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Volume 4 Issue 1 Spring 2021

CMANA nection Con

The Official Newsletter for the Student Chapter of the Coptic Medical Association

CMANA CONNECTION • SPRING 2021

CHRIST, OUR ANCHOR BURNOUT AND RESILIENCE IN THE FACE OF THE STORM

CONTENTS CHRIST OUR ANCHOR: BURNOUT AND RESILIENCE IN THE FACE OF THE STORM JASNEET DEVGUN, DO

HE PROVIDES HANNAH GIRGIS

STEPS OF FAITH FR. DAVID MILAD, MD

ASCETICS IN THE WILDERNESS 18

WAVES, STORMS, AND ANCHORS: TOOLS FOR CAREGIVERS

JESUS IN THE WORKPLACE

CECILE BIBAWY

MIRIAM SALEH

RESILIENCE: GOD AS OUR ANCHOR

NO ROOM TO EXERCISE

NARDIN DERIAS

ANDREW NASHED, MD

SPRING 2021 • CMANA CONNECTION

CHRIST, OUR ANCHOR BURNOUT AND RESILIENCE IN THE FACE OF THE STORM “This hope we have as an anchor of the soul, both sure and steadfast, and which enters the Presence behind the veil” Hebrews 6:19 As we start the year 2021, we look back onto the challenges we had and look forward to a new year with hope. However, although the year has numerically changed, the circumstances have remained difficult and very well may continue to be so for some time. Needless to say, we are often faced with overwhelming pressures, trials, and challenges even outside of the current global events. Our work is quite difficult and can truly take a toll on us as healthcare providers. That is why it is so important to have Christ as our anchor. St. Paul so beautifully describes in Hebrews how Christ is an “anchor of the soul, both sure and steadfast” for the salvation of our souls. Likewise, we must remember that our current trials and tribulations are a part of a complex fabric of a story, connecting and intermingling our lives with the many, for the greater goal of our own salvation as well as that of others. The trials themselves are not the end but are a means to a greater goal. When we face burnout, exhaustion, and feel like we just cannot keep going, we must remember this greater story that is being told. Moreover, it is a sign that we must look inward and care for ourselves, for our mental health as well as spiritual illness. The key to finding and maintaining resilience often lies there. Indeed, our path to salvation is a journey full of trials and obstacles, and our sole source of strength through the wilderness is Christ – our anchor. Last Winter, we hosted our annual CMANA conference on a virtual platform. Although we were not all together in person, the experience was still incredible. We learned about the issues of burnout in the workplace, what resilience is through the eyes of a Christian, and how we can practically achieve and maintain resilience. We were honored by the presence of Dr. Albert Rossi, who shared incredible stories and insight both personally as well as from his book Becoming a Healing Presence. We also learned from Dr. Michael Karass and dove deeper into the concepts of burnout and how we can manage this appropriately, especially as followers of Christ. This newsletter is a continuation and extension of this particular theme, as it has become even more essential and relatable during these taxing times. We have many more wonderful voices in this issue who have offered their insights, stories, and experiences. It is clear that their hearts are truly in helping all of us through our trials. I hope that you find these wonderful pieces just as beneficial as I did, and I hope that they provide comfort and aid in getting through the difficulties you may be facing, even today. Jasneet Devgun, DO PGY-4 Cardiovascular Fellow Editor-In-Chief CMANA Connection Newsletter CMANA Student and Young Professional Board Coptic Medical Association of North America 03

SPRING 2021 • CMANA CONNECTION

STEPS OF FAITH FR. DAVID MILAD, MD

Driving on the famous Road to Hana on the Hawaiian island of Maui, you will witness some of the most amazing sights nature has to offer. As you witness the breath-taking landscape, it is hard to imagine that this was the site of volcanic eruptions years ago. How can a sight of utter destruction produce such beauty? How can life spring forth from an environment inconsistent with life? Disasters are a part of nature that carry the ability to disrupt what is already considered beautiful, while at the same time, it unleashes the regenerative power that lies hidden beneath the perceived “beauty” of nature. Similar to nature, humanity is no stranger to storms that can cause havoc on our personal lives in just a matter of moments or over the course of a season, often leaving us shattered or burnt out. Like nature we possess an equally, and arguably greater, potential to bring forth something more beautiful than before by virtue of being made in the image and likeness of God, who is infinite in His capacity for healing and renewal. But what does it all hinge on?

Much of the potential to bring forth a surpassing beauty has to do with how we choose to walk through our personal storms.

