Chapter Twenty-One

LEVELS OF GUIDANCE

IN A HEALTHY PERSON, the components of the nervous system work together in a beautiful, singing harmony. As I walk to work in the morning, I think about my patients and notice the birds perched in the branches; the motor units in my legs need no conscious direction from the brain. Loyal neurons will slow my pace if my heart complains and will take reflexive action if I stumble. Every level in the hierarchy contributes to my well-being.

I dare not leave out one more influence on cellular behavior: hormones. These chemical compounds act as agents under orders of the head to orchestrate major events. Whereas the brain sends precise, targeted messages to specific nerves, hormones issue a general summons that can reach every cell in the body. Although all cells hear the call, only the appropriate ones respond.

I see the power of hormones most dramatically in the phenomenon of pregnancy. The adult woman’s body prepares for that possibility every month until one day a fertilized egg settles on the receptive cells of a freshly lined uterus. An alarm sounds, hormones kick in, and the nine-month countdown begins. Molecules that previously have never provoked more than a mild reaction suddenly, after conception, foment revolution.

Progesterone, for example, has visited the uterus monthly in small concentrations, sometimes irritating the lining and causing the noxious reaction of menstrual cramps. Now, after the egg’s fertilization, uterine cells fully realize their calling. At once the uterus undertakes a massive reinforcement project, thickening its walls to prepare for the fetus it will soon shelter and protect. Cells pile on top of cells, layering, stretching, dividing, so that eventually the uterine wall grows to a hundred times its previous size.

More and more, the woman’s body reorders its priorities toward creating a new life, not just preserving a familiar one. For example, as the body devotes fewer resources to the production of digestive enzymes, nausea may result, the familiar “morning sickness.”

A remarkable organ, belonging neither to the mother nor the child, begins to develop: the placenta. From an immunological standpoint, the placenta represents foreign matter to the mother, but her body knows to welcome it. No open passage connects the two beings, no cells cross the membrane, and the mother remains wholly mother and the child wholly child. (Often their respective blood types differ so that any blending of blood might prove fatal.) The placenta forges a supreme bond of symbiotic intimacy.

People who see the placenta only after it has played its role dismiss it with the inglorious name afterbirth. In reality the placenta is one of nature’s most elegant structures. Burrowing deep into the tissues of the mother, the placenta weaves a lacy web of vessels through a fine membrane so that the chemicals in the mother’s blood can diffuse into the child’s, and the wastes from the child can be eliminated through the mother. It serves the function of kidney, stomach, and liver for the developing fetus.

Elsewhere, progesterone and its companion estrogen summon responses from cells in remote sites such as the hips, tendons, breasts, and uterine muscles. Ligaments that have always kept the skeleton taut and stable now defy their heritage. They must, for the pelvic bones need to stretch apart enough for a baby’s head to pass through. For the mother, the loosening of connective tissue may bring on backaches and a waddling gait known as “the proud walk of pregnancy.” Other joints, scanning the very same chemical message, recognize that it does not apply to them, and thus pregnant women are spared the problems of a wobbly head, loose knees, and elbows that dislocate easily.

Hormones that direct cells to loosen hip ligaments and firm up uterine walls also transform the breasts. These molecules have floated past breast cells each day for years, with no effect. At the onset of pregnancy, however, cells that have been relaxing on reserve duty now report to active service. A milk production factory takes shape, with some cells arranging themselves into a tube that branches out through fat tissue, even as the fat cells shrink to accommodate the new ducts. The change in breasts also requires blood vessels to elongate, skin to grow, and pectoral muscles to strengthen.

Finally, after eight or nine months, reports from the womb convince the mother’s body that the time for birth is approaching. The mother’s blood adjusts its clotting properties to prepare for probable vessel breakage. It also increases in volume by as much as 50 percent, a safeguard against potential heavy loss during childbirth.

Next, the uterus undergoes a burst of contractions and relaxations as extreme as anything the body will experience. Even after delivery, hormones keep flooding the body, in many cases causing the opposite reactions from those in effect just minutes before. The uterus no longer enlarges, it contracts. Blood vessels torn from the placenta seal themselves. The placenta itself, masterful supervisor of much of this activity, exits anticlimactically and gets discarded.

New priorities take over: healing, restoration, and a bonding between two separate beings. In the lovely symbiosis of nursing, the mother now needs the baby just as the baby needs the mother, for the engorged tubes of the breasts must rid themselves of congestion and pain. The placenta’s final signals before expulsion, the newborn’s first attempts at sucking, and even the baby’s cry all combine to stimulate the flow of milk, which the baby quickly learns to ingest. Breast milk communicates two ways: when the baby’s spit-back alerts the mother to possible threats, her immune system kicks into gear, which she transfers to the baby through a newly formulated variety of milk.

