Pressing On When Faced with Medical Ordeals

(English Translation of article that appeared in the Fall 2017 issue of “Ilira Revista”)

by Marie O’Toole

Ilira1“Elena” has just arrived in the examination room for her chemotherapy treatment. A tiny Bulgarian grandmother of 82, she sets up the bed with the blanket she has brought from home, adjusts the headscarf that covers her bald head, and enthusiastically hands me a plastic bag filled with tomatoes, peppers and fresh basil from her garden. “For you, Marie!” she exclaims, her pleasure obvious at being able to give her interpreter a treat.

Elena has been fighting pancreatic cancer for three years, as aggressively as the tumor that pumps malignant cells into her frail body. However, she refuses to dwell on her physical limitations – or sometimes, even admit that they exist. Last year, her oncologist was astonished that her body was responding so well to treatment, and that she was not complaining of the usual side-effects of chemotherapy: fatigue; nausea; or mouth sores. I could barely conceal my delight at her response: “Don’t you know, Doctor, that Christ heals us? You doctors know your work, but I pray. And Jesus heals my body!”

While Elena’s strong faith anchors her, there is no denying that a serious illness such as cancer is extremely difficult. Her daughter, a woman about my age, tells the full story: there are dark days, some when Elena is barely able to get out of bed, and must rely on pain medication. How does she summon the strength to press on, while waiting for the next treatment that will hopefully shrink the disease – yet make her extremely sick in the meantime? “I have work to do,” she says. “I tend the garden – we have zucchini as well as tomatoes; they are so good for cooking! And I teach my grandchildren Bulgarian,” she says proudly. “I must leave them this gift. If I don’t teach them, who will? My son-in-law is American, and my daughter is always working so much; poor thing. It is very important for the children to know their heritage….the little one can already read the Cyrillic alphabet!” Does she ever get anxious while waiting for test results, which will reveal the progression of her cancer? “Eh!” She waves her hand, in the dismissive gesture so typical of Balkan people of her generation. “It’s not for me to worry about that. I am in God’s hands.”

Joy: the Nature of God, Pumped Through Our Bloodstream

Despite Elena’s admirably positive attitude, it is undeniable that serious illnesses such as cancer are difficult and painful both for patients and the family members who help care for them. pic2 (1)A friend of mine from church, “Altin”, describes the feeling after chemotherapy as “being in a boxing match, and losing”. A fellow Christian and writer, being diagnosed with pancreatic cancer was a shock for Altin and gave him much time to reflect on his life in Christ in the midst of frightening circumstances. He and his wife started a Facebook page, “Ad Alta Simul” (Latin for “To the Summit Together”) to update friends on the progress of his medical treatments as he took step after painful step to fight the cancer. During the worst of his treatments, he wrote:

“Joy is a topic I have thought long and hard on over the past 5 months during this battle with cancer. Can I be joyful in the midst of all of the uncertainty of my future? Is it possible for me to be joyful when experiencing near constant physical and emotional pain?

The Bible certainly indicates that it is possible for me to do so. “Consider it pure joy when you fall into all sorts of trials” (James 1:2). To transpose James for my current situation: Can I consider my cancer as nothing but joy? Joy is nothing less than the nature of God pumped through our bloodstream. It’s a blessed invasion of the Spirit of God deep into my soul. Let me contrast happiness and joy: Happiness is all about the here and now. Joy is rooted in eternity. Happiness is a sound bite that does not last, while joy is like a pleasing chorus that can’t be stopped.

As I reflect on the words of James, I can’t avoid the high bar that he sets for God’s gift of joy. Any lingering confusion between joy and happiness must end with this passage. If I claim to be happy when my life has been turned upside down with cancer, I am either lying, deluding myself, or am downright insane. Happiness and cancer (or any trouble for that matter) simply don’t mix. But according to James, I can rejoice in the same situation. If he is correct, then God’s joy must be made up of material so strong and sturdy that it can withstand the toughest pain and sorrow that this world can thrash upon us. Trials thus emerge as joy’s greatest and toughest proving grounds.”

Far from treating chronic illness as a pleasant gift or simply pretending it doesn’t matter, the Christians I see fight this curse with courage, but humility. As Scripture instructs believers to “carry one another’s burdens, and in this way fulfill the law of Christ”, believers in Christ are humble enough to seek and accept help and practical expressions of love from others when they are most needed. pic3When Altin was diagnosed with cancer, he and his wife were grateful for the much-needed support of friends and church family that came in the form of cards, letters, prepared meals, and assistance with other needs as they arose. After months of grueling treatments to get the disease under control, Altin and his wife hosted a joyful “No More Chemotherapy” party attended by many friends. This marked a milestone of success, but as with many chronic diseases, the battle continues.

Caring for Caregivers

When life is disrupted by serious illness, it is not just the patient who needs support and care – but often his or her spouse or family as well. While Elena speaks sincerely about her steadfast faith in God, it is impossible not to notice the exhaustion on her daughter’s face. Early morning hospital appointments, 24-hour care for a sick parent, child or spouse, and the stress of waiting for conclusive test results are a daily reality for family members. Do you have a family member who has fallen ill? Here are some suggestions to help you in your battle:

·         Learn about your loved one’s diagnosis, and get to know his medical care team. Each member of the medical group will have specific responsibilities, and you will want to become acquainted with each one.

·         Share the responsibilities of caregiving with other people. It will be overwhelming to try and do everything alone; learn to ask for help when you need it.

·         Take care of your own health. You need to get sufficient sleep, eat healthy food and drink enough water in order to have the energy you need to help your sick loved one.

·         Find ways to relax and relieve stress. It is not selfish to make time for yourself – relaxation will help you mentally and physically prepare for each day’s challenges.

·          Try not to take anything personally. Sometimes, your sick loved one may be upset or frustrated, and you may feel unappreciated. Do not forget that your loved one truly appreciates you and all you are doing, even if it is not always said.

·         Let your loved one be in control. You do not have to make all the decisions and plans; whenever possible, let your loved one be in charge of his or her experience with treatment.

Small Gestures that Mean a Lot

“Doviana” cares for her son, a man in his early 30’s, who has had a painful condition creating a large tumor on his hip for several years. While dealing with the challenges of her own chronic illness (Multiple Sclerosis), Doviana and her son take an eternal perspective: “Everyone has an expiration date; some of us are simply more aware of it than others.” Faced with possible amputation, he lives with constant pain but possesses an unshakeable faith. “Physical problems can take you down spiritually faster than anything else,” Doviana says, and points out that many well-meaning people simply don’t know how to approach tragedy. “We have learned patience, and don’t judge people who don’t know how to respond. Most people who ask a chronically-sick person ‘how are you?’ don’t really want to know how they are, but we have learned to give gracious answers, because we realize that [we] may be their first experience with serious illness,” she explains.

Simply knowing that others care and are praying for them – or receiving small but tangible gestures of compassion – often lifts the spirits of patients who are fighting serious or long-term illnesses. Doviana found comfort in meeting with another woman from her church who had cancer, talking about the day-to-day difficulties they each faced, and praying together.

When Illness Leads to Serving Others

In 2006, “Albina” was diagnosed with breast cancer. Fortunately, it was caught early enough to be cured; but the road to recovery was a difficult one. Although initially Albina felt abandoned, the new church she attended let the congregation know (through an email prayer chain) what she was going through and what help she could use. “The results were amazing,” she said. “Cards, meals, phone calls (at least weekly from the pastor). The cards came almost every day, and I still have them. To have a physical item to show that someone was thinking of you and praying for you meant so much.” Because this support from other people was so crucial to Albina during her recovery, she started to reach out to others facing the same ordeal. In 2006, the same year she was diagnosed, she started a ministry called “Haven of Hope”. At her own expense, Albina has been sending encouraging letters, cards and books to people battling cancer for the past 11 years. “I have 3 scrapbooks of notes from people telling me how much it means. [The money] comes from designated offerings and income I get from selling tote bags. The sewing only cost me my time, because the fabric has all been donated,” she said. A small thing like a letter or uplifting booklet can make the day of a frightened cancer patient just a little bit brighter, and give them renewed hope.

When facing a potentially life-threatening illness, life for a patient can revolve around hospital visits, waiting for test results, and medication. Yet a person’s health cannot be measured purely in physical terms, and maintaining one’s emotional and spiritual health is possible even when circumstances are bleak. Working towards personal goals (whether teaching grandchildren; writing a book; gardening tomatoes or encouraging other patients likewise struggling) is important to a chronically-ill patient, as it takes the focus off of his/her disease and helps them focus on a normal life. And there is no replacement for simple human compassion; often expressed in the simplest of ways that cost very little.

“Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all.  So we fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal.” (2 Corinthians 4:16-19)



Të ngulmosh përballë sëmundjes së hidhur

(nga “Ilira Revista”, Vjeshtë, 2017
Botimi i 61-të)

Marie O’Toole


Elena sapo mbërriti në dhomën e kontrollit për trajtimin e kimio-terapisë. Një gjyshe vocërrake 82-vjeçare nga Bullgaria, ajo shtroi krevatin me mbulesën që kishte marrë nga shtëpia, rregulloi shallin që i mbulonte kokën pa flokë dhe më dha tërë ngazëllim një qese plot me domate, speca dhe borzilok të freskët nga kopshti i saj. “Për ty, Mari!” tha nga kënaqësia që po i jepte diçka përkthyeses së saj.

