The inherently tardy semi-annual update from Barney 

(cleverly posted in timely fashion in advance of “Giving Tuesday”)

“...And now, behold, I am this day eighty-five years old. I am still as strong today as I was in the day that Moses sent me; my strength now is as my strength was then...so now give me this hill country...” Joshua 14:10-12

Ah, my hero: Caleb. I am not 85; I’ll be 78 this Christmas Eve. And I am not as strong today as I was even last month; the trajectory of aging has made itself evident much more physically than in other ways, unrelentingly so. Yet, here I still find myself blessed by the ability to provide services to members of the missionary community, still able to travel, still able to be part of the big picture of member care. I am grateful.

I suppose I should be making plans for when I cannot do this work; I had originally targeted age 75 as a time of cutting back travel to the field and even virtual care, but when I reached that milestone I realized that I had no clue of what “retirement” would look like; all the plans for the sunset years that Karen and I had made (there was a boat involved in there somewhere) are simply not attractive without her. And, I’m still having more fun doing the work I can do than I have ever experienced in 48 years of medical practice. So, for now, Lord willing I will shoot for the round number of 80, not to retire but to plan cutting back a bit on travel, spending more time doing on-line consultation and care. The needs for member care are still great and increasing, and as long as I have the ability to offer help I do plan to do so, even if I’m still lagging a few years behind Caleb.

This year included several international trips (Greece for CMDE; Thailand for MedRefresh) as well as multiple in-USA conferences and consultations; the majority of the work involved providing care to those serving in “global health work”, i.e., medical missionaries whose ministry involves using their medical skills to create opportunities in remote and restricted areas to spread the good news of the gospel. It’s a high risk, typically stressful work where attrition of current workers often outpaces deployment of new ones. I am privileged to be assisting with the “Longevity Project”, developing outreach and support designed specifically for these workers both on-site and virtually to make it possible for them to continue their work. I am already scheduled for similar outreach in Thailand and Turkey in the first half of 2023.

All the travel components of ministry are expensive, and most of that expense is my responsibility (on occasion, the sending agency will provide some level of reimbursement; I don’t charge a fee for any medical/psychiatric service). Many of you have graciously supported this work in the past and I am grateful to those that can continue to do so. The logistics of giving (tax-deductible donation) are at the bottom of this note.

Were I able to share all the stories of what I have seen the Lord do in the lives of missionaries, including my own, we’d have to live longer than Caleb to do justice to the list. This is the best work in the world. I am blessed. Your prayers and support are cherished.

May the remainder of 2022 bring blessings of family, reunion, and increased awareness of His amazing grace...

Barney

barney.davis@barnabas.org

Instructions for donations: www.barnabas.org, click on the blue “Give” button at top right Click on “Browse Global Servants” box in the “Give to a Global Servant” option Scroll down until you see my picture; click on the green “Give” button

For surface mail donations or to use a debit or credit card, additional details are at the bottom of the “Give” page 

Barnabas International

PO Box 708

Elkhorn, WI 53121

815-395-1335 

"Just what is it you do?"

Not a first time: arrive to do an assessment with a group I have not known before, to find that most of them have no idea of why I am here. And not all that surprising, since I am not all that clued in myself. None of them knew I was a physician. Most of them knew something about the organization I work with, but the nagging question arises: "What is a shrink doing here? Just what does he do, anyway?"

Searching for a simple image that would capture the complex nature of my usual task, I looked up (well, not quite lifting mine eyes unto the hills, but nevertheless getting prompts which cometh from above) to see how electric power is typically transmitted in this location...and wondered what the electrician called to sort out a loss of power or other malfunction might feel when encountering such an situation. I can identify...

Basic connections can get problematic when adequate separation isn't possible; sometimes the chafing of constant pressure can lead to short circuiting, often it is hard to determine which component transmits what information to which destination, and finally there can be such interference and disruption that fire breaks out and the whole system can collapse. Effective communication ceases. Damage control is now the goal, and that isn't always successful. It isn't always the case that the linesman is called first; sometimes it's the fire brigade. 