FR. DAVID MILAD • STEPS OF FAITH

No one is given the option to either change or avoid a storm; we are too limited to think this is possible. The increased rates of burnout, anxiety, depression, and general dissatisfaction in life are suggestive that the choices being made amidst the storms are more in search of control or avoidance, which can be equally destructive, rather than choices towards resilience. Attempts to control or avoid the storm manifest in a variety of ways. For example, a storm naturally puts more on our plate, and a desire to “keep it together” prevents us from allowing things to fall off our plate to embrace our limits. The stress of storms may cause us to hold on to unhealthy relationships or allow addictive behaviors to settle in as a coping measure. The inherent business in storms prevents us from seizing small opportunities of stillness that afford us an inventory on our inner being. These responses are a posture of resistance to what is happening to us and our feeble attempts to keep the status quo until a

things pass. Any constellation of these responses or similar ones over time allows the storm to penetrate deep into our inner being, planting seeds of doubt, unrest, confusion, and fear. The greatest atrocity is that far too often, we feel we have no choice in the matter.

Or do we have a say in the storm? If so, what do we have a say over? Victor Frankl was a psychiatrist and concentration camp survivor of Nazi Germany who would go on to pen his experience in Man’s Search for Meaning. After observing prisoners stripped of their career, families, possessions, health, and freedom, he made a key observation in a small, yet sufficient, number of prisoners:

“…the last of the human freedoms - to choose one’s attitude in any given set of circumstances, to choose one’s own way…It is this spiritual freedom - which cannot be taken away - that makes life meaningful and purposeful.” (p. 66 & 67)

FR. DAVID MILAD • STEPS OF FAITH

No matter the circumstances in life, concentration camps being of the most horrific in history, we retain a spiritual freedom to choose our attitude and actions in the storm. The personal question to wrestle with is whether you believe you retain this freedom in your own storm.

In this story, the Lord sends his disciples sailing after the feeding of the five thousand so He could pray. In the middle of the night, while praying and watching His disciples struggle in the storm for hours on a tiny boat, Christ walks to them on the water nearly giving them a heart attack thinking they have seen a “ghost.” Sensing their fear, Christ presents them the first opportunity to exercise their spiritual freedom saying, “Be of good cheer!” What?! In the storm? But how? By knowing that it is God who walks with them, “It is I.”

The current pandemic offers us a realtime opportunity to personally evaluate how you are holding up in the storm. All of us have been impacted in different ways, and when you mix in our various temperaments, personalities, and life stages, the outcomes are exponential. While some appear to handle it more gracefully and some on the verge of a breakdown, we must fight the urge to find greener grass on the other side and focus on ourselves. Regardless, of whether you like or dislike your output during the pandemic, the reality is that - everyone must walk through the storm. Thankfully, we have a Savior who understands the storms of our lives and knows exactly how to walk us through. Matthew chapter 14:22-33 captures one of the most amazing stories of how Jesus uniquely navigates the storm and presents an opportunity to walk on water, which is an experience held by only one person in history next to Christ, Peter!

One layer to finding comfort in the storm is by reminding ourselves that Christ walks with us and is closer than we realize. Christ was, and is, always vigilant to the intricacies of our storms. At times when we feel He is far, we must remember that He is watching us, much like He was watching the disciples from the mountain-side while praying. 06

FR. DAVID MILAD • STEPS OF FAITH

Learning to love God “with all our mind” (Matthew 22:37) challenges us to engage in the mental warfare of storms which send us repeated scripts that you are alone, no one understands you, and God has left. Combating these scripts through our daily spiritual practices, stories of God’s steadfastness towards his children, and through opening to others, provides us a degree of comfort and keeps us grounded.

with what he knew to be contrary to the ability of humans. It’s at this point that many of us stop short of experiencing God’s ability to guide us through the storm, being unable to see the potential that lies beyond the limits of our ability. But reaching the potential comes by way of obedience to his voice. God may be asking you to lighten your load, learn new life strategies, sit with a mentor or spiritual guide, ask for help or cut off certain toxic relationships. Taking proactive steps to get out of the boat requires courage, and courage will be found through prayer. There were 12 disciples who had witnessed many miracles, but only one took a courageous step out of the boat. The offer to “come” is presented to us all, but it takes intentionality and a capacity for discomfort to get out of the boat, because it calls us to rely on God for grace to accomplish what I cannot do on my own.