Elena po lufton me kancerin në pankreas prej tri vitesh në mënyrë po aq agresive sa tumori që nxjerr qeliza malinje në trupin e saj të brishtë. Por ajo refuzon të përqendrohet në kufizimet e saj fizike – ose ndonjëherë, të pranojë se ato ekzistojnë.

Vitin e kaluar, onkologu u habit që trupi i saj reagonte aq mirë ndaj trajtimit dhe që ajo nuk ankohej për efektet anësore të kimioterapisë: lodhje, të vjella ose plagë në gojë. E pamundur ta fshihja kënaqësinë që ndjeva kur ajo u përgjigj: “A nuk e di doktor që Krishti na shëron? Ju doktorët e njihni punën tuaj, por unë lutem. Dhe Jezusi më shëron trupin!”

Edhe pse besimi i fortë i Elenës e mban fort, askush s’mund ta mohojë që një sëmundje serioze si kanceri, është jashtëzakonisht e vështirë. E bija e saj, një grua në moshën time, na tregon të gjithë historinë: ka ditë të errëta, atëherë kur Elena e ka të pamundur të ngrihet nga shtrati dhe merr ilaçe për dhimbjen. Por, si i mbledh forcat të ngulmojë ndërsa pret trajtimin e radhës me shpresën që sëmundja do të tkurret, por që e bën të ndihet jashtëzakonisht keq ndërkohë? “Kam punë për të bërë”, thotë ajo. “Kujdesem për kopshtin, kemi kunguj, domate; janë të mira për gatim! U mësoj edhe nipërve dhe mbesave bullgarisht”, thotë me krenari. “Duhet t’ua lë këtë dhuratë. Kush do t’i mësojë nëse nuk i mësoj unë? Dhëndri im është amerikan dhe ime bijë është gjithmonë në
punë, e gjora. Është shumë e rëndësishme që fëmijët ta njohin trashëgiminë
e tyre… më e vogla mund ta lexojë alfabetin cirilik!”.

A ndjen ndonjëherë ankth ndërkohë që pret rezultatet e analizave? “Eh!”, tund
dorën me një gjest kaq tipik për ballkanasit e brezit të saj. “Nuk jam unë ajo që duhet të shqetësohet për këtë. Jam në duart e Perëndisë”.

Gëzimi: natyra e Perëndisë që rrjedh në venat tona

Me gjithë qëndrimin pozitiv për t’u admiruar të Elenës, pa dyshim që një sëmundje aq serioze sa kanceri është e vështirë dhe e dhimbshme për pacientët dhe anëtarët e familjes që kujdesen për ta. pic2 (1)
Një miku im nga kisha, Altini, e përshkruan ndjesinë
pas kimioterapisë si “të jesh në një ndeshje boksi, dhe të humbasësh”. Diagnostikimi me kancer në pankreas ishte tronditje për Altinin, një mik i krishterë dhe shkrimtar; kjo i dha shumë kohë të reflektojë për jetën në Krishtin në mes të rrethanave frikësuese. Ai bashkë me gruan hapën një faqe në “facebook”, “Ad Alta Simul” (latinisht për “Në majë

së bashku”) për t’i përditësuar miqtë për progresin e trajtimit mjekësor pas çdo hapi të dhimbshëm në luftën kundër kancerit. Gjatë periudhës më të keqe të trajtimit, ai shkroi:

“Gëzimi është një temë për të cilën kam menduar gjatë këtyre 5 muajve të betejës me kancerin. A mund të jem i gëzuar në mes të çdo pasigurie për të ardhmen? A është e mundur të kem gëzim kur përjetoj dhimbje të vazhdueshme fizike dhe emocionale? Bibla sigurisht që tregon se kjo është e mundur për mua. “Ta quani gëzim të madh, o vëllezër të mi, kur bini në tundime të ndryshme” (Jakobi 1:2).

Për ta zhvendosur vargun nga Jakobi në situatën time:

A mund ta konsideroj kancerin veç si gëzim? Gëzimi nuk është asgjë më pak se natyra e Perëndisë që rrjedh në venat tona. Është një pushtim i bek


uar i Frymës së Shenjtë thellë në shpirtin tim.

Dua të vë në kontrast lumturinë me gëzimin: Lumturia është e përkohshme. Gëzimi është i rrënjosur në përjetësi. Lumturia është një tingull që nuk zgjat, ndërsa gëzimi është si një kor i ëmbël që nuk mund të ndalë. Ndërsa reflektoj fjalët e Jakobit, nuk mund ta shpërfill cakun e lartë ku ai e vë gëzimin, dhuratën e Perëndisë. Çdo konfuzion mes gëzimit dhe lumturisë duhet të marrë fund me këtë pasazh. Nëse pretendoj se jam i lumtur kur jeta ime është kthyer për së prapthi nga kanceri, ose po gënjej, ose po mashtroj veten, ose kam luajtur mendsh. Lumturia dhe kanceri (ose ndonjë telash tjetër) nuk pleksen bashkë. Por sipas Jakobit, unë mund të gëzohem në të njëjtën situatë. Nëse ai është i saktë, atëherë gëzimi i Perëndisë duhet të jetë bërë nga material aq i fortë dhe i ngurtë, sa mund të durojë dhimbjen dhe hidhërimin më të ashpër me të cilin kjo botë mund të na godasë. Kështu që sfidat dalin si sprova më e madhe dhe më e fortë e gëzimit.

Ata nuk e trajtojnë këtë sëmundje kronike si një dhuratë të pëlqyeshme apo thjesht bëjnë sikur nuk ekziston, por të krishterët që njoh e luftojnë këtë mallkim me kurajë, me përulësi. Ashtu siç i udhëzon Shkrimi të “mbajnë barrët e njëri-tjetrit dhe kështu të përmbushin ligjin e Krishtit”, besimtarët në Krishtin janë aq të përulur sa të kërkojnë dhe të pranojnë ndihmë dhe shprehje praktike dashurie nga të tjerët atëherë kur u nevojiten më shumë. Kur Altini u diagnostikua me kancer, ai dhe e shoqja ishin mirënjohës për mbështetjen aq të nevojshme të miqve dhe familjes së kishës që erdhi në formën e kartolinave, letrave, vakteve të përgatitura dhe ndihmës për çdo nevojë që doli. Pas disa muajsh trajtimi të mundimshëm për të mbajtur sëmundjen nën kontroll, Altini me bashkëshorten organizuan një festë “S’ka më kimioterapi” ku morën pjesë shumë miq. Kjo shënoi një moment suksesi, por ashtu si me shumë sëmundje kronike, beteja vazhdon.

Kujdesi ndaj atyre që kujdesen

Kur jeta të prishet nga një sëmundje serioze, nuk është vetëm pacienti që ka nevojë për mbështetje dhe përkujdesje, por shpesh edhe bashkëshorti, bashkëshortja apo familja. Ndërsa Elena flet me sinqeritet për besimin e patundur në Perëndinë, është e pamundur të mos vësh re rraskapitjen në fytyrën e së bijës. Vizitat herët në mëngjes në spital, përkujdesja gjatë 24 orëve për prindin, fëmijën apo bashkëshortin e sëmurë, dhe stresi i pritjes së testeve përfundimtare, janë realitet i përditshëm për anëtarët e familjes.

A keni një anëtar në familje që është sëmurë? Ja disa sugjerime për t’ju ndihmuar në betejën tuaj:

• Mësoni për diagnozën e të afërmit tuaj dhe njihni doktorët që po kujdesen për të. Çdo anëtar i grupit mjekësor ka përgjegjësi specifike dhe është mirë të njiheni me secilin prej tyre.

• Ndani përgjegjësitë e përkujdesjes me të tjerë. Është jashtëzakonisht e rëndë të përpiqesh dhe të bësh çdo gjë vetë; mësoni të kërkoni ndihmë atëherë kur ju duhet.

• Kujdesuni për shëndetin tuaj. Duhet të flini mjaftueshëm, të hani ushqime të shëndetshme dhe të pini mjaft ujë për të patur energjinë e duhur për ta ndihmuar të afërmin e sëmurë.

• Gjeni mënyra për t’u qetësuar dhe për të çliruar stresin. Nuk tregoni egoizëm nëse gjeni kohë për veten – çlodhja do t’ju ndihmojëtë përgatiteni mendërisht dhe fizikisht për sfidat e çdo dite.

• Përpiquni të mos merrni asgjë personalisht. Ndonjëherë, i afërmi i sëmurë mund të jetë i zemëruar ose i mërzitur dhe mund t’ju duket sikur nuk ju vlerëson. Mos harroni se i afërmi juaj ju vlerëson juve dhe çdo gjë që bëni, edhe pse nuk e shpreh gjithmonë.

• Lejojeni të afërmin tuaj të jenë në kontroll. Mos merrni çdo vendim dhe mos bëni çdo plan vetë; nëse është e mundur, i afërmi juaj le të jetë personi që do të vendosë vetë për përvojën e vet me trajtimin.

Gjestet e vogla tregojnë shumë

Doviana po kujdeset për të birin, një djalë në të tridhjetat i cili ka një sëmundje të dhimbshme që i ka krijuar një tumor të madh në ije prej disa vitesh. Ndërkohë që merret me sfidat e sëmundjes së vet kronike (sklerozën multiple), Doviana dhe i
biri kanë një perspektivë hyjnore: “Të gjithë e kanë një datë të fundit, por disa nga ne janë më të vetëdijshëm për këtë sesa disa të tjerë”. Ai jeton me dhimbje të vazhdueshme dhe rrezikon amputimin, por ka një besim të patundur. “Problemet fizike të rrëzojnë shpirtërisht më shpejt se çdo gjë tjetër”, thotë Doviana dhe tregon se shumë njerëz me qëllime të mira nuk e dinë si ta trajtojnë tragjedinë. “Kemi mësuar të tregojmë durim dhe nuk i gjykojmë njerëzit që nuk dinë si të reagojnë. Shumë njerëz që e pyesin dikë me
sëmundje kronike “Si je?”, nuk duan të dinë se si është, por kemi mësuar të japim përgjigje me hir, sepse e kuptojmë se [ne] mund të jemi përvoja e tyre e parë me sëmundjen serioze”, shpjegon ajo.