Listening for My Role

I look to the physical body for insight into how cells in a spiritual Body can best collaborate. The same chemical messenger instructs uterine cells to contract but cervical cells to relax during childbirth. As one cell among millions joined together in the spiritual Body, how do I discern my specific role, my calling?

I must admit, I sometimes chafe at being one cell. I might prefer being a whole body or another kind of cell with a different role. Gradually I have learned to view myself as a minor part of a great enterprise that will only realize its purpose under God’s direction.

In the human body, direct connections to local neurons help inform each individual neuron how to act in community. I believe that God similarly communicates through local agents: spiritual leaders, my loved ones, the community of faith around me. How should the church respond to a decaying inner city? To refugees? To the increasing strains that tear families apart? In the Bible, God lays out principles governing the response of the whole Body and also delegates the details to local groups of Christ-followers.

A sensitive member of the Body will hear many stirring calls to action. Some will describe the desperate plight of people in other lands while others will direct attention to neighbors close by. Some will highlight specific causes such as prison reform, racism, the environment, abortion, poverty, addictions, sexual trafficking; others will stress the contemplative life. All these calls have merit and apply in some degree to each of us. But God’s Spirit will instruct us in our specific response, and it is to the Spirit that we must listen.

Having spent much of my life in India, where physical needs are great, I rejoice when sensitive Christians are stirred by human needs. Yet the form of our response will vary. Praying for and encouraging those on the frontlines, lobbying for aid, taking a short-term assignment, supporting causes financially—the options are as diverse as the responses of my body’s cells to a hormone.

Some Christians seem almost paralyzed over specific questions of guidance. Who should I marry? How should I use my excess income? What role can I play in issues such as racism or world poverty? In short, how do I know God’s will for me?

On the opposite end, I have met Christians who use a phrase like “God told me” as a casual manner of speech. “God told me it’s time to buy a new car,” a person might say, or “I know God wants our church to use our money this way.” Actually, I believe that the Bible already contains most of what God wants me to know. A direct hotline from God is not the ordinary way of discerning God’s will.

I recall the apostle Paul’s phrase from Romans 12: “Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will” (v.2, emphasis added). That passage introduces the first full mention in the New Testament of the body analogy, followed by a list of abrupt commands detailing God’s will: Hate what is evil; cling to what is good. Honor one another above yourselves. Share with God’s people who are in need. Don’t be proud. Live at peace with everyone.

Paul does not dwell on the family dysfunctions and sociological factors that might make such responses difficult. He simply states God’s will and admonishes us to “renew our minds”—a process that helps us realign with the hierarchy God has provided. The individual Christian would do better to focus on daily obedience to what God has already made clear rather than seeking some private revelation.

Tellingly, when the New Testament lists leadership qualities or spiritual gifts, it does not emphasize technical skills. For leaders, spiritual qualities are paramount. How committed are they to God? Can they control their own temperaments? What are their families like? The key concern centers on loyalty to the Head. God seems to say, I will work with anyone as long as he or she is committed.

I have learned that the first job of a faithful cell is to listen. I must assess the needs of the Body, peruse the various messages, and wait in readiness. God’s Spirit will employ various means to speak to me and instruct me in the way I should go, but only if I tune in. I may want to leap into action, but unless such a response is prompted by the Spirit, it will not help the overall Body.

At times I find myself nearly overwhelmed by busyness, and at such moments I am strongly tempted to shunt aside my normal time with God. Over the years I have learned, with difficulty, that those moments of stress are precisely the times when I most need spiritual renewal. I must carve out a time to bring heaven and earth together. I prayerfully commit my day’s clutter to God, asking to see the details of my life in the light of God’s will.

God’s Sensor

Mahatma Gandhi, one of the busiest and most famous men in the world, used to set aside Monday as a day of silence. He scheduled no appointments and said nothing all day. He needed the stillness, he said, in order to rest his vocal cords and to promote an inner harmony in his soul amid the turmoil of life around him. I wonder what power would be released if all Christians devoted one day a week to listening to the voice of God in order to discern the coded message for our lives. The Counselor can only direct us if we tune in.

My Grandmother Harris lived to age ninety-four, and I never saw her walk unassisted. Poor health confined her either to bed or to “Grandma’s chair” in a quaint room with lace curtains and dark, Victorian furniture. My sister and I would visit that room for about an hour or so each day. Of Huguenot descent, Grandma had us read the French Bible to her so that we could practice the language and also learn the Bible by discussing the passage we had read.

Grandma was bent and wrinkled, and she suffered severe headaches. She rarely laughed and could never comprehend our jokes, yet her quiet joy and peace somehow reached even us play-minded children. We never resented our daily visits to her room. She radiated love.