Our journey through the storm cannot be relegated to a mental practice; rather, it is the mental practice that enables us to identify and seize an experience with God, like walking on water. By combating the negative scripts in a storm, we prepare ourselves to see God walking towards us, and it is here that our experience of comfort is found. Peter wanted more than the knowledge of His presence; he wanted proof. “Lord, if it is You, command me to come to You on the water,” (Matthew 14:28) to which the Lord responded, “Come.” The word “command” can give the impression that Peter wanted no choice in the matter, but that cannot be the case since Peter started sinking after a few steps. Peter had to exercise his spiritual freedom to obey the Lord’s invitation, by overcoming his fear of the storm. Peter also had to wrestle with

In getting out of the boat, there are a few things to point out. Once out of the boat, Peter’s direction was towards Christ; he did not get out on the other side of the boat. As we leave the boat, we need to make sure that our trajectory is Christcentered. Christ-targeted movements are essential because, at any time, the storm can still rattle us, taking our sights off God, our source of grace, and onto the size 07

FR. DAVID MILAD • STEPS OF FAITH

size of the storm. We are still human, so failure is inevitable, but by walking towards Christ, we are able to reach back in a focused effort to grab His everextended hand. Someone drowning in the middle of the pool doesn’t know where to reach for help, versus someone drowning by the edge has a general sense of where the wall is and will focus their attempts in a certain direction.

formative and brought about a deeper beauty that would flourish later. In any storm, keeping the long view in mind, knowing that a good work is being done in us, though it can’t be seen or understood at the moment, keeps us resilient. It enables us to see the season of the storm as one of many seasons that are character-building.

There will be times of rests between storms, allowing us to appreciate the beautiful work God has brought out of us during the storm.

Though Peter faltered at the end, it was the entire experience of the storm that led to the shaping of his character as he, through many other experiences, became the “rock of faith” Jesus saw in him. Peter, like many of us, probably would have preferred normalcy in lieu of a storm. But was the experience of the storm that was formative

SPRING 2021 • CMANA CONNECTION

WAVES, STORMS, AND ANCHORS: TOOLS FOR CAREGIVERS CECILE BIBAWY

The crashing waves of Waimanalo Beach in O’ahu, Hawaii, from where I have recently returned, shocked me with their power and unsettled me with their force. You can’t run away from these giant waves. They hit me from all sides and knocked me down more than once. Now, back from my Aloha adventure, nestled comfortably in my cozy slippers and quiet wintery Ohio country home, I wonder what those waves do in a storm. When a storm rages, hope seems to vanish. Catastrophe seems inevitable. Fighting seems futile. Storms are like that, and they frequently precipitate fear, distress, even despair. We’ve all had our share, but we don’t all respond in the same way. In their wake, storms can either embitter or embolden us. They can weaken or strengthen our resolve to survive and overcome.

In the storms you’ve weathered, have you fought or flown? Rebounded or Recoiled? Whichever category you fall in, one thing is true for all of us. We have a choice. And whichever one we make is fueled by faith.

CECILE BIBAWY • WAVES, STORMS, AND ANCHORS: TOOLS FOR CAREGIVERS

Faith - that anchor we so desperately need during a storm. St. Paul points this out in a discussion of hope spurred by our faith:

“This hope we have as an anchor for the soul, both sure and steadfast. It enters the Presence beyond the veil, where the forerunner has entered for us, even Jesus, having become High Priest forever according to the order of Melchizedek.” - Hebrews 6:19 We know about the direct correlation between faith and storm survival by the story of St. Peter tutored by Jesus in the lesson of walking on water. When his faith wavered, so did the fervent disciple. Experiencing victory over the storm, even for thirty, ten, or one second as he walked on the tumultuous waves, he learned well the lesson of faith. He led many to Christ, found churches, wrote letters from the mouth of God, and became one of the greatest saints in history. I’d say that he earned an A+. But how do we get that kind of faith? How do we personally secure that available anchor that keeps us from sinking? During one of the greatest storms of my life, my child-self shook and shivered in the face of emotional neglect and confusion about my family and my role in it. I convulsed between reality and delusion in the frenzy of my mother’s schizophrenia. I tell this story in my book, Loving Her Mind: Piecing Together the Shards of Hope. Like any church-going girl who had been infused with the stories of miracle healings by St. Mary, St. Abanoub, St. Philopatir Mercurius, St. George, St. Mena, St. Pope Kyrillos… and St. Peter, I prayed for her to be healed. I cried out for years, believing in the miraculous power of God’s healing hands, but she remained as she was - diseased with a condition that ravaged her mind and our family around the clock. When I left home in my twenties, married and had children, thinking it was over and that I was free, little did I know that I would not be free and that my faith will not have grown much. Distancing myself from my mother did not distance me one bit from another storm I was to face 20 years later. Depression would engulf me and have me sinking fast. I needed an anchor. 10