Kur e dinë se të tjerët kujdesen dhe luten për ta, ose marrin gjeste të vogla dhe praktike dhembshurie, shpesh kjo i inkurajon pacientët që po luftojnë me sëmundje të gjata e serioze. Doviana ka gjetur ngushëllim duke u takuar me një grua tjetër nga kisha që kishte kancer, duke folur për vështirësitë që hasnin çdo ditë dhe duke u lutur së bashku.
Kur sëmundja ju nxit t’u shërbeni të tjerëve Albina është diagnostikuar me kancer në gji në vitin 2006. Kanceri u zbulua aq herët sa mund të kurohej, por rruga drejt shërimit është e vështirë. Edhe pse Albina u ndje e braktisur, kisha e re në të cilën merrte pjesë u njoftua (përmes mesazheve elektronike për një zinxhir lutjeje) se çfarë po kalonte dhe për çfarë kishte nevojë. “Rezultatet ishin të mahnitshme”, thotë ajo. “Kartolina, ushqime, telefonata (të paktën çdo javë nga pastori). Kartolinat vinin çdo ditë dhe ende i ruaj. Kur ke në dorë diçka fizike që tregon se dikush po mendon për ty dhe po lutet, do të thotë aq shumë. Për shkak se kjo mbështetje nga të tjerët ishte aq domethënëse për Albinën gjatë
kohës së shërimit, ajo nisi t’u shërbejë të tjerëve që po kalonin të njëjtën përvojë si ajo. Në vitin 2006, në të njëjtin vit kur u diagnostikua, ajo nisi shërbesën “Limani i shpresës”. Albina u ka dërguar me shpenzimet e veta në këto 11 vitet e fundit, letra
inkurajuese, kartolina dhe libra njerëzve që po luftojnë me kancerin. “Kam tri albume me pusulla nga njerëzit që më kanë thënë sa shumë i kam inkurajuar. [Paratë] vijnë nga
ofertat dhe të ardhurat që mbledh nga shitja e çantave. “Unë investoj vetëm kohën që i qep, pasi copa është e dhuruar”, thotë ajo. Diçka e vogël, si një letër apo një libërth inkurajues, e bën ditën e një pacienti të trembur nga kanceri pak më të shndritshme
dhe i përtërin shpresën.

Kur vihet përballë një sëmundjeje që të kërcënon jetën, jeta e pacientit sillet rrotull vizitave në spital, pritjes për rezultatin e analizave dhe marrjes së ilaçeve. Ilira2Megjithatë, shëndeti i një personi nuk mund të matet me gjëra materiale dhe ruajtja e shëndetit emocional dhe frymëror është e mundur edhe kur rrethanat janë të vështira. Puna për të arritur qëllime personale, (qoftë mësimi i nipërve, shkrimi i një libri, kujdesi ndaj domateve apo inkurajimi i atyre që janë në të njëjtën luftë) është shumë e rëndësishme për një pacient me sëmundje kronike, pasi largon fokusin nga sëmundja e tij/e saj dhe e ndihmon të fokusohet te jeta normale. Dhe nuk ka zëvendësues për dhembshurinë njerëzore, e cila shprehet shpesh në mënyrën më të thjeshtë që kushton shumë pak.

Open Letter to Adult Children of Patients



By Marie O’Toole

Dear Son or Daughter:

I just interpreted for your father or mother. It may have been our first encounter; or I may have had the pleasure of knowing him or her for a good many years. The medical encounter proceeded just as always: pleasantries; information relayed; test results discussed; plan of treatment considered.

Today you worried that you offended me.

You didn’t.

You see, we medical interpreters are a perceptive group with thick skin. And we care about your parent, who is far more than the medical record number we write on our Service Verification Forms.

I realize, as does the healthcare provider, how well you speak English. Even moreso, how you care for your ailing parent. You are your parent’s best advocate, and that’s why I appreciate your presence. Some of you work in healthcare in the United States; some of you have battled diseases such as cancer yourself. All of you, it seems, come to the exam room far better equipped than I, a mere linguist, to help Mom or Dad make the best healthcare decisions for him or herself.

And of course, you all understand the constraints of HIPPA law; consent forms; waivers of services (if you decline my services). None of this is personal, and the implications of serious illnesses such as cancer naturally make a family want to turn inward.

I am often an uninvited witness to your very personal pain. I get that. And I respect it.

More than that, I am incredibly grateful to YOU.

Sometimes, the doctor pauses mid-sentence in order to allow me time to consequitively interpret his or her sentence and as I do so, you pick up on the fact that I don’t understand where he or she is going with it. Focused purely on linguistics, I may have missed the gravity of the situation and you interject something. No, you did NOT offend me. Do not apologize, as you often do, for reeling off crucial medical information that only you would know during an appointment. You have all this information in your head; the physician needs to know it.

I am there purely as an interpreter – a conduit of language. I am not the one who has sat up with your mother or father countless nights, through nausea, pain, or other symptoms. Do NOT apologize for interjecting.

Sometimes you catch my eye, as if to communicate the gravity of what the doctor is saying. This is especially true when we are with an oncologist, and timeframes such as months and years are being relayed. The relief you all show at not having to be the interpreter in those situations is palpable, and I sense your deference to let me interpret this painful information from language to language.

As I do my job, I hope and believe I do not come across as overly-clinical and sterile. Once, when interpreting a terminal cancer diagnosis, I had to fix my mind on getting the accents on the correct syllable and noun declension so that I would not burst into tears myself. As a mother, I dread the pediatrics floor. As a daughter, I pray not to be in your shoes.

You asked the physician additional questions in English, and feared I was offended. I wasn’t.

You see, there is only one person who matters right now: your mum or dad. You have information inside your head that neither I nor the doctor are privy to; by all means, share it. I’m no stranger to cross-conversation (hey, I lived in the Balkans for years!) so I can easily interpret the additional information simultaneously into mum or dad’s ear. Stop worrying about me and focus on your parent.

I saw how relieved your eyes were today when I interpreted every word the doctor said, with the appropriate gravity – and YOU didn’t have to be the one to deliver bad news. The brief second of eye contact we made spoke volumes, and in that moment I again realized that we are a part of a team. Team “Your Parent”.

You corrected a mistake I made, and feared I was offended. I wasn’t.

Everyone makes mistakes sometimes. I lack the hubris, even after 16 years in the profession, to think that I am incapable of making an error either in medical terminology or syntax. I learned Bulgarian as a young adult, so while I may enjoy near-native fluency of the language, I carried my medical dictionaries around for years after becoming certified as an interpreter. And you know what? Many times, your English is better than my Bulgarian. I realize that I still have an accent in Bulgarian, even after 25 years. Please rest assured that your proficiency in English does not offend me.

And thank you for allowing me to enter into what is, often, an incredibly sensitive and painful time for your family. I have often (MANY times!) been racked with guilt after leaving an assignment (a precious encounter with your mum or dad, and often you) that I had to impersonally rush off to my next assignment with an LEP (Limited English Speaker) at a neighboring hospital. I worry that I come across as cold, uncaring, and impersonal. I rationalize such thoughts by reminding myself that I am an interpreter; not a patient advocate. And healthcare professionals are trained in the art of emotional detachment from their patients.

See, I missed that day in “detachment training”. But many years of experience of having the privilege of being part of your intimate circle has taught me much.

The Bible says to rejoice with those who rejoice; and mourn with those who mourn. This morning, I interpreted for a gentleman whose cancer remains in remission. Good news is easy to interpret, and I’m objectively glad for him. This afternoon, your father presented with additional malignant growths outside the area of radiation, and I had to interpret hard facts. I am deeply sorry. Maybe I don’t always show it in the exam room, especially as new pages come in, but I truly do care and want everything to be alright.

A few of you have found me on Facebook or social media, and thanked me for my “compassion” towards your ailing parent. I am ashamed to admit I did not even remember being particularly compassionate, even though I truly did care – I was concerned that my rushing off to another appointment would be seen as coldness.

We are a team, you and I. You have the best interest of your beloved parent at heart; and in a professional, much more detached way, so do I. At BIDMC, (one of the hospitals at which I interpret), their slogan is “Human First”. I am a human…..a mother; a sister; a daughter; first – I understand to a certain point what you are going through, and can empathize. And then I am a medical interpreter. Trained; linguistically adept; and socially neutral, completely at your service.

Thank you for allowing me to be part your “team”. Please know that I love my career, and I feel privileged to have had the opportunity to speak into your parent’s life, even if only as an interpreter. A reassuring glance; a smile, a hand squeeze….these are the things people remember. If I incorrectly conjugated a verb in Bulgarian, I beg your pardon. And I thank you for your indulgence in accepting my assistance as a linguist on your parent’s team.

I value every one of you.


Marie O’Toole

Bulgarian – English  Interpreter

“Unë i Kam Pasur Flokët si të Tutë”

Nga Marie (Notcheva) O’Toole

hair_albLexoni në anglisht ketu.

