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by Maria L. Evans

My heart is pounding, my strength has failed me,

And the brightness of my eyes is gone from me. ~Psalm 38:10 (BCP)

Psalm 38 seems to be one I hear in my parish’s Morning Prayer service each Wednesday more than most. For some reason, as the Daily Office works its way through the Psalter, Psalm 38 often falls on a Wednesday. The main reason I notice is because I’m always on the lookout for verse 6–“I am utterly bowed down and prostrate…”–if I’m the least bit sleepy or distracted, I slip and say prostate instead of prostrate…and when I hear verse 10, I almost invariably think, “Hmmm. Sounds like anemia to me.”

One of the constant medical truisms I try to pound into medical student, intern, and resident heads is that even though anemia has a diagnosis code in coding and billing systems, anemia is not a “diagnosis” in the true sense of the word. Anemia is a symptom. When we encounter anemia in patient, it’s important to remember that it’s a symptom of something else gone wrong, and try to figure out its underlying cause. Is someone anemic from iron, Vitamin B12, or folate deficiency? Is there a gastrointestinal bleed? Is the patient elderly and chronically ill, with an ever-dwindling functional bone marrow, simply because our functional bone marrow is replaced by fat as we age?

The other thing about anemia–particularly the more chronic, insidious forms of it–is when someone is chronically anemic, their body adjusts to some degree to the decreased oxygen-carrying capacity of the red blood cells. Chronically anemic people “get along just fine” if they live a sedentary life, at hemoglobin levels that would leave most of us dead dog tired and feeling terribly run-down. They don’t even notice they are becoming more anemic until it is so severe they are short of breath and their heart rate is increased–and then they often think something more terrible is wrong.

I know there are two particular times in the liturgical year where I am prone to being spiritually anemic. One is in Time After Epiphany, and the other is in that draggy time of what I call “The long green season”–the tail end of Time After Pentecost.

For me, the first one is more of an acute anemia–like that caused by blood loss–where I think all the waiting of Advent, followed by hubbub and hoopla of Christmas and Epiphany, pitches me into a place where I know I’m tired, and need a nap, and I spiritually crash and snooze. A lot of times, I’ll drop or get lazy about a spiritual practice. This scared me at first. I was afraid I’d drop a practice and then just push it aside. But over time, and with the work of a good spiritual director, I had this put in perspective. Just as I used to crash and sleep for hours post-call in the days of my clinical training, I have come to realize that’s just a “post season” thing. It’s a fact humans eat when they’re hungry and sleep when they’re tired, and relieve themselves when their bladders and colons are full. We probably do these things in our relationship with God, too. Lent becomes a time I “get back in spiritual shape.”

The second one–that tail end of the “long green season”–for me is more of a chronic anemia. I have slowly “adjusted” into minimally unhealthy thoughts and occasionally find myself “zoning” through my prayer time and Scripture reading. I don’t mean “zoning” like when I am in the deep prayer place–it’s more like “I’m sleeping standing up.” That is a type of anemia where it’s dangerous for me to just think I’ll nap and get over it on my own. I have come to learn that is the time I most need the interactions with my faith community, and need others to inspire and buoy me (and occasionally kick me in the shin and yell, “WAKE UP!”)

The fact is, every person of faith goes through anemic times. Perhaps they cycle with the church year, as mine seem to do, or they are more insidious dry or plateau-type segments in our lives. It’s important to understand that this is part of the cyclic nature of life, and not a failing or a pathology on our part. Anemia is not always a sign of loss or “drainage,” or “deficiency.” After all, people get anemic when they’re pregnant, too.

It’s more important to see anemia as an invitation to spiritual self-awareness, and to consider what we need to do (or not do!) when it comes upon us. It also begs the reverse question–when we are feeling spiritually robust, how are we available when someone else feels spiritually anemic? Are you called to be the transfusion someone else needs?

Maria Evans, a surgical pathologist from Kirksville, MO, writes about the obscurities of life, medicine, faith, and the Episcopal Church on her blog, Kirkepiscatoid


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Maria L. Evans

You’re welcome–and thanks for stopping over by my blog, also.

Leslie Scoopmire

This is very well done. Great use of a metaphor. Thank you for this.

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