CECILE BIBAWY • WAVES, STORMS, AND ANCHORS: TOOLS FOR CAREGIVERS

Just before our last day on the island, my family visited Pearl Harbor and walked the memorial that was built over the sunken U.S.S. Arizona. The battleship that began as a soldiers’ vessel of service ended as a tomb for most of the 1,177 men who died. Just outside the museum is a strange towering structure attached to a giant chain. Upon inquiry, I learned that it is in fact the Baldt Anchor, one of three on the Arizona. At 19,585 pounds, this anchor was one of only two raised from the hulk of the ship for preservation.

Gaping at this giant object, I realized I had a strange faith in it. If a battleship like the U.S.S. Arizona needed to be stilled, this would be the thing to do it. And if this is so awe-inspiring in its strength and ability to still a gargantuan war vessel and keep it from sinking, so is God.

CECILE BIBAWY • WAVES, STORMS, AND ANCHORS: TOOLS FOR CAREGIVERS

That’s a simple enough syllogism. What is not so logical is that my weakness in my struggles were meant to glorify Him.

“And He said to me, ‘My grace is sufficient for you, for My strength is made perfect in weakness.’ Therefore most gladly I will rather boast in my infirmities, that the power of Christ may rest upon me.” - 2 Corinthians 12:9 Settling into my role as my mother’s caregiver, and with my sister’s late onset of the same disease, the challenges we faced reminded me over and over of my weaknesses. I always believed in God’s ability to heal them both and couldn’t rest in the idea that He might not. He wanted something other than their healing. He wanted my complete faith. He wanted to be the anchor in my storms. This is how He is glorified in our weakness! Even a life-altering, terminal, and savage condition like schizophrenia does not surpass God’s perfect love, tenderness, and great glory. He simply wanted me to trust Him that it would be okay even if my mother and sister stay mentally ill. When I finally let go of my will and surrendered to God completely, my prayers waxed calmer, and freer. Our loving God spoke to me clearly through my readings and devotionals, and I finally had peace, like a quiet sea just before sunrise. The burden of caring for Mom weighed down heavy, but my Anchor weighed heavier. On that I leaned and rested. Then I began to learn of effective tools and resources for caregivers. In addition to prayer, there are many ways to get help and to equip ourselves. Four Equipping Tools for Caregivers 1. Prayer Prayer is the anchor! God waits for us to come to Him with all our problems. He is the light in the darkness and the anchor in the storm. Filling our hearts and minds with Christ through prayer and praise in solitude and in church stills and strengthens our minds, hope, and resolve to fight our battles. 12

CECILE BIBAWY • WAVES, STORMS, AND ANCHORS: TOOLS FOR CAREGIVERS

How often do you pray? How do you pray? Do you have an aid for prayer? A prayer rope, book (like the Agpeya), written list? Do you use arrow prayers - tiny little supplications or praises exhaled through an hour or a day, like the Jesus Prayer? Communal prayer is powerful and lifegiving. Though for many of us, attending liturgy regularly during these times is challenging, it is worth going out of your way to join the assembly of believers, lifting hearts in unity, share in holy communion, and check in on each other. 2. Set Boundaries Setting clear boundaries in relationships has been proven to contribute to healthy relationships and preventing mental distress, abuse, guilt, and shame, to which family caregivers are susceptible. Two good ways to set boundaries are clear communication with your people and self-care - your own! Practice the LEAP method (Listen-Empathize-Agree-Partner), an effective communication tool mainly for mentally ill people, but can work for those with many other types of struggles. Read about it here: https://lfrp.org/about-leap Self-care is paramount to setting boundaries and strengthening relations with everyone around you. Replenishing mind, body, and spirit must be a priority for your sake and for those around you. What do you do for selfcare? For ideas, here’s a good start: https://www.psychologytoday.com/us/blog/shyness-is-nice/201403/seventypes-self-care-activities-coping-stress 3. Use Resources There are hundreds of local and national groups for caregivers. Look in your area and online. Read articles and books on the stories of people who walk your walk and share a similar journey. Fortify yourself and your plan with tools, hotlines, and support groups. Don’t be afraid to try new things. If they’re not effective for you, try something else. You never know whom or what God will place in your path to ease the burden, brighten your outlook, and keep moving forward. For mental health advocacy, information, services, and encouragement, here are two leaders: https://nami.org/Home https://www.mhanational.org/ 13