Në karrierën time si përkthyese në mjekësi, një nga vendet ku kam punë çdo javë është një spital shumë i njohur i kancerit në Boston. Me një arredim të bukur të brendshëm dhe një staf të dashur e të mirëtrajnuar për të ruajtur dinjitetin e pacientëve, ai të jep më tepër ndjesinë e një hoteli me 5 yje, sesa të një spitali. Kjo bëhet qëllimisht: kanceri është një sëmundje e tmerrshme, sinonim me vuajtjen dhe, çfarëdo mase rehatie që u ofrohet pacientëve dhe familjeve, është hartuar për t’i ndihmuar që t’i largohen atij tmerri.

Dhimbja që kanceri shkakton nuk është vetëm fizike.

Kati i kemoterapisë

Jo shumë kohë më parë, isha ulur në një pavion te kemoterapisë me një pacientin tim (një burrë i moshuar nga Bullgaria me një prognozë të mirë). Trajtimet zgjasin disa orë, kështu, mbasi ndihmova pacientin të nënshkruante formularin e Pranimit të Trajtimit, u rehatova si pa mendje duke parë Instagramin dhe Facebook-un në telefonin tim. Një grua e re që po merrte kemoterapi e ulur ndoshta 2-3 metra përballë meje, dukej sikur nuk po m’i ndante sytë. Nuk dukej e lumtur. Askush të cilit i futen helme në trup nuk pritet të duket i lumtur. Sa herë që ngrija kokën, ajo largonte shikimin.

Të tretën herë që ktheva sytë në drejtimin e saj, e pashë në sy dhe i buzëqesha. “Mot i çuditshëm, apo jo?”, ishte fraza e mençur që doli nga goja ime. Duke e shpërfillur komentin tim, ajo zbrazi çfarë kishte qenë duke menduar:

“Unë i kam pasur flokët si të tutë”.

Toni i saj i zërit ishte i përzishëm. Ishte vështirë të dalloje se çfarë moshe kishte, sepse kemoterapia ka edhe efektin anësor të fryrjes së fytyrës së pacientit. Të kuptuarit sa është përhapur kanceri, opsionet e trajtimit dhe pritjet e jetëgjatësisë ndonjëherë duken më abstrakte sesa humbjet e momentit, të flokëve të fertilitetit, të bukurisë fizike për gratë. Pashë e shokuar që përveç infermieres, isha e vetmja grua në atë dhomë që kishte flokë. E shoh këtë çdo ditë dhe duket sikur jam bërë më pak e ndjeshme. I shikoj pacientët si “raste mjekësore”, por nuk mundem të futem plotësisht në dhimbjen e tyre, ose në ankthin e një gruaje të re për humbjen e flokëve.

Dhe këtë doja.

E ruajta kontaktin me sy. “Më vjen shumë keq që ke humbur flokët,” i thashë. “Duhet të ketë qenë shumë, shumë e vështirë për ty.” Sytë iu mbushën me lot dhe vetëm tundi kokën. Jam e sigurt që nuk kishte nevojë t’ia kujtonin që “do të të rriten prapë” ose t’i thuhej “Oh, janë vetëm flokë!” për të njëmijëtën herë. Ishte dhimbje. Ajo kishte nevojë që dikush ta pranonte këtë fakt.

Edhe flokët e kokës suaj janë të numëruara

Si të krishterë, ne jemi kaq të shpejtë për t’u fokusuar në “gjërat atje lart” dhe në “frytet shpirtërore”, saqë është pothuajse një tundim që t’i kalosh përciptas gjërat e përkohshme (si puna e humbjes së flokëve), ose edhe të kapërcejmë shqetësime të tilla si thjesht kotësi. Por dëshira për t’u dukur dhe për t’u ndier e bukur është kaq thellësisht e ngulitur në të gjitha gratë kudo, saqë ta ulësh këtë si një vogëlsi, do të ishte e pashpirt dhe e pandjeshme. Unë besoj se ky aspekt i kancerit është më i vështirë për gratë sesa për burrat (burrat më të vjetër ndonjëherë edhe bëjnë shaka për rënien edhe të atyre dy fijeve që u kanë mbetur). Për një grua, nuk është aspak shaka. Është një tragjedi e pashoqe. Nuk është e mundur, e as e përshtatshme, të futësh me forcë një shkak të tillë hidhërimi, në kallëpet teologjike. Është shumë më e rëndësishme që thjesht të tregosh përkujdesje…, ashtu si Krishti do të bënte, dhe bën, për çdo aspekt të jetës së saj (Luka 12:7).

Dashamirësia e thjeshtë shpeshherë ndodh larg zyrave të këshillimit. Si mund ta këshillojmë një grua që hidhërohet për humbjen e flokëve të saj, apo për heqjen e gjirit? Ne sigurisht që duhet t’i ofrojmë sigurinë që ajo prapë është e bukur në sytë e Perëndisë dhe që ajo duhet ta besojë të ardhmen e saj në duart e Tij. Ka, me shumë mundësi, shumë mënyra se si ne mund ta inkurajojmë atë në marrëdhënien e saj me Zotin ndërsa përleshet me dhimbjen e një sëmundjeje (ndonjëherë drejt vdekjes). Por nuk ka nevojë të jemi këshillues (apo të dimë shumë teologji) për të ofruar atë lloj kujdesi për të cilin një grua ka nevojë dëshpërimisht në kohë të tilla.

Prova e recipetave

Të nesërmen u ktheva në të njëjtin spital për të përkthyer për një grua të vjetër që kishte humbur njërin gji. Ky nuk ishte një takim mjekësor. Ajo do të bënte prova për një recipetë dhe protezë të veçantë në butikun e spitalit. Asistentja gazmore e ndihmoi pacienten që të zgjidhte një palë recipeta të modës me ngjyra pranverore; u sigurua që gjithçka të ishte në simetri; disa herë ia përsëriti se sa mirë i rrinin. Dhe gjëja më e bukur ishte se ajo ishte krejtësisht e sinqertë. Kur pacientja i mori recipetat, filloi të qante ndërkohë duke i kërkuar falje asistentes për shenjën e saj të shëmtuar të mastektomisë. Gruaja e re fshiu lotët, e përqafoi atë dhe e siguroi që ajo ishte e bukur.

Kjo, shumë më tepër sesa testet e gjakut apo rezultatet e skanerit, është shpeshherë çfarë një grua ka nevojë të dëgjojë. Qe një moment tepër prekës, dhe përforcoi një mësim në përkujdesje që dua ta mbaj mend jo vetëm në këshillim, por edhe në jetën e përditshme të krishterë. Të gjitha gratë kanë pasigurira, dhe kur ne jemi të ndjeshme ndaj nevojave të njëra-tjetrës për inkurajim dhe siguri, Perëndia gjithmonë na jep mundësira për ta ndërtuar njëratjetrën.

Një nevojë e vlefshme për bukuri…dhe dashuri

Kaq shpesh në dishepullizim, ne jepemi kaq shumë pas teologjisë dhe “parimeve biblike” që zbatohen në një situatë (që janë kyçe, sigurisht), saqë harrojmë nevojat e thjeshta, bazë, që janë dhënë nga Krijuesi. Sigurisht që rritja shpirtërore është e një rëndësie më të lartë se pamja. Askush nuk do ta mohonte këtë, dhe është ngushëlluese të kujtosh përkufizimin e Perëndisë për bukurinë: “një shpirt i butë dhe i qetë” (1 Pjetri 3:4). Por kemi edhe lejen që të “qajmë me ata që qajnë…. të pikëllohemi me ata që pikëllohen” (Romakëve 12:15). Edhe nëse janë të pikëlluara “vetëm për flokët”, apo se kanë humbur bukurinë fizike, gratë, ashtu si dhe burrat, janë bartëse të imazhit të Perëndisë dhe dëshira për të reflektuar bukuri është e mirë, legjitime dhe, kur kanalizohet siç duhet, është një dëshirë e perëndishme. Kur vuajnë këtë lloj humbjeje personale, gratë nuk kanë nevojë për fraza apo vargje nga Bibla që janë ngazëllyese. Ato kanë nevojë për përkujdesje, përqafime, siguri që ato akoma janë të bukura dhe kanë shumë për të dhënë. Dhe ndoshta kanë nevojë për një mike që t’i nxjerrë për të blerë recipetat apo ndonjë shall të bukur.

“I Used to Have Hair like Yours”


by Marie Notcheva

In my career as a medical interpreter, one of the places where I have weekly assignments is a well-known cancer hospital in Boston. With a beautiful interior and compassionate staff, well-trained in maintaining patients’ dignity, it has more the feel of a 5-star hotel than a hospital. This is intentional. Cancer is a horrible disease synonymous with suffering, and any measure of comfort offered to patients and families is designed to help them escape that horror.

The pain cancer inflicts is not only physical.

The Chemo Floor

This week, I was sitting in a chemotherapy ward with my patient (an elderly Bulgarian man with a good prognosis). Treatments last several hours, and after consenting the patient I settled in, mindlessly scrolling Instagram and Facebook on my phone. A young woman receiving chemo, seated perhaps 12 feet across from me, seemed to be staring at me. She did not look happy. No one having toxins pumped into their body could be expected to look happy. Each time I looked up, she’d shift her gaze.

The third time I looked in her direction, I made eye contact and smiled. “Weird weather we’re having, isn’t it? A snowstorm in April,” was the wisdom that came out of my mouth. Ignoring my meteorological observation, she blurted out what was on her mind.

“I used to have hair like yours.”