Thank God most of the intertwined nature of complex relationships that I am met with aren't this convoluted. Given time and persistence, we can sometimes disentangle things sufficiently to repair the frayed places, tighten up the connectors, and provide a better image of the desired wiring diagram. But, there are those times when what we find is the relational equivalent of a Gordian knot, attempts to unravel things only leading to further entanglement. And those are the times when we can report truly miraculous interventions by the Master Electrician, with what then emerges not just a new wiring diagram but a whole new ability to transmit more power than one would have been able to expect, or explain. And it is those times that keep me climbing the pole.

This, BTW, is not a commentary on the current work I am doing at the time of this writing; some short circuits here and there for sure, some resistors slowing transmission and the routine tendency to just add another wire while keeping the old ones in place, rather than a true re-wiring to meet new needs: all are evident. But even in this sort of "simple" challenge, nothing will work now or ever if we don't follow His wiring diagram. And when that happens, ahhh...the power, the power displayed....

Coming About: Rhumb Lines and Course Changes...

It looks like the shortest distance between points, plotted on a flat nautical chart: take a ruler and draw a straight line from one’s current position to the destination: this is known in sailing as the “rhumb line”; just set your course, adjust your sails accordingly, and stay on that same heading. Ah, but if one takes that flat chart and places it on a globe, that straight line becomes a large curve. And, reversing the process, if one plots a straight-line path between origin and destination on the globe, and then converts that to a flat chart, this “great circle” course now looks to be itself a curve. Measuring both tells the tale: the “rhumb line” that appears straight on the chart is actually the longer distance than the “great circle route”. The latter requires constant changes and more careful monitoring of the course, but in the end is the route of choice. Sometimes what looks like the more circuitous route is the quickest and best way to get where one wants to go. 

As I learned to sail many years ago, one of the first principles one finds is that one cannot sail directly into the wind; practically, the closest one can sail is 45 degrees off the wind, the sails on the “leeward side” of the boat, the wind coming from the “windward side”. At some point it becomes necessary to turn the boat the other direction, now sailing with the wind coming from the other side of the vessel, this zig-zag course back and forth being still the most efficient means of making headway when the wind is coming from directly ahead. The process of making that turn from one side to the other is known as “tacking” or “coming about”; I used to feel very much a salty captain at the helm when I would announce an upcoming tack: “Ready about!”, followed by “helm’s a'lee!” as I would put the rudder over, the bow of the boat turning and crossing the oncoming wind, the sails being released on one side and hauled in on the other. When done well, the process results in the boat quickly regaining speed, on a different heading but still progressing toward the desired destination. To get where one wants to go, sometimes one has to change course, take a different tack, come about, head another direction. 

When Karen and I “launched” what was then the fledgling Godspeed Missionary Care ministry almost 30 years ago, our sailing was simple, our vessel was small, and the crew was limited. We could explore shallow waterways and visit places with little or no safe harbor. Over the years as demands grew, the boat got bigger. Eventually as others took the helm of the good ship Godspeed during Karen’s lengthy illness, the crew became more numerous and the boat more able to carry more and go farther; the name changed (GRC; Godspeed Resources Connection) and as member care vessels go, it’s arguably the best ship in the business. 

But as I am aging into what I want to do when I grow up, I long to take those trips into uncharted, out-of-the-way areas, go places where the big boats can’t go, visit places and people that are otherwise hard to reach. I may be an anachronism personified, but I still feel called to go the places that others may not want to go or have the ability to get to. So, it appears that my life course, my most-direct great circle route, will have me not just come about onto another tack, but to transfer to another vessel that better is suited for this style of voyaging. After open discussion with the owners and crew of both vessels, all are in agreement that it’s time; this is a transfer, not a mutiny. 

I will be leaving GRC by March 31st to affiliate with Barnabas International, another highly valued member care organization, more known for pastoral services but with a small group of dedicated clinical workers. Their mission vision is to provide no-expense on site care where possible, giving counsel to missionaries and teams who request their services. This will allow me to be responsive to those more difficult-to-get-to locations that may require a visit; I fully expect to be able to go places I have never been while still being able to visit ports I have frequented in the past.