CECILE BIBAWY • WAVES, STORMS, AND ANCHORS: TOOLS FOR CAREGIVERS

4. Talk about it Sharing your struggle openly heals and breaks the wall of stigma that entraps the sick and their caregivers. It opens doors and windows of hope and lets in the balmy breeze of assurance that you are not alone. Pray, and ask God to lead you in this so you’ll know when it is right to share your story - for your benefit and your listener’s. To complete St. Paul’s admonition:

“Therefore I take pleasure in infirmities, in reproaches, in needs, in persecutions, in distresses, for Christ’s sake. For when I am weak, then I am strong.” -2 Corinthians 12:10 Not only He, but we are strong on the anchor of Christ. Cecile Bibawy Author, Speaker, Teacher Sunbury, Ohio

Cecile Bibawy spreads truth about mental illness, inspires people to tell their story, and promotes health of mind, body, and spirit. She homeschools her four children with her husband in Sunbury, Ohio, and teaches fitness classes. Cecile is a speaker, teacher, and author. Connect with her at cecilebibawy.com, Facebook, Instagram (@sincerelycecile) and her favorite coffee shops. To Purchase her book, Loving Her Mind: Piecing Together the Shards of Hope: https://www.amazon.com/Loving-Her-Mind-PiecingTogether/dp/1647464986/ref=tmm_pap_swatch_0? _encoding=UTF8&qid=1604325280&sr=8-1

SPRING 2021 • CMANA CONNECTION

RESILIENCE: GOD AS OUR ANCHOR Many of us can agree that this past year has challenged us in a multitude of ways. We were forced to confront our own mortality and the uncertainty of the world around us. Although this could have shaken our faith, I firmly believe that we instead leaned into religion as a source of comfort and solace. There are several references in the Holy Bible that show God as our anchor and the ultimate key to our resilience. Hebrews 6:19-20 says, “We have this as a sure and steadfast anchor of the soul, a hope that enters into the inner place behind the curtain, where Jesus has gone as a forerunner on our behalf…” The time we get to spend reflecting and growing with Christ allows us the opportunity to better see Him in our daily lives. I think that the story of Jonah is a great example of this. Jonah tried to run away from the path that the Lord had set before him. The storm raged on while Jonah was at sea until the whale swallowed him up and delivered him to Nineveh where he was able to fulfill God’s plan. It took Jonah being in the belly of the whale, fasting and praying, to truly understand the word of God. There is a lot to learn from this particular example of how when we stop to listen and understand God’s will, that

NARDIN DERIAS FOURTH YEAR MEDICAL STUDENT OCALA, FL

that He will show us how to lead a righteous life. God is our anchor when there is turbulence in our lives, and we seem to amplify our prayers when times are tough. I think prayers that making the time for God in our lives, even when everything appears to be going well, is oftentimes more challenging challenging. However, trying to find the time to set aside to read the Bible, attend church services, and give back to the community community are all ways we can communicate with God. The time we dedicate to our spiritual lives will further allow us to call on God as a source of strength strength and hope. As the new year rolls in, I encourage us all to make a plan on how we can support one another anotherin our mission to rely more on God. Our time on earth may be fleeting, but the efforts we make towards our spiritual life are eternal. One of my favorite favorite verses, which is a reminder to me of our Christian faith helping to make us more resilient, is Joshua 1:9: “Have I not commanded you? Be strong and courageous. Do not be frightened, and do not be dismayed, for the Lord your God is with you wherever you go.” Armed with this knowledge and hope, we are capable of all things. 15

SPRING 2021 • CMANA CONNECTION

He Provides HANNAH GIRGIS

I was staring at my medical school schedule on the screen in complete disbelief. I could not help but think, “How in the world was I going to get through all the things I need to get through? What did God think I was capable of?” My eyes refused to leave the screen, and my legs refused to move, so I relented and stayed as I was. Seconds turned to minutes, and I decided that staring at a list would not assist in the completion of these tasks, so I turned my mind to the actual assignments at hand. As morning became evening, my anxiety grew, and burnout loomed over me. I did not have the time to get through all of this, much less the energy. I shrugged off the stress and rose from my chair, noticing my Bible on the nightstand – I had forgotten to pray this morning. I sat on the edge of my bed, opening my Bible to where I had left off in Isaiah the day before. It was chapter 44. I thirsted for the words on the page and He quenched. I read verse 8:

“Do not fear, nor be afraid; Have I not told you from that time, and declared it? You are My witnesses. Is there a God besides Me? Indeed there is no other Rock; I know not one.” My heart tore within me as I broke down the verse into pieces. “Do not fear, nor be afraid.” How many times had He said this to me? Had I become as the Israelites, unable to learn from my past mistakes and instead looking for tangible idols and gods I could see to comfort me, only leaving me more aware of the hole in my heart? “You are My witnesses.” How many times had God rescued me out of situations that felt direr than this one? How many times had He used His greatness, a power that is not limited by my weakness but rather amplified by my inability, to calm the seas around me? “Indeed there is no other Rock.” Was there anything else or anyone else in the world that I could count on to be my unmoving foundation? Had there been anything else that rescued me when my situation overwhelmed me? I closed my Bible and hugged it, fully aware of how weird it might have looked to someone looking on. I clutched to His letter, and tears filled my eyes. I had forgotten. I had limited God to my ability.

HANNAH GIRGIS • HE PROVIDES

Burnout is very good at sneaking up on us, especially on those of us in the medical field. As physicians, pharmacists, physical therapists, nurses, occupational therapists, physician assistants, and so many more individuals in the healthcare field, we are part of a system that condones and encourages constant work. When we rely on ourselves, on our limited energy and ability, burnout is inevitable. When we refuse to take time out of our days to feed our souls and our bodies, burnout is unavoidable. As Christians, we have the greatest resource in the game. The power that raised Christ from the dead lives in the heart of each and every one of us. I limit God constantly. I tell Him that I am incapable and get mad at him for giving me situations that I cannot and refuse to do. I get burnt out when I get overwhelmed by my inability. Instead of seeing my inability and resting in God’s ability, I refuse His help and accept burnout.

I want to challenge you. The next time you are faced with burnout or a problem that seems to tower over you, I want to challenge you to do the following. First, take a step back. Actually, physically, take a step back. (If you can. If you are in the car, please do it in your head. Please. Keep your feet on the pedals!) Second, close your eyes. (If you are in the car, please do not close your eyes!) Imagine yourself putting the problem or burnout at Christ’s feet. Imagine leaning on the Rock for support (Not Dwayne Johnson, the OG rock). Open your eyes. The problem, the burnout, it is no longer yours. You have relinquished it over to Christ and it is now His. Now…start. I promise, He provides.

SPRING 2021 • CMANA CONNECTION

Coming This Lent:

ASCETICS IN THE WILDERNESS In this series, we will explore the aspects of asceticism found in the daily life of healthcare workers, from prayers offered on behalf of patients to the hard work done for their sake with humility and sacrificial love. Drawing from the example of the Desert Fathers, this series will present practical lessons from which all may benefit, particularly healthcare professionals.

Interested in Writing? Contact us at: cmanastudents@cmanamerica.org

SPRING 2021 • CMANA CONNECTION

JESUS IN THE WORKPLACE MIRIAM SALEH As a soon-to-be therapist, I started to see some connections between what I was learning academically and what I know spiritually. Mental health in the workplace, thus far, wasn’t an assigned chapter or topic. From what I have learned, however, I can concretely say that none of us have our two identities (personal and professional) perfectly separated down the middle. Though all jobs are different, these two are never equally split. In that same breath, I can say the same thing about bringing Christ to work. None of us have our spiritual lives “just at church” and our professional selves “just at work.” By our speech, demeanor, and actions, we always bring Christ to work. Hopefully we represent Him well, but we do represent Him. Work is not a distraction from our spiritual lives, but actually part of it. Though work is not a sacrament, it carries sacramental value. The first recording of work was written in Genesis 2:15: “The Lord God took the man and put him in the Garden of Eden to work it and take care of it.” Adam surely experienced God in the Garden even as he worked. St. Luke experienced Christ working in medicine, thus why he is regarded as “The Gentle” of the four-gospel writers. St. Paul experienced Christ in his work as a tentmaker, as he records the famous verse, “by so toiling one must help the weak” (Acts 20:35). King David had diligence in tending the sheep, which edified him to tend the nation as King. Lastly, Jesus Christ, a carpenter of wood, defeated death through the wood of the Cross.