Her tone was one of mourning. It was hard to tell how old she was, as chemotherapy has the additional effect of bloating the patient’s face. Staging, tumor markers, and life expectancy sometimes seem more abstract than the immediate loss–of hair; of fertility; of physical beauty–to women. I realized with shock that aside from the nurse, I was the only woman in the room who had hair. Seeing this every day causes a sense of desensitization–they are “medical encounters,” but I cannot fully enter into the pain of the patients, and the anguish of a young woman losing her hair.

And I wanted to.

I maintained eye contact. “I’m very sorry you lost your hair,” I said. “That must have been very, very hard for you.” Her eyes filled up, and she just nodded. I’m sure she didn’t need to be reminded “It will grow back” or be told “Oh, but it’s only hair!” for the umpteenth time.

Even the Hairs on Her Head are Numbered…

As Christians, we’re so quick to focus on “things above” and “spiritual fruit” that there is almost a temptation to gloss over temporal things (like hair loss), or even to dismiss them as vanity. But the desire to look and feel beautiful, or even pretty, is so deeply ingrained in all women everywhere that to dismiss it as trivial would be callous and insensitive. I believe that this aspect of cancer is harder on women than on men (older men will sometimes even joke about losing what little hair they have left). For a woman, it is not a joke. It is an unparalleled tragedy. It is not possible, or even appropriate, to force every such cause of grief into our theological mold. It is far more important to simply care…as Christ would, and does, about every aspect of her life (Luke 12:7).

Simple compassion often happens far from the counseling office. How would we counsel a woman who mourns the loss of her hair, or her breast? We would certainly assure her that she is still beautiful in God’s eyes, and that she should trust Him with her future. There are probably lots of ways we could encourage her in her relationship with the Lord as she struggles with the pain of a (possibly terminal) illness. But one need not be a counselor (or even know much theology) to extend the kind of caring a woman desperately needs in such times.

The Bra Fitting

The following day, I was back at the same hospital to interpret for an older woman who had lost a breast. This was not a medical appointment. She was being fitted for a special bra and prosthesis in the hospital’s boutique. The cheerful assistant helped the patient choose a fashionable bra in spring colors, made sure all was symmetrical, and repeatedly told her how great it fit her. And the amazing thing was that she was totally sincere. The tears came when the patient took it off, and she began apologizing to the assistant for her ugly mastectomy scar. The young woman wiped her tears, hugged her and assured her that she was beautiful.

This, more than blood test or CT imaging results, is often what a woman needs to hear. It was an incredibly touching moment, and solidified a lesson in compassion I want to remember not only in counseling, but in daily Christian life. All women have insecurities, and when we are sensitive to one another’s needs for encouragement and reassurance God always provides opportunities to build one another up.

A Valid Need for Beauty…and Love

This is not one of my more “theological” posts. So often in discipleship, we get so caught up in the doctrine and biblical principles that apply to a situation (which are crucial, of course), that we forget simple, basic emotional needs which were instilled by the Creator. Of course spiritual growth is of higher importance than appearance. No one would deny this, and it is a comfort to remember God’s definition of beauty: “…a gentle and quiet spirit” (1 Peter 3:4). But we also have permission to “weep with those who weep….mourn with those who mourn” (Romans 12:15), even when it is “just hair” they are mourning, or loss of physical beauty. Women, like men, are image-bearers of God and the desire to reflect beauty is good, legitimate and, when appropriately channeled, a godly desire. When enduring this very personal loss, women don’t need chipper-sounding platitudes or Bible verses. They need compassion, hugs, and assurance that they are still beautiful and have much to offer…and maybe, a friend to take them bra or scarf shopping.

Biblical Womenhood: Breaking Molds and Building Each Other Up

This article originally appeared on the Biblical Counseling for Women site on February 18, 2016. I do not think any other article I have ever written has stirred up the poop-storm of controversy this one has, eloquently making my point for me. My harshest critics were utterly incapable of explaining what, specifically, they disagreed with on biblical grounds. Emotional reactions and passive-aggressive non-responses from my detractors only served to better prove my point.  
Sometimes women themselves are afraid to think critically, and question whether all they’ve taught as being “biblical” truly is. How complicated legalism makes following Christ, when He has given so many and varied giftings to His daughters! 
Biblical Womanhood: Breaking Molds and Building Each Other Up

If you are an American* evangelical woman over the age of 30, chances are you have encountered at least some of the following:

  • Surprise that you cannot attend a mid-week ladies’ Bible study, because you’re at work at that time;
  • Disappointment from others that you don’t home school your children;
  • Mild feelings of inferiority because you do not bake your own bread (you tried….and failed);
  • Frustration at the poor exegesis in Bible study materials marketed to women;
  • Your husband being cornered by several men at a social gathering, who are grilling him on why he “lets” his wife work outside the home;
  • Nagging guilt because you rarely get home from work in time to drive your children to AWANA or Youth Group.

Stop the Guilt! It’s Not Biblical

Maybe you’ve even wondered at times about a “wardrobe makeover,” to better reflect how ‘biblical womanhood’ is portrayed in Christian magazines. As Elyse Fitzpatrick writes in her excellent book, Good News for Weary Women, “Many of the practices we Christian women pressure ourselves (and each other) to uphold are unnecessary and burdensome.” While drafting this article, I came across an online magazine called, Keepers at Home.  Dedicated to the idea that holy = cooking/sewing/cleaning, the site sells a Little Keepers at Home handbook “so that girls ages 4 to 6, can begin to be little keepers and future Christian homemakers!” (Emphasis mine.) Really? Do we really want to send our daughters the message that being a follower of Jesus essentially means cooking well and doing craft projects? Of course, some women love homeschooling their children, baking, and teaching Sunday School – and are good at it! These are great activities, and women who enjoy them should be encouraged.

But so should the women who don’t.

“Biblical womanhood” is an ambiguous catch-phrase which has gained popularity in recent years, often subjectively interpreted to mean “stay-at-home, homeschooling mom who sews and bakes.” As I mentioned in last week’s post, the resurgence of extreme patriarchal thought and overly-conservative gender roles is probably more in response to radical feminism than to the spirit of the Scriptures. What Christian women need to realize is that following Christ does not limit them strictly to homemaking duties, but rather frees them to embrace the unique gifts, abilities and calling He has placed on their lives. As author Sarah Bessey writes, “A man is most truly “helped” when a woman is walking in the fullness of her anointing and gifts and intelligence and strength, not when she reduces herself out of a misguided attempt at righteousness.”

‘Biblical Womanhood’ Takes Many Different Forms

To be sure, no serious student of Scripture would deny the God-ordained gender roles He has established. Nature itself, as well as both the Old and New Testament, inform us of responsibilities (including child-rearing; care of household; and spousal support). Candidly, I am a complementarian and am not arguing that women should seek to usurp their husbands, or fill a man’s role. But what is often instilled in evangelical women is that their gifts and abilities should be channeled only  into homemaking, and to seek to use them elsewhere does not honor God. This leads to needless guilt, which comes out both in the counseling room and in private. One source of depression among Christian women is feeling unable to live up to the expectations of being a perfectly ‘submissive wife’ and perfect homemaker.

This is a heavy burden to carry, but for a woman with a college degree it can be devastating – she may even be conditioned to feel guilt for having a career. Using the fine mind God has given her is a way of glorifying Him; and women need to be told this. The world needs more Christian women in medicine; in the hard sciences; and in other fields. Far from being unbiblical, God is greatly honored when His daughters work up to their highest potential. A woman can only serve God with joy if she is doing what she loves; and if she loves computer science more than doing crafts at women’s conferences, she has the freedom in Christ to pursue it. (My oldest daughter, 19, is a freshman at a secular university majoring in chemical engineering. Not only is she preparing academically for a very worthy career, but also, due to the discernment and critical thinking skills she has developed, she is able to discern the anti-God bias and unbiblical worldview inherent in any university). This is as valid a model of “biblical womanhood” as is learning any homemaking skills I have taught her.

The Balancing Act

A well-known celebrity pastor spoke at a conference several years ago on biblically-prescribed gender roles, and categorically claimed that women who pursue careers are outside of God’s will (ie sinning). His entire message was based on Titus 2:5, but he did not touch on the fact that the home can be “kept” by delegating some responsibilities, as the Proverbs 31 woman did. He cited an encounter he’d had with two female students at a Christian university who challenged his view. A law student and a medical student, they insisted they would be as good at motherhood as they would be at their perspective careers. “No you won’t,” the pastor rebutted. “The average physician or attorney works 60 hours per week. You will not be raising your children; you will be paying someone else to raise them.”

While the pastor’s point had some validity – most careers do demand long days and on-call status – it was his black-and-white thinking (and painting all career women everywhere as ‘outside of God’s will’) that was wrong. What he seemed to miss is that there are times and seasons; flexibility of schedules at certain points in careers; options to take unpaid leave. Doctors and lawyers, who are well-paid and will always have job security, have the option of cutting back on their hours during child-bearing years. One of the godliest women I know is a family physician in England. Having recently become a mother, she still practices medicine while raising her own child and being active in her church (where her husband is a deacon). Even after maternity leave ends, it is possible to pursue a career without becoming derelict in one’s duties as a mother.