There is grief in the leaving, of course, but there’s excitement as well as great peace in the going. God has blessed me for my entire ministry career, it is He who provides the vessel and He who protects in stormy seas. I could never have had such an intimate view of His work, His creation, and His purpose without His provision and His direction. I sense He wants me to show me more. I am grateful that He has allowed me to continue to serve even in my latter years.

To the captain and crew of GRC: It has been a wonderful voyage. I offer the traditional Latin wish for “be well, stay strong”, a nautical goodbye hail to a sailing vessel leaving port: VALE!!

To my new crewmates at Barnabas: thank you for taking on this aging crew member. He’s ready about. And the helm’s a'lee…

Barney

For those who have provided financial support for this work over the years, my ministry account will transfer from GRC to Barnabas, and future contributions can be made in much the same way as before: full instructions are at the BI website:

https://give.barnabas.org/support/barney-davis

Surface mail donations can be sent (with the usual sticky note memo: support of Barney Davis):

Barnabas International

PO Box 708

Elkhorn, WI 53121

My email address will change as well: barney.davis@barnabas.org

Full info about Barnabas International available at:

www.barnabas.org

Final Log Entry

It was one week ago, this evening. I watched my wife enter heaven. 

In my last post ("Landfall") I expressed evidence of God's grace in that Karen was at that time without evidence of physical or emotional pain. That changed over that final 10 days of her life; she had lost the ability to express herself verbally, so we were limited to trying to discern the nature and location of her discomfort based on the grimacing that would happen particularly when she was moved from one position to another (perhaps the most helpless feeling I have had in all of this journey, watching her in pain without having a clue as to why or what to do about it). As hospice became more involved, medication relieved the discomfort, from whatever the origin, but left her more sedated. During the final 24-36 hours of her life, she was essentially unresponsive, with that half-lidded non-focused stare that suggests there is no apparent connection with anything external. On the evening of her death (Friday, February 13) the Lord arranged circumstances for me, our younger daughter and son-in-law, and a dear pastor from our church, to all be by her bedside. It was evident from breathing patterns that death was near; a few minutes before the end, she opened her eyes, stared intentionally and with apparent connection, toward the ceiling. After a minute, she then closed her eyes completely (which we had not been able to make happen -- to protect her eyes from drying -- at any point prior), and soon thereafter breathed her last.

Since, for some years now, I have been saying goodbye to the Karen I had known, I was not aware of how her Homegoing would affect me. The logistics of processing a death are more cumbersome than I had remembered from dealing with the passing of my parents, and as we are now planning three memorial services (Arizona, South Carolina, Maryland), I have been too busy to recognize the extent of the emptiness that I fully expect to come. Coming back to the condo after her death, and seeing her slippers sitting on the floor of our closet (for use when I would bring her home for a meal) was more painful that watching her die. I have been struck by how many of her clothes and personal items I have retained to this point, while not being consciously aware that I was harboring an expectation of a miraculous healing and a return to who she, and we, had been.

But when I have missed her the most thus far has been in the mornings.

For years, Karen and I would start the day sitting on our couch, sharing a cup of coffee and taking time (even when disharmony would threaten to keep us silent) to pray out loud, for our family, for our marriage, for each other, and for the activities of that particular day. That stopped, of course, when she moved to Sarah's Place, but I have tried to continue the tradition on my own, and as I would pray for family, there was always that point in the prayer when I would pray for Karen. Now, over these past seven days, I have not been able to get through the prayer without stuttering, derailed by what to pray in the place of praying for Karen. I can and do express gratitude to God that she is now totally healed  and in complete joy, forever; she doesn't need my prayer any more. But there is still something palpably missing. There has been so little I could do for Karen over these past few years, particularly toward the end, but I could always pray for her. That is gone. And I, the one who had for years longed to do a solo circumnavigation, find that I now do not like sailing alone. Not at all.

For all of you who have journeyed with us, who have bathed us in prayer and love, there are no words that adequately express my gratitude. This will be the last "Meanderings" post; I may find another venue to comment on how God directs that which is to come, but this journey has come to an end. I find I can no longer write about Karen's courage, her fears, her stubborn spirit, her huge smile, her childlike faith, that special birthday song she would sing to somebody, anybody, almost every day, the myriad of things that challenged, irritated, encouraged and endeared all in equal measure. In the end, she finished well. It has been an honor to be her husband and I am very, very proud of her.