“The glory of God is the human person fully alive.” ST. IRENAEUS BISHOP OF LYONS

MIRIAM SALEH • JESUS IN THE WORKPLACE

Orthodox icon of Adam naming the animals (See Genesis 2:19-20)

Work has changed radically for many of us in the past year, but that does not make it less holy. The same goes for the pains you feel at work. In our spiritual lives, when something bad happens, we immediately ask God to strengthen us spiritually. In my humble opinion, we should start attributing it as God strengthening us spiritually and mentally. Simply put, when we have physical ailments, we go to the doctor. When we have spiritual ailments, we go to Abouna. But when we have mental ailments, do we consider seeing a therapist? To be fair, that question is difficult. This area can be complex. Orthodox theology takes each of us as three separate entities, however, the combination of body, mind, and spirit is becoming a newly explored area. As H.H. Pope Shenouda III explained in his book What Is Man?, our Orthodox theology defines humans as consisting of 3 main parts (body, soul, spirit) with a few additional facets that fall under these (e.g. mind, heart, conscience, etc). The spirit, however, is considered the highest form of us. The spirit is what purifies the rest of the nature of man through our union with Christ. But in treating the spirit as the highest form, that should not undermine the other two aspects of our nature (i.e. body and soul). Our Creator deeply cares for all three. Our Liturgy acknowledges this in the Fraction. The Priest prays:

“Purify our souls, our bodies, our spirits, and our consciences, so that, with a pure heart, an enlightened soul...” How beautiful is it that our Liturgy has highlighted this? As our Father, the Great Physician, sanctifies the work we perform daily, He sanctifies the healing He performs in us. The Orchestrator of all things has ordained your priest, your doctor, and even your therapist for the ministry of this work. As aforementioned, your profession bleeds your personality. It was the case for St. Luke, St. Paul, Adam, and for you too. It can be both a good and bad thing. For the former, it is so the goodness of our Lord can be unveiled to others. For the latter, this could be the effect of fatigue, burnout, and even trauma. 20

MIRIAM SALEH • JESUS IN THE WORKPLACE

Let me explain with a vignette:

You come to therapy because you are stuck in the position of being fatigued, overworked, and overcrossing boundaries. Thus far, you have justified these behaviors because you have a critical role at work, but on that same note, this is now costing you your personal needs. This is even leading you to experience emotional numbness (i.e. anhedonia) and depersonalization. You also explain that you feel triggered by certain people, experiencing contempt often. It is now more than you can bear, thus you are here today. If I were your therapist, we would start by discussing the environment, norms, and expectations. Ultimately, I would ask you what behaviors I should expect from which people. I would also want to know more about your origins. I would ask about what the job means to you, what your parents’ work styles may have been, or what your general relationship with work is. I would also ask about how you have been coping thus far, what has worked or has not, and what we can change. Lastly, we would retrace the steps from enjoying the job to where you are today.

Among other things, starting therapy might look like reframing past behaviors, learning cognitive strategies, or speaking to the root(s) of the issue. For example, could “workaholic” behaviors come from a fragile sense of self? Or is this a developed fear and mechanism of survival-mode learned at a young age from family? Here you would dig deep as to where the fear, shame, or vulnerabilities come from and how to navigate through it. With a therapist, you would build the “emotional vocabulary” to move forward. But do these types of discussions have much to do with spiritual life? Again, we are made of three parts, which are meant to work together. The spiritual nature can enhance and influence lessons learned in therapy or may help in the therapeutic process where therapy itself is foundational. The mental health nature could enhance spiritual concepts as well (i.e. what do I reflect on, who do I take comfort in, what do I believe in, etc). This mirroring can go even deeper. Our intellectual natures could be developed in therapy the same way our intellectual natures could also be developed when hearing spiritual discussions. These concepts, along with additional ones, are all interlinked and created by God. And when they work together, they work to glorify Him. 21

MIRIAM SALEH • JESUS IN THE WORKPLACE

I could go on for pages on this topic, but I do not desire to be sounding brass or clanging cymbals (1 Corinthians 13) by not bringing Christ’s love back to the discussion. As painful as these experiences can be, our Lord does so out of love. God put the prolonged hours, the tough supervisor, or even the situation above, to create something new in you. Receive each experience from Him. Our Lord is also intentional in ordaining people to help untangle this with you. The innerbattles you are facing have been studied by professionals everywhere; use this to your benefit. If you aren’t yet ready to see someone, let me at least recommend learning the “language” of mental health with other resources, many of which I can provide if interested. Your servant, Miriam Saleh MEd Candidate, Clinical Mental Health Counseling Washington, DC miriam.saleh23@gmail.com