Embracing Our God-Given Identity

What, then, is ‘biblical womanhood’? (Is it possible to read that phrase without an image of a long dress and head covering coming to mind?) It should be possible. Biblical womanhood means a woman, heart sold out to her King, pursuing the life He ordained for her, and her alone, to live. It means cultivating the passions and talents He has uniquely gifted her with. It means being a leader like Deborah; a businesswoman like Lydia; an instructor of her children like Lois and Eunice; and being actively engaged in charitable work like Dorcas. It can mean staying home and teaching her children full-time, if that’s her calling; it can mean becoming a nuclear physicist or isolating the cancer genome if that is the passion God has instilled in her heart. Just as there are “many members of the Body” (1 Cor. 12:12), there are many individual versions of womanhood that fall well within God’s blessing. Living up to their personal and academic potential to the glory of God is a message girls and women in the evangelical church desperately need to hear. Shake off others’ expectations (no matter how “holy” they may sound); and embrace who you – and only you – were meant to be in Christ. This is true ‘biblical womanhood’!


*Home schooling is illegal in most countries, and women electing not to be employed is not an economic option in most of the world. Even among conservative Christians, the expectation in the Western world is that women will receive higher education and pursue careers commensurate with men.

“We Need Real Textbooks” – Meet the ‘Student-Translators’ of Albania

chris-vanderzeeThis article first appeared in Magazine Way in two parts. *All names have been changed in order to protect identities. 

Marie Notcheva ©

It’s an ‘open secret’ in some Albanian universities that professors use students to translate large volumes of academic material. These makeshift textbooks are then used for the next year’s courses, often sold at a profit to the instructors. Working without pay, these student-translators are expected to produce texts from often poorly-written material in addition to their regular course of study. Refuse, and the professor may fail them for the year. The result? Textbooks that are full of errors; exploitation of already-exhausted students; and a degradation of the translation industry itself. One Tirana student is speaking out.

Last June, during university final exam season, I received the following message from “Elvis”, a third-year Tirana student in a medical field:

“Marie… said something about how important it is to correctly translate a text related to medicine. A mis-translated word in medicine is fatal. Teachers in my university tell their students to prepare projects, and that ‘project’ contains information in English. What the student must do is to translate it into Albanian. That is all. Nothing else. And they are all medical articles. What they do with these translated projects is they publish their own book next year containing this information, which these students translated into Albanian. They are just students; I am a student, and I have been told 4 times to translate medical articles from English into Albanian. Imagine how dangerous it is to translate a medical article. One mistake in medical books may cost a life. This is how it happens in Albania. All the time. You have to translate it, otherwise the teacher will fail you or remove a grade from you.”

Knowing I am a medical and courtroom interpreter in the United States, and have also accepted many translations over the years, Elvis was asking my advice on how to address the delicate, ethical issue of using untrained students to translate professors’ material – to be published under the professor’s name, usually for profit.

Without “repercussions”.

Evidently, when a university professor “asks” a student to do a “favor” not included on the course syllabus, the student is not, realistically, in a position to politely decline – if he values a passing grade.

Never mind that these students are not being paid anything for their efforts.

Not the Modus Operandi Everywhere…Yet Still a Problem

It should be noted that while instructors at certain universities do utilize student translators, and then keep records of students who purchase their books (penalizing the ones who don’t with lower grades), this is not common practice in private universities or at the University of Tirana, which has a reputation as being among the best.

“Lediana”, a third-year Finance major in Tirana University’s Economics faculty, points out that there are very good and professional-level instructors at accredited universities. She has never encountered this problem, and the incidence of using students to translate is relatively low.

“The professors who teach in the University of Tirana, Polytechnic University, Faculty of Sciences or Arts University of Tirana mainly ask some Master’s Degree candidates for translation, not the Bachelor Degree students. They ask their best students and in return give them higher grades or make them exempt from some course projects.

“I want to add that they don’t tell students what they are really doing; often they just ask them to translate 20-30 pages as a course project,” she explains.

Elvis concurs: “It is so common in [the general medicine university] it’s like a routine. Basically, that’s what we call a “project”. Imagine….most of these books I have studied might have been translated by students. It’s crazy.” His friend, a student in Durrës, notes the same problem – while she has never been approached to translate, her textbooks are full of errors. “My sister, who doesn’t even speak English, has been asked to translate some books for her teachers because they know I can do it,” he adds.

A Precedent is Hard to Break

According to “Blerta”, who earned her Bachelor’s Degree at the University of Tirana’s Faculty of Social Sciences in 2003 (and her Master’s Degree in 2006), the practice of using students to translate professors’ work was more wide-spread in years past.

“At that time, the Dean of the university, who was a professor of psychology had several published books made entirely from student translations. He would give a chapter to each, and it was considered “course work” you submit before entering the exam. You couldn’t say “no”.  Personally I liked doing it, because the extra reading helped me (also internet access was so limited), but it was difficult in terms of terminology. Once he said he would pay us $10/ page, and I planned to buy furniture at home as a gift for my parents who were paid very low rates. Of course he never gave us any money.”

She also cites numerous cases where professors gave students the option of translating for them, with the “reward” being exemption from final exams for their efforts. Across the board, however, professors are known for publishing the students’ work under their names – errors and all.

“In one case, the head of the sociology department translated a huge book, “Introduction to Sociology” by Anthony Giddens. It was around 400 pages, all translated by her students. I have read that book, and you could tell it was translated but not edited – from chapter to chapter the same term was translated in different ways.”

All of the students I interviewed for this article cited the problem of error-filled textbooks.

“Text books I have to say have so many grammatical errors! But not all of them,” says Lediana. There have been perhaps 2-3 books in the 3-year Bachelor’s program I have attended. But as I said, this is true only for the best universities. Luckily I study in the Faculty of Economics which is rated as the most fair and professional one. I have never been asked to translate anything, nor have any of my classmates. Maybe the Master’s students may have experienced that scenario, but all I have heard are words from other students or seen some really bad book translation and assume they have been translated by students.”

Several years ago, Elvis’ college, the University of Medicine (UMT), split off from the University of Tirana – bringing with it all sorts of problems. Diplomas were delayed, and when they were finally awarded, graduates found they were worthless – the university was not accredited with any educational institution. However, the biggest practical problem, according to Elvis, remains the coerced student translation – resulting in dangerously-inaccurate textbooks.

“I might have been learning many wrong concepts during all these years, because students like me translated them in order not to fail the class. Crazy people work in my school. If you read my textbooks, you will find unlimited grammar mistakes. It’s as if the whole book was run through Google Translate. It is so terrible…not to mention that there are books that they did not used “ë” or “ç” letter at all.”

In one biology textbook, Elvis said, he found over 100 mistakes in only a few pages of text. Evidently the source document was in English, and the harried student tasked with translating it into Albanian ran it through Google Translate. “Instead of saying “quhen” – ‘are called’, it was written “qihen” which means ‘are being fucked’”, he laughed.

1This is what some of Tirana’s future doctors and nurses are being given as academic material.

When Volunteerism Becomes Exploitation

 Interestingly, many of the students I have met studying in Tirana speak and write English almost on a native level. If students genuinely wish to “volunteer” their skills by translating their teachers’ books, is that really a problem?

Yes. Time constraints, pressure, technical terminology and the sheer principle – using students to do qualified, professional work which – compromise the quality of the textbooks and put students in an unfair ethical situation. The professors hold persuasive psychological power over them, and they know it.

In the United States, interpreting and translating are both highly-regulated fields, especially when legal or medical wok is involved. Although the certification process is different, organizations such as ATA (American Translators’ Association) and NAJIT (National Association of Judiciary Interpreters and Translators) exist, in large part, to ensure qualified, professional translators are providing service; to uphold a standard of ethics in the profession; and to protect the rights of professional translators. Translating 3,000 words per day is considered a very respectable day’s work (keep in mind the average textbook has over 100,000 words).

Going Rates for Translation

When I last bid for a translation project online, perhaps 15 years ago, Bulgarian translators were working for $.03/word, and Albanians for as little as $.02/word. Although there is no minimum standard wage for translations, the industry average here in the United States is between $.10 – $.12/word (although most freelancers charge more for a minimum fee when given small projects.) For large-volume translations, such as books, the per-word rate might be lower, as most professionals use software such as TRADOS to catch repetitive word recognition. Straker Translations, a firm specializing in Albanian translations with a significant online presence, charges between $.13 – .19/word, depending on language pair and turnaround-time.

By contrast, a professional translator who works in Tirana told me that (depending on textual difficulty and turnaround time), 900 lek would be considered a fair rate there (about $7.30).

Please note: Translation is real work; requiring a certain set of skills. We all like to be paid for what we do; and no one translates for free.

Unless, of course, your university professor so highly esteems your language skills that he asks you to – as a “personal favor.”

“Hello Marie,” began Elvis’s recent voice message.

“It happened again…a teacher of mine gave me a text, over 100 pages of medical information. It’s a project of an Asian student. He is using it to teach, and he asked, “Elvis, can you translate the first chapter? And then we will continue.” I actually translated those first 8 pages in about one hour, several days ago but I haven’t yet sent him the document, because I want him to realize that translation takes a while and that I’m busy. If I sent the e-mail as soon as I had the translation, he will think, ‘oh, that was quick!” Now, he is demanding that I meet him tomorrow and give him the work I’ve completed.”

The implication was that Elvis would be unable to refuse the remainder of the project, as he had already done several pages. I suggested he might refer his professor to a certified Albanian <-> English translator to take it on, either in Tirana or the United States. “Are you kidding me?” he laughed. “In Albania no one would pay for translations. It would be his entire salary…they choose Google Translator over everything.”

The quality control issue extends beyond academic texts. “Albina”, a translator who graduated from University of Tirana several years ago, told me that while she personally has not encountered students being coerced into translating for professors, she does know of publishing houses that hire students for book translation.