Firmly anchored, sails furled, disembarking. 
I miss my wife. 
God is good. All the time. 

Gratefully, 
Barney (and, finally, for Karen, too). 

Landfall...

"How blessed is he whose help is the God of Jacob, whose hope is in the Lord his God, Who made heaven and earth, the sea and all that is in them, Who keeps faith forever..."                Psalm 146;5-6

"The distance that one can see to the horizon from sea level depends on the height of the observer; at the average height of eye level a bit less than six feet, the horizon is roughly 3 miles away. If one had a 100 ft mast and could reach the top, the horizon would be about 12 miles distant..."                                                                                                                             Nautical lore from multiple sources

Our journey with dementia and other aspects of life began almost 13 years ago with the first singular symptom of Karen's being unable to recognize a familiar face ("prosopagnosia"). Through stormy seas of denial, anger, acceptance, estrangement, loss, and readjustment the good ship Davis has sailed on. The expected duration of this type of voyage (4-8 years from diagnosis to death) has been far exceeded on our journey, and while we have always known the destination, it has remained over the horizon, out of sight. I have learned (am still learning) that minding the helm is not my duty, and in spite of my efforts to offer navigational suggestions, course changes, and even advice on when to set or strike sail, I have found I have no control of the vessel. Whether (as I have written before) our assignment is in the depths of the ship tugging on an oar, or simply maintaining watch and doing what one can to keep things shipshape, to this point we have grown accustomed to not seeing any clear signs of impending landfall. Over the past two weeks this has changed. 

This past December I unexpectedly lost my job, the work that I have been doing since Karen entered full time care, the work necessary to provide the income to continue her care. As part of my soon-expressed "Why, God?" and more specifically, "Why now, God?", I have been reminded that God often answers any question of "why?" with an answer of "Who", as in a reminder of Who He Is, and who we are not; this pattern is particularly seen in the Book of Job. God has used this most recent change in my life to point out to me that I had become accustomed to relying more and more on my own limited sailing skills, taking credit for the fact that our ship is even still afloat. But since December, feeling more adrift than on course, I have been working to get back under proper authority, to be more aware of truly Who is Captain and who is crew. 

Less than two weeks ago, Karen began to develop new, troublesome, and rapidly progressive symptoms: more confusion, loss of bladder control, and difficulty with ambulation to the point where as of early this week she could not stand or walk without total assistance. All of this led to an all-day tour of a nearby emergency room, where studies including CT scan and spinal tap led to a diagnosis of "Normal Pressure Hydrocephalus", a relatively uncommon neurological disease most likely unrelated to her dementia; the normal production, circulation, and resorption of cerebrospinal fluid is blocked by an unknown process, allowing slowly increasing pressure to build up, as her brain has shrunken further and further in an effort to accommodate the change. The "treatment" of this irreversible condition is to place a shunt within the brain, draining excess fluid from the brain into the abdominal cavity; this process carries roughly a 70% chance of stabilizing the problems with walking, but would not be expected to have benefit for the other symptoms. There is a 30% risk of complications from the procedure, none of which are minor and almost all of which would include pain and further neurological damage. If we were to pursue the shunt placement, she would hopefully be able to maintain some ability to ambulate, but only with assistance; she is at this point unable to arise from a seated position or to walk unaided, and those defects would not be expected to improve. Her risk for falling has increased dramatically. My shipmate has, in truth, lost her sea legs.  And a lot more.

Yesterday we met with the neurologist to review options, essentially only two: proceed with shunt or do nothing. Either course also now carries the reality that this new condition will restrict her access to the research medication that had seemed to slow the decline of her underlying Alzheimer's dementia. Either course will still reach the same destination, one with a longer passage and more risk of painful and difficult waters, the other much shorter but with expected calmer seas; at this point in all of the above, Karen has had no physical pain, and the often seen phenomenon of "neurological neglect" has rendered her free of any angst or anxiety about the changes in her bodily functions and ability to walk unaided. Karen is still at peace with the voyage. 