When Grandma had trouble sleeping, she sometimes lay awake half the night softly reciting chapters from her storehouse of memorized Scripture and praying for her eleven children and scores of grandchildren. My aunts took turns sleeping in her room, and often in the middle of the night Grandma would suddenly call on them to write down her thoughts. She would say, “I sense that Pastor Smith in Ipswich is in need of help just now. Please write to him like this . . .” She would then dictate a letter and ask my aunt to enclose a check.

Days later, when the mail brought a letter of reply, Grandma would beam with joy. Invariably, the letter expressed astonishment that she should have known the precise timing and amount of a need. She would laugh with a pure sense of innocent delight. We children marveled at the conspiracy of intimacy between God and Grandma.

In the spiritual Body, I picture her as a nerve within the sympathetic nervous system, a sensor that God entrusted with the moment-by-moment responsibility of sensing need. Pastor Smith had sent cries for help to the Head. My grandmother heard the transmitted impulse from the Head and supplied whatever resources were needed.

Grandma had prepared all her life for that behind-the-scenes role. In her youth she had physical energy and beauty. During those busy years of rearing eleven new lives, despite constant demands on her schedule, she had taken the time to know God. She had saturated her mind with the Word of God, storing away in memory whole books of the New Testament, as well as all of the Psalms. Later, when her body grew old and withered, she became a clear channel for God’s grace.

In the human body, a minute amount of the proper hormone can guide the transformation necessary to produce new life. In the spiritual Body, the still, small voice of God, when heard and responded to, can change a person, a community, and perhaps a world.

Apparent Detours

In my experience, God normally guides in subtle ways: feeding ideas into my mind, speaking through a nagging sense of dissatisfaction, inspiring me to make a better choice, bringing to the surface hidden dangers of temptation. Only on a few occasions have I felt unmistakable guidance, as if from a direct connection to the Head. The Spirit, a prompter, supplies real help, though in ways that will not overwhelm my freedom.

As I look back on my life, circumstances fit together in a kind of pattern, despite the fact that at various points the opposite seemed true. For example, in my childhood and teenage years I wanted to be a missionary. My parents had impressed on me values that ranked helping the needy as among the highest ends a person could seek. And so, following my father’s example, I decided to pursue a career in construction. My father had built schools, hospitals, and homes, and I knew such skills would prove useful in India.

Declining an uncle’s generous offer to pay my way through medical school, instead I studied masonry, carpentry, and principles of engineering for four years. After my full apprenticeship I spent one year at Livingstone College taking a medical course on first aid and basic treatments. There, for the first time, I felt a tug toward medicine (mainly because of the experience at Connaught Hospital mentioned earlier), and I fleetingly wondered whether I had made a mistake by turning down my uncle’s offer four years before.

Putting these thoughts behind me, I called on the director of my parents’ mission and announced to him my willingness to serve in India. To my surprise, he did not see matters in quite the same light. He asked numerous questions about my motives and preparation and then cordially said no. He judged me unready for the kind of work the mission required and suggested more preparation, after which I could submit another application.

I was crushed. God’s will had seemed so clear to me, and now this key person was standing in the way.

Following his advice, I signed up for a course at the Missionary Training Colony, a school that taught how to manage life in remote settings. There too I took a brief course in medicine, and the inner voice inside me got louder and louder. I felt inescapably drawn to the field of medicine—so intensely that I withdrew from the two-year missionary course and enrolled in medical school.

At this point, the four years in the building trades nagged at me as a wasteful diversion, a detour. Despite the late start, I did well in school and finished my general training as a physician. Again I presented myself to a mission board, proudly qualified in both construction and medicine. Again I was turned down! This time the interference came from the Central Medical War Committee of Great Britain. They rejected my application to work in a mission hospital and instead ordered me into the bomb casualty services in London. Impatiently biding my time during the forced delay, I studied for qualification in orthopedic surgery.

Twice my good plans had been stymied, once by a wise and godly mission administrator and once by a secular committee of bureaucrats. Each time I felt shaken and confused. Had I somehow misread God’s will for my life?

I backed into medicine by apparent accident. Now, as I look back, I can see that God’s hand was directing me at every step. Eventually, a man named Bob Cochrane convinced the same Central Medical War Committee to assign me to a new medical college in Vellore, India, and it was he who brought my life’s vocation into sharp focus.

Revelation at Chingleput

The author Frederick Buechner gives a succinct summary of discerning God’s will: “The place God calls you to is the place where your deep gladness and the world’s deep hunger meet.”

When the opportunity to return to India finally came, I stipulated a one-year contract, still uncertain about my future. I taught in the Christian Medical College, performed surgery, and filled in daily hospital duties. After a few months I scheduled a visit with my sponsor, Dr. Robert Cochrane.