“This has seriously damaged the quality of foreign literature being translated into Albanian,” she said. “When people who simply ‘know English’ are hired to “translate” or “interpret”, it really devalues translation as a profession.” Elson adds, “Trust me when I say that Albanians do not hire translators at all. Not even editors. They say, ‘Oh you speak English. You can help me with something’. We reply, “But my English is not proficient enough,’ and they counter with, “That’s not a problem at all”. Elvis then qualifies his statement a bit: “Well, not all Albanians. Teachers at my school who happen to write the books and the subjects for us.”

Need for Reform

According to a student in the UMT’s pharmacy faculty, the first reform that must be made is editorial. “The head of each department should, at the very least, be checking the books for obvious errors before approving them for the students,” he said. Of course, as he added, the students should not be given material in English in the first place; but with so much of academia’s literature being produced in English, it is not feasible to expect original research to be published in Albanian at the same rate. The source texts are not the problem; the means of translation and distribution is. “I am surprised that the professors do not check the translation before using it as a final material,” Albina said. “I thought that if it is something the school needs officially, they would always hire professionals…but apparently not.”

I suggested the universities might allocate a budget for translation of necessary textbooks, to ensure quality and not put students into an unethical situation. Since the industry rate is several times lower in Albania than in Western Europe or the United States, the work would be done locally but not necessarily in-house. Master’s Degree candidates, as Lediana pointed out, might be better equipped to take on such projects, but should always be compensated for their work – from the university’s budget; not from the professor’s pocket.

Most importantly, students need to find their voice. The longer such accepted practices are allowed to continue, the more difficult it becomes to stem this sort of unethical behavior. Quality standards and principles of professionalism are hard to maintain when cash-strapped educational institutions, exhausted students and underpaid professors need to get through the day. In the end, however, all suffer from these (and similar) shortcuts. A future generation of doctors, nurses, and other profession deserves a quality education – which is, in large part, contingent upon quality translation of technical literature. The era of using students and Google Translate must end, if all Balkan universities are to be on a global playing field.

The Rolls-Royce of Macaroni and Cheese

The International Melange of Deliciousness – a hybrid of cheese culture

In my entire writing career, I have never done a food blog or posted a recipe. Not that I mind cooking – it’s just that it’s a distraction from the more interesting things in life; namely, writing. (You people have no idea how many meals I have burned while working on articles or book manuscripts!).

Food is just not all that interesting to me. It is simply a way to keep from dying. Besides, “foodie blogs”, like arts and crafts, are more the domain of perfectionist home-school moms who grind their own organic, grass-fed grain to make homemade bread and raise their own free-range, gluten-free chickens and stuff like that.

I don’t do any of that stuff because:

  1. I’m too busy doing other stuff; and
  2. Frankly, I don’t care enough to bother.


That being said, sometimes, perhaps once every 6 years or so, I astonish myself with the sheer awesomeness of something that comes out of my kitchen. Like tonight, for example. I felt inspired to make homemade mac ‘n cheese, rather than opening a box with the incandescent orange “cheese-like product” packet. But not just ANY macaroni and cheese, mind you! Oh no. This mac ‘n cheese is high-class – with Wisconsin cheddar, Swiss Jarlsberg, and Bulgarian kashkaval. It is:

The Rolls-Royce of Macaroni and Cheese

Because cheese is God’s way of letting us know He loves us, and wants us to have a nice day.

What You Need:

  • 400 g macaroni
  • 1/2 cup butter (4 Tbs)
  • 1/2 cup flour (120 ml)
  • 3 cups milk (750 ml)
  • 1 cup grated cheddar (250 g)
  • 1/2 cup grated kashkaval
  • 1/2 cup Jalsberg
  • 1/2 cup white cheese (feta)
  • 1/2 tsp salt

Now, here’s what to do: 

  1. Boil and drain the macaroni like a normal person.
  2. Melt butter over medium heat; whisk in flour. Now here’s the part where you have to pay attention to what you’re doing: while whisking flour, do NOT be watching TV, or texting your editor, or your daughter, or your buddy Dritan in Albania. The flour will burn and you’ll have to throw it out and start over; so make sure you whisk well.
  3. Pour in the milk and keep whisking it (see note above, so lumps don’t form). Add salt. When it gets thick, take it off the heat and dump in the shredded cheese, except for the feta, mixing well.
  4. Now it’s a melty, gooey cheesy mixture! Doesn’t that look good? Dump the macaroni back into the pot, and mix it all up.
  5. Now pour it into a greased casserole dish, sprinkle more cheddar on top, and bake at 350° (177 Celsius) for about 15 minutes. When you serve, mix in some Bulgarian white cheese to give it extra zip.
Happy children enjoying The Rolls-Royce of Macaroni and Cheese

You now have happiness on a plate. Adults will be happy. Kids will be happy. World hunger will be eradicated. World peace will be achieved, through the harmonious blending of an international array of cheeses. Your taste buds will rejoice and sing “The Star-Spangled Banner”….oh, and The Rolls-Royce of Macaroni and Cheese goes well with Chardonnay or Savignon Blanc.


The 15 Weirdest Things Patients Have Asked Me (or Asked Me to Do)

cupcakesBy Marie Notcheva ©

Let me start with a disclaimer: I love being an interpreter. I love having a career where I can combine my love for linguistics with my love for people (true confessions: I’m kinda an extrovert); and best of all, get paid for it. Getting up at 4:00 am (occasionally 5 or even 6:00 am) to fight Boston traffic is a small price to pay for the satisfaction I get out of helping Bulgarian immigrants navigate the medical and legal system, and often have some nice interaction.

My (mostly elderly) clients inspire me. Well into their 60’s and 70’s, most are working hard to learn English – often while caring for grandchildren and trying to assimilate into American culture. Their friends are in the villages back home, and they have few opportunities to talk to someone outside their immediate family.

The Interpreter’s Role

According to the ethics of our profession, “cultural brokering” is part of an interpreter’s role. (For example, when a non-translatable term finds it’s way into the dialogue between patient and doctor, part of our job is to explain it – without personal bias or subjective narrative). But in my experience (roughly 15 years, give or take) in Boston’s finest hospitals, most of the fun “cultural brokering” takes place in the waiting room.

Between me, Bulgarian-Speaking-American-Chick – and (mostly) Elderly Bulgarian Grandma or Grandpa.

Second disclaimer: I love these patients. They are adorable. Most of them have been “frequent fliers” for years, and look at me almost as a member of the family – a daughter of sorts, onto whom they can unload their burdens. I don’t mind, and enjoy listening when I can help. Of course, the bounds of professionalism prevent me from getting overly-involved in their lives; but I have socialized outside of work with several of them. (Hey, I am in my 40’s yet have many close friends in their 20’s. Why shouldn’t I gain from the experience and wisdom of a lady in her 60’s or 70’s?)

What makes it fun noting the difference in what constitutes a “polite question” (obvious to me, as someone who lived in Bulgaria for years). So today, after a week of fielding particularly weird questions, I give you The Top 15 List of some of the most bizarre (by American standards) questions my Bulgarian patients have ever asked me – as their interpreter.


1) “Can you fix my cellphone?”

Short answer: “No, I cannot. I am a linguist; unfortunately I know very little about cellphones.” (My teenage son probably could; or my husband, since he’s a telecommunications engineer…but alas; I cannot fix your cellphone.)

2.) “Honey, can you put my eye drops in? I forgot earlier.” (in hospital waiting room)

“Mr. D, I really don’t feel comfortable doing that. Here, let’s wait and let the doctor do it. We’ll be going in any minute.”

3) “Oh, your husband is Bulgarian? Nice.” (Two seconds of silence). “What does he do for profession?”

“He’s an engineer.” (Bow head; hunch over Smartphone. Pretend to do something really important while scrolling Facebook).  Brace for next question (related to #3:)

4) “What kind of car does your husband drive?”

“Uhh…it’s like…some kind of a Volkswagen. Why?”

5) “Do you live in an apartment or a house?”

“House…..out in a rural area…..probably you’ve never heard of it, it’s called ‘Rutland’ and it’s like 2 hours away from Boston…”

         5a) “Aha!! Really? And how much did your house cost? Just        asking…informationally!”

“Yeah… know, I really don’t recall. You’d have to ask my husband!” (NOTE: Only time in life I pull the “Helpless Female” routine. But it’s better than saying, “None of yer business”!)

6) “Can you pick my mum up for surgery and drive her to the appointment? And drive her home afterwards? I’ll pay you.” (Asked by patient’s adult son)

“No, sadly I cannot. I’d get fired by the hospital. It’s a little thing called “liability issues”. However, I’ll gladly call a taxi for her.”


Bulgarians are endlessly fascinated by the topic of religion, despite the fact that relatively few of them believe in God. Discussing religion doesn’t hold the same social taboos as for Americans. Still, I’ve had some wonderful discussions as a result of inquisitive thoughts.

7) “Dr. K….is he a Jewish doctor? Because I’ve heard all the best doctors in America are Jewish!”

 8) (Closely related to #7): “What do you think this doctor is, by nationality?”

(Patient’s adult daughter, dying of embarrassment): “Mama! You don’t ask such questions in America!”

9) “Marie, Are you Bulgarian Orthodox?”

“No I’m not – but thanks for asking! Isn’t it wonderful what the Lord has done for us?” (Not a joke, by the way. On occasion, a patient will ask me about my family’s church, faith, and religious practice and I am happy to share when asked. Knowing I am a Christian, I have even been asked by terminal cancer patients to pray with them, which I count as a precious privilege. But many times, religion is simply a topic of curiosity.)


