am emotionally ready to get out of here. The hospital isn’t even looking for replacement for when I and 2 other PAs leave next year; I have a huge patient database, what is going to happen to them? If I was valued here and the hospital was held to standards, I could see myself staying here because I love my patients…but sadly that is not the case and will never be. Bottom line, is I can deal with everything written above…but my dying patients, what are they supposed to do? I seem so helpless sometimes, there is nothing I am going to do for some of my patients that need to get off-island. When I go back to the states I hope I remember nothing is worth getting upset about unless life and death are involved. Absolute insanity here…glad I am here but it is completely overwhelming...how can people dying, injustice in healthcare, ect not get to you?

Jennifer Knapp

Keeping a blog is harder than I thought. Being disorganized, disconnected, and declared to have attention deficit disorder; there are so many ideas and thoughts in my head cluttering my brain, wanting to come out on paper, but difficult to express. A lot of them are about my time here in Samoa which I will share at some point. But I just need to say something that is on my heart. I have listened to Jennifer Knapp’s music since high school and fell in love with her music during a very difficult time. I went through a major depression my junior year of high school, and I hung tightly to her words and songs. She has continued to influence me over the last 10 years of my life, probably more than any other musician has. Her music is sincere, raw, and honest and every time I listen to it, it connects me to my Heavenly Father. She has recently come out to the community with her sexuality claiming to be gay. Some of the comments I have read from Christians really astonish me. As you probably know, I am a Christian...and it hurts me to read some of the things posted. Shouldn’t we as Christians love everyone? Billy Graham was once asked ‘What would you do if your son was gay?’ His response was ‘I would probably love him more’. Aren’t we called to love the sinner…we are all sinners…no one is perfect. Sometimes I wonder if Jesus were here (physically-walking on this earth in 2010), would he be disappointed in the way we AREN’T loving people? I mean we will all fail at loving, we are bound to at some point because of the fact that we are not perfect, but shouldn't we try to love? In the picture above, all I see is a child of God in love with HIM and letting go of everything tying her down...letting go so she can openly and honestly be who she is and love God. That picture is a spiritual statement for me. I stand before my God in same expression wanting to know him better. I support her, this doesn’t mean I am gay or completely understand where she is coming from, but I support her 100%. She is an amazing singer and songwriter and I am glad I was introduced to her as a teenager. Thank you Jennifer for your music.

“I’m weak, I’m poor, I’m broken, oh but I am yours, hold me now, hold me now” Hold Me Now JK

To Remember

I don’t want to be morbid….which I actually have the tendency to do…Hell, my high school career questionnaire scored me as #1 A Funeral Parlor Director and #2 A Grave Digger…and I guess my obsession with the HBO Series ‘Six Feet Under’ doesn’t oppose this tendency either…But if my mind were to go or I should die tomorrow, there are some things I want to remember and would like for others to remember me about me…

I want to remember to live life not so seriously, enjoy everyday, see God’s beauty, and share the love God gave me with others—I know sometimes I will succeed and most of the time I will fail…but I hope to remember…

I want others to remember me as one who was real and honest, one who loved—deeply and sincerely. I think my honesty freaks people out…this has undeniably scared the opposite sex away, and probably even friendships in my past…But I want others to see me as someone who knew her flaws, limitations, imperfections…I will be the first to tell you I am disorganized, flighty, even flaky…that my house is never clean, my brain is scattered…I forget things, I am not always a good listener…and while the list goes on, that I never pretended to be anything else than who God made to be… I think we need a sense of peace and freedom to express ourselves, our true selves…My sister whom I love to death is a vault and doesn’t share much with others...Maybe that works for her? But that is not who I am, not how God designed me…And I don’t want to be ashamed anymore for expressing myself in my own way…I think if more of us were honest we would have a better understanding of each other and where they are coming from…And above all else, I want others to remember me as loving God and others—deeply and sincerely…even when I messed up, when I showed my humanity, when I let anger, rebellion control me--that deep down my heart was hopefully in the right place and I tried to seek out love…A love despite people’s background, race, culture, past decisions, ect…that I tried to see the good in people…And although it had burned me several times, that I still tried to see the good, be open and real, and truly love without exceptions…well maybe, perhaps, sometimes, most of the time, others can remember...

Introduction

I have been in American Samoa over a year now. For those of you who don't know me or where that is...my name is Jamie Stevens, a brown eyed girl from Virginia and I currently live on a small island in the South Pacific. What am I doing here you may ask? I am a Physician Assistant repaying my debt to the National Health Service Corps...I am wondering why I didn't start this earlier...as a way of therapy, self-realization...I started thinking this last Easter weekend when I was in Ofu (pic above-one of the smaller AS islands...truly heaven on earth)...It came about reading a journal I started but never commited to when I first got down here...I began to think about how far I have come since then, what God has taught me and how important it was for me to write it down. First of all, I think I need to go back a year and share my pit of what I thought was despair. I decided to share what I wrote back in February 2009...last year.

'So I have been here a month to the day and I haven't started this journal. I arrived in American Samoa January 15, 2009. I can't believe it is 2009, it is weird to write that as the date. So I am truly alone for probably the first time in my life...thousands of miles from home. Now I am looking at the ocean trying to navigationally find my way home from here...is it straight ahead or behind me...if I was to look to the right would that be correct? Difficult to say, but all in all it doesn't matter because I am here for two years. I am trying to embrace the art of relaxation here. If there is an art of being alone I must embrace that also and learn to adapt...my survival depends on it. Sounds drastic but that is how I am looking at life after sleepless nights and cries turned into retching. How can being alone affect a person that much? Being a Psychology major, I refer to Maslow's Hierarchy of needs and try to remember where companionship fits into that. Lately I have been living my life with companionship as my foundation and it has left me broken-hearted, bitter, and alone. Therefore, I am choosing to embrace myself and God as my foundation. That's all I have right now so it makes sense...'

So I had just gotten out of a REALLY bad relationship when I first got down here, (which I am sure I will write about later)...But when I look at what I wrote then, I can't believe how lonely I really felt (feelings are a funny thing, can be so damn consuming if we let them)...Was it really that bad? I have to say, things have gotten much better in the last year...and I think I am learning to embrace lonliness...attempting seperation from all that is known and familiar...from my culture, my family, friends; from the world and wordly possessions...and I am also working out a realization that I am never truly alone because I have the Creator whom I call God with me, always...no matter where I may be physically. Lastly, I am realizing that deciding to move here is all in God's great plan even if it is a 15 hour plane ride from home. I can't wait to share more!