We will not proceed with a shunt. Karen's life expectancy is now measured in weeks, perhaps but less likely, months. Her homegoing is expected to be painless, and hospice will soon be involved; their mandate is to make sure that there is minimal suffering. Thanks to my having lost my job, I have been available to be with her throughout all of the doctor and hospital forays these past few weeks, and will be with her in all aspects of what is to come. God had already been preparing our ship and crew for this sooner-than-anticipated landfall, and for that I am grateful. 

One would think that after such a long voyage, landfall would be welcomed; in some ways, it will be. Karen is perhaps the best-prepared person I know to immediately run down the gangway directly into the arms of Jesus. But in spite of knowing for so long that this would be the termination of our journey, I am heartsick. And in spite of the fact that dementia has already erased any capacity for sharing with each other in our marriage, I sense an impending emptiness of even greater depth. At this point in the log, words now fail me.

Your prayers have sustained us and will continue to do so. God is good. All the time. 

A YEAR OF CHANGE...

"Jesus Christ is the same, yesterday and today and forever..."    Hebrews 13:8

"Where is it? I can't find it!"I had my eyes closed during church this morning, trying to focus on the pastoral prayer, when suddenly Karen turned to me and in a loud voice announced that she could not find the book of Jude, the focus of the morning's sermon. This is the same woman who could in earlier stages of her illness still pray aloud with clarity and substance, and in later stages has assumed the little girl "praying hands" posture during any pubic prayer. But today she was totally unaware of the setting and circumstance. Once I was able to show her how to find Jude, she was still agitated; she insisted that the name "Jude" was actually the name "Luke", as she now struggles to recognize words. 

"I am...the true...vine...and...and..." John 15:5 has been Karen's life verse, embroidered on pillows, inscribed on wall hangings about our house. Karen was often asked to read Scripture at Christmas and Easter church programs; she has been one of those people who could read complex passages as if she had written them herself. This morning in our adult class our table was assigned to discuss John 15, and she volunteered to read; she made it through the first few words, then could not decipher, nor remember, the initial verse of a passage that in the past was inscribed on her heart.

Karen is no longer who she was. Part of me has known this for some time, but this was the year the reality set in. This was the year that I went to Texas for Thanksgiving with our older daughter, leaving Karen behind as travel is nigh impossible. There have been other occasions, birthdays, social events where the "frontal lobe syndrome" has kept us apart: further intellectual decline, yes, but more so the loss of awareness and empathy, abrupt emotional outbursts, intolerance of change. In spite of the research drug that Karen has received which has slowed the decline, nevertheless the decline continues. She is not who she has been. 

Nor am I. As I write in the last few days of my sixth decade, wear and tear on the parts is evident; I acquired a total knee replacement (left; the right awaits its turn) in August. And I may not be exempt from following Karen's path; possessing a two-generation maternal history of dementia in my own family, I signed up for a new research trial involving the same medication Karen has received. The concept is that if one who may get the disease receives the drug before symptoms develop, there may be a way to prevent progression. I have completed full neurocognitive testing (good news: I passed, at least for now) and had the PET scan that searches for the telltale amyloid deposits that can accumulate in the predisposed person for years before symptoms develop; I find out those results in early January to determine if I am at risk. Another unexpected change: I have found (caused?) conflict in the clinic job where I have worked for two years, and it is almost certain that I will need to find other work in early 2015. Knowing I need to generate income to pay for Karen's care, I am still less than excited about another change. Yet I sense that God is telling me that my part in this situation arises from my clinging to who I have been, still relying on my own now-aging skill set, doing things the old way, not yielding to the changes He has for me. 

Positive changes:The rest of the family is changing in all the right ways: older daughter remarried this year, and now both my daughters are in marriages being led by godly husbands. Mary Poppins has nothing on my practically-perfect-in-every-way grandchildren, each growing into a bright, inquisitive kid, each growing up in a Christian home. The Godspeed ministry where we invested our years prior to Karen's illness, is growing both in personnel and outreach capabilities. There are good things happening; change is not all bad. 