A renowned skin specialist, Bob Cochrane supervised the leprosy sanitarium in Chingleput, a few miles south of Madras (Chennai). My own hospital did not admit leprosy patients, and I had little familiarity with the disease. Bob showed me around the grounds of his hospital, nodding to the patients who were squatting, stumping along on bandaged feet, or following us with their unseeing, deformed faces. Gradually my nervousness melted into a sort of professional curiosity, and my eyes were drawn to the hands of the patients.

I study hands as some people study faces—often I remember them better than faces. At the leprosarium, hands waved at me and stretched out in greeting. But these were not the exquisite paradigms of engineering I had studied in medical school. They were twisted, gnarled, ulcerated. Some curled into the shape of a claw. Some had missing fingers. Some hands were missing altogether.

Finally, I could restrain myself no longer. “Look here, Bob,” I interrupted his long discourse on skin diseases. “I don’t know much about skin. Tell me about these hands. How did they get this way? What do you do about them?”

Bob shrugged and said, “Sorry, Paul, I can’t tell you. I don’t know.”

“Don’t know!” I responded with obvious shock. “You’ve been a leprosy specialist all these years and you don’t know? Surely something can be done for these hands!”

Bob Cochrane turned on me almost fiercely, “And whose fault is that, if I may ask—mine or yours? I’m a skin man. I can treat that part of leprosy. You’re the bone man, the orthopedic surgeon!” More calmly, with sadness in his voice, he told me that to his knowledge not one orthopedic surgeon had studied the deformities of the fifteen million people who suffered from leprosy.

As we continued our walk, his words sank into my mind. Leprosy afflicted more people worldwide than the number deformed by polio or disabled by auto accidents—and not one orthopedist to serve them? Cochrane blamed a basic prejudice. Because of the stigma surrounding leprosy, most doctors kept their distance.

A few moments later I noticed a young patient sitting on the ground trying to remove his sandal. His disabled hands refused to cooperate as he attempted to wedge the sandal strap between his thumb and the palm of his hand. He muttered that things were always slipping from his grasp. On sudden impulse I moved toward him. “Please,” I asked in Tamil, “may I look at your hands?”

The young man arose and thrust his hands forward. I held them in mine, a bit reluctantly. I traced the deformed fingers with my own and studied them intently. Then I pried his fingers open and placed my hand in his in a handshake grip. “Squeeze my hand,” I directed, “as hard as you can.”

To my amazement, instead of the weak twitch I had expected to feel, a sharp intense pain raced through my palm. He had a grip like a vise, his fingernails digging into my flesh like talons. I cried out for him to let go and looked up with irritation. Immediately, the gentle smile on his face disarmed me. He did not know he was hurting me—and that was my clue. Somewhere in that severely deformed hand were powerful muscles. They were obviously not working in coordination, and neither could he sense the force he was using. Could those muscles be liberated?

I felt a tingling as if my whole life were revolving around that moment. I knew I had arrived in my place, the place where my deep gladness and the world’s deep hunger would somehow meet.

That single incident in 1947 changed everything for me. From that instant I knew my calling as surely as a cell in my body knows its function. Every detail of that scene—the people standing around the sanitarium grounds, the shade of the tree, the face of the patient whose hand I was holding—remains etched into my mind. It was my moment, and I had felt a call of the Spirit of God. I knew when I returned to my base I would have to point my life in a new direction, one that I have never doubted since.

Decades later, I look back with profound gratitude on the time I spent in construction and engineering. Hardly a day goes by that I do not use some of those principles in trying to perfect a rehabilitation device or design a better shoe or apply engineering mechanics to surgery techniques or set up experiments on repetitive stress. And I am equally grateful for the detour that forced me into surgery.

I have stood under the thatched roof of our New Life Center in India and reflected on God’s pattern in all those years. As I watch patients do carpentry in our workshop, and the smells of wood shavings and rhythmic sounds of tools rush in, I flash back to my days in a London carpentry shop among my fellow apprentices. I quickly stir from my reverie and see the differences. These are all Indian leprosy patients with reconstructed hands and tools adapted to protect them. God has permitted me the honor of serving them on several levels: as a doctor treating their disease, as a surgeon remaking their hands, and as a carpentry foreman helping to fashion new lives for them.

Only the zigzag course of guidance allowed me to interact with my patients on all these levels. At any point—if I had gone to India earlier, for example, or had bypassed those years in construction—I could easily have strayed slightly out of line and thus have proved less useful. In hindsight, I have a settled sense that God was planning out the details of my life even when the movements at the time seemed like detours. I take great comfort in the promise of Romans 8:28: “Moreover we know that to those who love God, who are called according to his plan, everything that happens fits into a pattern for good” (Phillips).