10) “How many children do you have?”

“Four.” NOT a weird or personal question…but it leads to all kinds of sub-questioning, such as:

11) “Why are you so skinny if you’ve had four kids?”

I get different variations on this one a LOT. Just this week, on Monday- Macedonian grandmother (approvingly): “Ahhh…you have fixed yourself! You look good.” (Balkan grandmother code for, “You’ve gained weight and look better.”)

On Tuesday – Bulgarian grandmother (incredulous): “How are you so skinny? I don’t eat, yet I am fat. You must not eat at ALL.”

Disclaimer 3: Yes I eat; yes; my weight has been stable for 2 decades. No need to worry about me, thanks for your concern!

12) “Do your children speak Bulgarian?”

Seemingly innocent question, but it is loaded with judgement. What if they don’t? Actually, the younger ones don’t. We taught them Cyrillic after they learned to read in English, but guess what – American public education and all else being equal – we had to teach them more important things (although agreed; knowing another language is a highly valuable skill).

When our younger son, Stefan, was in AWANA, at age 7, he won an award for memorizing the most Bible verses (38!) in his age group. (By the way, I didn’t care then and I care even less now.) But can your grandson do that? No? Then I rest my case.

13) “Who takes care of the children when you’re at work?”

I smile sweetly, because I know where this is going. “I take care of them. You see, my husband and I managed between us until they were all in school, and now that they’re big…well, they all help out. My 9-year-old daughter is learning to cook!”

Not the expected answer, because most of my patients are here in the United States to care for their grandchildren, 24/7. The idea of a working mom taking care of her own children – without the assistance of a live-in “Baba” (grandmother) – is something alien to them. Still, I greatly respect and value their experience, input and wisdom in childrearing, as they are far more experienced than I.

And tired. They are much, much more tired from raising their grandchildren than I am from managing my household.


Much like religion, Bulgarians candidly discuss issues of a political bent without the American straight-jacket of etiquette prohibiting this. I personally have never been offended by this and find it quite enlightening.

14) “So, did you vote for Obama?”

“No.” (Awkward silence.) I use the silence to keep scrolling Facebook.

15) “What does your husband think of Obama?”

I have actually been asked this several times, and I don’t know if (perhaps) the expectation is that if A) he is Bulgarian; then B) he must be a liberal; but the reality is vastly different. My (very much Bulgarian) husband is also a Christian, politically conservative, with common sense in spades. His answer (and I quote): “There is only one thing I do not like about Obama….he is a socialist. I left Bulgaria to get away from the ‘socialists’ and their ideology. I did not like them in Bulgaria, and I like them even less here in America.”

And as George Carlin famously said,

That seems to satisfy their curiosity.”

“I Want to Sit at Jesus’ Feet….But Who’s Going to Drive the Kids to Soccer?”

Making-Time-for-God-Every-Day© Marie Notcheva

One of my favorite authors, Jerry Bridges, describes a common malady among us evangelical Christians as “Prayer Time Guilt”. In “The Discipline of Grace”, Bridges writes: “we’ve come to believe that God’s blessing on our lives is somehow conditional upon our spiritual performance.”  We’ve been taught to set time aside for regular Bible reading and prayer, and we want to do this – it’s how we get to know God better.  The problem comes in when we grow so busy that we just don’t do it. Forgetting that our relationship with the Father is irrevocable and depends on His faithfulness, rather than ours, we feel guilt and anxiety over not keeping up our end of the bargain.

We women know how challenging it can be to go to work every day, raise a family, keep the household running smoothly, and spend time with God. There do not seem to be enough hours in the day, and yet if we neglect reading the Bible and praying, we will not grow spiritually. Every Christian woman knows this, and most of us feel guilty for failing in this area.

I like the idea of giving God the “first fruits” of my day. It seemed to work well enough in university when I was a new Christian – my first class wasn’t until 8:30 am. I would get up, shower, spend time with God and go to class before gymnastics practice. This was my life. It was all so linear; so predictable.

Then I got married, had a family, and life got more complicated.

“Anxious and Troubled Over Many Things….”

Several years ago, God taught me a lesson about spiritual apathy. I accepted a large, technical Macedonian translation from a British agency. The unrealistically tight deadline made it necessary for me to sub-contract most of it out, and consequently I spent as much time proofreading and revising as I would have spent translating it myself. The agency kept sending revisions to my revisions, questioning both legitimate changes and errors I had missed. For eleven days, I averaged four hours of sleep per night as I tried to satisfy the client.

During this time, my younger children sat in front of the television all day; the older kids struggled through their homework unaided; and I burned several meals. My husband tried to help, but we ended up quarreling with each other. I became nervous and upset, finally succumbing to tears only when the agency short-changed me on the pay. Since I am also a full-time interpreter, driving home from an assignment one night I suddenly realized I was supposed to lead Bible study at church the next day. “Oh NO!” I thought. My Bible had been sitting unopened, for two weeks. I had neither prayed nor reviewed the week’s lesson. “Good thing it’s Romans 9 – election and effectual calling. I can teach it,” I told myself.

That was the day I realized I had a time management problem, and it was quickly becoming a spiritual problem. The peace and joy that marked my daily life was quickly vanishing, and I didn’t know what to do about it.

“…But Only One Thing Matters” (while you still serve your family)

When you are a new mother, having regular devotional time is somewhat easy. You probably won’t go to work for a few months, and babies (although they wake during the night) take regular naps. The home is quiet. You have (some) time. Add to that you’re still basking in the joy and wonder of God’s newest creation, and drawing near to Him in adoration seems to flow naturally. Like many moms, I found myself drawn back to regular devotional life after I became a parent. Suddenly, spiritual matters seem to take on a new sense of urgency. Our single most important job, as parents, is to raise up our children to know and love God. To do justice to this task, I knew I needed to be in prayer daily – not just in church on Sunday.

Then more children came, grew older, and my “job description” changed. It wasn’t just about diapers and milk bottles anymore.

Hours at work increased. Laundry became an everyday task, where once it was weekly. Talking to God was replaced by writing about Him. I tried to justify spending less time with the Lord: “The more I work, the more we can give to your Kingdom, Lord. Laundry and cooking are necessary parts of serving my family…isn’t that what being a Proverbs 31 wife is all about? Besides, writing is my ministry. I’m using the gifts You gave me to edify people. I want to sit at Jesus’ feet like Mary of Bethany did, but she didn’t have kids running around!”

Of course, God didn’t accept my excuses. I had to concede that washing machines, microwaves and vacuum cleaners didn’t exist in 1st century Judea, and somehow Martha and her sister got all the housework done while managing to feed over a dozen men who didn’t call or text ahead of time to say they were coming. The uncomfortable fact of the matter is, He gives us all the same 24 hours in a day, and we make time for what we truly desire. Susanna Wesley had 19 children, yet she communed with God daily. She would famously resort to kneeling under the dining room table, with a towel as a head covering, in order to pray in peace. This was the children’s signal that Mama was not to be disturbed. Thanks to her godly example and loving discipline, the Wesley children went on to change the world. Tenacity always pays off.

Finding Balance

Years ago, I used to spend the tranquility of the early morning to rest in God’s presence. It was quiet – I could read a passage of Scripture without being interrupted, and give Jesus my undivided attention. Being consciously aware of His love and presence made a definite difference in how I went through the day. Now, my schedule has changed – like many women, I have a very long drive to work, and much of the evenings and weekends are taken up by driving my kids to athletics. Evenings are filled with the frenzy of cooking dinner, checking homework, and household chores familiar to women the world over. If I do not spend at least some time with the Lord in the morning – even reading a single chapter of the Bible, or praying on my way to work – the busyness of the day will crowd Him out completely.

It’s a balance every Christian mother I know attempts to strike – God has given us our husbands and children as a precious gift, and expects us to invest our time, energy and love first and foremost into our families. Since He’s told us to “pray unceasingly” (Luke 18:1; Acts 1:14), praying silently while peeling potatoes or folding the laundry is a perfectly normal part of life. I have thought through biblical solutions to dilemmas while ironing my husband’s shirts. However, the consistent, disciplined pattern of devotion illustrated throughout the Bible means withdrawing from constant e-mails and crazy schedules and diligently seeking God. Spiritual growth only comes as we do that, although it seems harder to achieve during certain seasons in our life. I have gotten out of balance in the other direction, too – I remember several times, when my youngest child was an infant, getting annoyed that she would awaken and cry when I had hoped to read a Psalm or two. Realizing that Jesus didn’t mind being interrupted by a child, I saw my need to be more flexible.

Abiding in Christ

God’s blessing and sense of nearness in our lives is proportional to our obedience (John 15:9-10). Therefore, if we are walking in obedience to His Word and spending time in prayer, we are “abiding” in His love. The single biggest part of that “abiding” is our devotional life. Obedience that is motivated solely by duty, rather than love, will quickly lead to drudgery. How can we cultivate love for God if we don’t get to know Him, and how will we get to know Him outside of the Bible? Scripture is His way of talking to us – the only source of divine revelation.

In the midst of our demanding jobs, children’s schedules, never-ending housework, and even ministry opportunities (which may be a tempting substitute for “closet prayer”), it is still possible to pursue time alone with God. It may be necessary to give up other things, or even put some projects on hold for a while, but ultimately it is worth it. Just as you can’t pour out of an empty cup, it’s unrealistic to expect to be able to pour into other people’s lives unless you are being fed and encouraged at the feet of the Master.