So while dementia takes more and more of the "Karen that was" than I can sometimes tolerate, and while God continues to show me that I need to surrender more and more of the "Barney that was" than I can sometimes accept, I know further changes will inevitably fill 2015.  The only assurance is that He will not change, not now, not ever. May each of you enjoy His unchanging grace this Christmas and into the year to come.

We are blessed. 
Barney

Glossitis

"...a gentle answer turns away wrath, but a harsh word stirs up anger...."        Proverbs 15:1

"..but no one can tame the tongue...with it we bless our Lord...and with it we curse men...from the same mouth come both blessing and cursing..."      James 3:8,9

"..it is finished..."      John 19:30

"Ouch! Stop! You made it bleed!" Our adult Sunday School class completed, Karen and I are sitting out in the shaded area awaiting second service at our church; another doctor joins us to ask me about the process of leaving his active practice to be able to do volunteer work. At the same time, our daughter and two grandkids walk up; the granddaughter runs up to greet Karen, then me. Our daughter notices a piece of something on Karen's cheek and reaches out to brush it off, which elicits the immediate angry response above (there was no damage or trauma, certainly no bleeding). I was torn between mixed emotions: the part of me that would protect my daughter from anyone that would speak harshly to her was there of course, along with embarrassment that the other doctor was witness to the event, and finally the part of me that tries to understand Karen's behavioral changes and not react to them. But while my mouth was silent, my glare at Karen was intense, my heart full of anger for how she spoke to our daughter. It was all over in a moment, nothing more was said, and ten minutes later we were in church, worshiping; Karen sitting next to our daughter, no memory of what happened, the now-Karen that others comment on as always smiling, showing great joy as she sings with animation, prays with her hands held together in front of her as would a child, and agreeing out loud with any rhetorical question the pastor might ask during the sermon regardless of her inability to follow any of the content. 

It was Communion Sunday, of course; before the elements are passed, our pastor always reminds us that we need to clear our hearts and minds of anything that would keep us from being able to appreciate the meaning of Christ's sacrifice, and he gives us a time to privately confess, repent, and release. This is one of those times I envy Karen's memory disorder; she recalls nothing to confess, repent, or release; I was the one hanging on to the anger, the resentment not just at her but at the whole disease process that has taken my wife and stripped her of those social graces and compassionate awareness of others. While I wrote in my last blog entry that there has been little decline in the actual memory loss part of her illness (thanks to the experimental medication, we presume), the veneer of social skill, interpersonal sensitivity, and that single sense of any self-awareness and civility has worn so thin as to be essentially absent. 

So while Karen is singing, I am seething; there is something wrong with this picture. As I go to God to seek His understanding, I am suddenly aware of the sharp words I spoke to a co-worker earlier in the week, of my righteously indignant response to a perceived injustice at the hands of clinic leadership, of the not-so-humorous jibe I tossed out at the table in Sunday School which may have wounded more than one sitting around me, and of the reality that my silent heart response to Karen's audible outburst earlier this morning was no less unacceptable than hers. 

Today's sermon was on the meaning of the death of Christ, the substitution, the atonement, the payment due a just God for sins. And that this payment was complete is seen in the last words of Christ on the cross: "it is finished". Done. Debt paid. The debt of the sin of my sharp words and insensitivity, my anger at and about Karen, that of Karen's harsh words recalled or forgotten. All of them. Paid. What an incredible, credible gift of total grace. If only I could, if only I would remember that gift before my next opportunity for the angry response. 

And there will be more opportunities, I am sure. Karen will further decline and I will still, in my well practiced flesh, continue to feel wounded. But once again God is using the reality of Karen's illness to remind me of my own human frailties, while at the same time displaying the truth and totality of His provision for my forgiveness. We are truly unworthy, and yet truly blessed. 

Things here are otherwise relatively unremarkable; events upcoming include my total knee replacement in late August. And for those of you who have followed the work of Godspeed, be aware that there is a wave cresting that over the next year will carry the ministry farther than we would have ever imagined possible; details forthcoming. God, it appears, continues to be about His business...