SPRING 2021 • CMANA CONNECTION

NO ROOM TO EXERCISE ANDREW NASHED, MD

I covered one of our three intensive care unit pods during the time of the first COVID spike, leaving me responsible for one-third of our ventilated COVID patients each night for one month long. It was heart-wrenching, seeing ill patients transferred to our unit, looking me in the eyes with total hopelessness as I explained to them we would have to place a “breathing tube” into their mouth within hours. I would try to console them, citing hopeful statistics to alleviate their worries, but they all met the ventilator with utmost

utmost fear. I would urge them to think mind over matter and deliver hopeful words of comfort, however, they knew the odds were against them. By the time the disease had reached that extreme of a scale, very often it actually was too late. Many times, I was the last person to converse with these patients before they were sedated, ventilated, and ultimately palliatively extubated weeks later after all heroic measures had been attempted to no avail. In that setting, beds were constantly occupied and shuffled nightly as the patients came in and out, an unfortunate outcome brought about by tremendously high infection rates among our city’s vulnerable prison populations. A disproportionately higher number of our patients were being discharged deceased rather than alive.

ANDREW NASHED • NO ROOM TO EXERCISE

However, I did have the magnificent pleasure to encounter one particular patient who I will call Mr. W. He, like so many others we cared for, was transferred from the floor to the unit for impending hypoxic respiratory failure. He had a long history in the medical world, including ESRD on dialysis and bilateral aboveknee amputations. From the moment he arrived to the unit, he made it very clear to me that he did not want the breathing tube. It didn’t matter to him how urgent his case became, he was a fighter, and he was going to go out fighting to the best of his ability until either he or death won. We had a long exchange, as I urged him to rethink his stance. The pulmonary fellow followed suit, as well as the other residents, but he kept his resolve. Days danced with nights as his heated high flow oxygen settings neared the limit of what we were able to deliver. We topped his oxygen with non-rebreathers as well, essentially maximizing every last bit of oxygen we could get into his lungs. His oxygen sats soon began to drift into the 80s, 70s and finally 60s, yet there was nothing short of intubation left that we could do for him.

looked back at me and said, yes, “but I also might not die tonight.” As things would have it, he did not die that night, nor the next night despite his oxygen saturation continuing to hover well into the 60s and 70s. His mood began to fluctuate between manic agitation and somnolence. As time went on, he became much more the latter. Eventually, he transitioned to persistent somnolence and remained non-verbal or behavioral for nearly three days, which we all presumed was in the setting of severe anoxic brain injury. Miraculously, however, after a little over a week into his ICU stay, he slowly began waking back up. His oxygen levels improved, and somehow he was back to being able to eat and converse with those around him. I went into his room the first night I was back from my weekend break, and the first thing he told me was, “doc, you know what the problem is here? There’s no place for me to exercise!” I was blown away. He had proven himself against all the odds, and in reaction, the pulmonary fellows simply said he was “lucky.” But in the face of his positivity and determination, I felt humbled by my inability to prognosticate and the limits of modern medicine. Times like these remind me of mankind’s limited knowledge. They let me step back and think

I remember having yet another very resolved conversation with him as I looked him in the eyes to share that he would likely pass that night. He calmly looked 24

ANDREW NASHED • NO ROOM TO EXERCISE

spirit and the fantastic outcome. I could not have been more joyful than I was the night I walked into his room to share that he was the healthiest person in our entire hospital’s ICU, enough to send him out to make room for a new patient. The man deserved a standing ovation. This was a fantastic example of how having a positive spirit in our work can take us through the impossible. Christ tells us:

think of how much we don’t know and defer to God who is of unlimited knowledge that far surprises what our limited minds can fathom. I can dare to guess with reasonable certainty that had he relented to our pleas for mechanical ventilation, his course would have very likely been akin to the many others who came before and after him with an alltoo-familiar narrative of intubation, followed by days or weeks of proning, paralysis and ultimately palliative extubation. But he proved us all wrong.

“Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you.” The root of this is a positive spirit with an optimistic outlook that Christ can and will deliver. Christ is the endless source of positive spirit and with this we shall never lose heart.

Although we disagreed strongly with his decision-making, we were left humbled in the end by the simplicity of his positive

Andrew Nashed, MD Third-Year Internal Medicine Resident The Ohio State University

SPRING 2021 • CMANA CONNECTION

Calling All Writers! Would you like to contribute to the next CMANA CONNECTION Newsletter?

We are looking for writers! If you are interested in becoming a writer for future publications, please contact us at: cmanastudents@cmanamerica.org

CMANA nection Con

Volume 4 Issue 1 • Spring 2021