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Fearfully and Wonderfully Made, Pt. 1: The Sacramental Echo

“You formed my inward parts; You knitted me together in my mother’s womb. I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows this well.”  – Psalm 139:13-14

I watched the ceiling tiles pass overhead as the radiology nurse wheeled my gurney into the room where she would perform my echocardiogram. I remember thinking the dimly lit room felt familiar. This was my first echo and I knew I hadn’t been in this room before. But I had been in one like it. More than once, too. But when? And then I remembered—my babies.

My wife and I have four beautiful children. During the doctor visits leading up to each of their births, she and I were taken into rooms just like this one—peaceful, spacious, warm, and clean. We’d take our places—she on the paper-covered bed, me in the chair beside her, both of us wide-eyed with nervous excitement waiting for the doctor to come in and show us something we could hardly believe was possible—a live video of our unborn child kicking away in my wife’s womb.

The first time we went in for an ultrasound I remember being surprised that the equipment wasn’t larger, given the task it was built to perform. The sonogram machine stationed next to the bed didn’t look like much more than a low-profile computer cart with a few unfamiliar accessories neatly resting in their places. Surely a wonder like the one we were about to experience would require my wife to be squeezed into some sort of giant hi-tech tube. Or if not that, shouldn’t there at least be a luminous belly-shaped dome on a large mechanical arm controlled by a technician behind a wall of glass? This room had neither. There was just a computer, a display screen, a moon-shaped wand, and a squeeze bottle of warm lubricating gel.

I’ll never forget one particular visit late in the pregnancy with our first child. The doctor pressed the jelly-covered magic wand against my wife’s side and we saw our baby’s face as plain as day. We saw two eyes, a button nose, puckered lips, and wisps of hair swirling in the amniotic fluid. Next the doctor showed us tiny little legs and arms, knees and elbows, fingers and toes. Then, with a bit of flourish, she showed us the evidence of our baby’s gender. This little stranger was my son.

This was too much to absorb. A son. My son. What would he need from me? Everything. What could I give him? Not nearly enough. But there in that room, in that moment, a confidence arose in me that whatever this little boy needed I would find a way to get for him. I was going to have a son.

Everything was happening so fast I wanted to stop time. But the doctor resumed her tour of our son’s still forming body and showed us something I can even now close my eyes and see. She showed us his heart. We all stopped talking for a sacred moment and watched it fluttering away there behind his little ribs. The chambers pumped in such a precise rhythm that it had to have been made and set in motion by a master clock-maker—one little heart beating in the womb just inches away from another beating in his mother’s chest, keeping him alive. What a wonder.


Long ago Jesus said, “As the sower sleeps and rises night and day, his seed sprouts and grows and he doesn’t know how.” (Mk 4:26-27) I had no idea how my son’s heart knew to beat. But it did. It looked so meticulous yet so fragile. If it stopped, who could start it again? When did it start to begin with? Seeing my little boy’s chambers and valves keeping time to some mysterious cadence no ear has ever heard awakened a new kind of reverence in me for the Author of Life, and with God as my witness that reverence remains.


I heard the door open behind me. Someone else was in the room with me now. The radiologist came around to the foot of my gurney before saying hello. She had a kind face and a motherly way about her. She asked for my name and birthday. These were the two questions every nurse, doctor, or staff person were required to ask to make sure they had the right patient. The correct answers, of course, were written on their charts. They were also on my armband. We both had cheat-sheets.

I thought it was funny that these routine questions were two of the most profound, existential, and eternal questions one human being could put to another: “Who are you?  When did you come into this world?” But I knew she wasn’t asking for my hope and dreams here. She just needed a name and a date.

I said, “I’m Russ Ramsey and today is my birthday.”

“Really? Well, it is, isn’t it?” she said looking at her chart. “Happy birthday then. What brings you here on your birthday?”

I’d been running a fever for three weeks. For the first ten days I assumed it was a virus. But after the standard seven-to-ten day lifespan of a virus came and went, the fever remained as strong as ever. A few days later I made an appointment with my doctor but couldn’t get in for another week. When my appointment eventually came, my doctor listened to my story with a look of concern. He told me no one should have a fever that long. When he checked my vital signs, he discovered that I had a heart murmur. He asked me if I knew about it. I did. Doctors found it during a routine physical when I was in High School. Back then they weren’t too concerned. I had a misshaped valve but my heart seemed to be working fine. Overall, I was a healthy seventeen-year-old boy.

But that was twenty-two years ago. My doctor explained that it was a rather pronounced murmur and was concerned that one of my heart valves might be providing a place for a blood-born bacterial infection to grow. The human body is designed to be an inhospitable place for pathogens, but in those places where our physiology decided to break with the norm, as with, for example, a misshaped heart valve, bacteria can sometimes find a place to hang on and multiply.

My doctor sent me over to the lab to have enough blood drawn to run some cultures to see if this was what was going on with me. Those cultures came back positive, meaning I did have bacteria in my blood. As soon as he saw the results, he called and told me he wanted me to go to the ER. I needed to be admitted to the hospital because an infection like this could only be treated with IV antibiotics.

That was what brought me in to the hospital.

What brought me in for the echocardiogram was another story. In the process of going through all the tests and physician consults, my doctors—a team which had quickly grown to include representatives from internal medicine, intensive care, infectious disease, cardiology, and, to my surprise, cardiac surgery—shifted their focus from the bacteria and fever (which they were now successfully treating with IV antibiotics) to that murmur everyone wanted to hear.

My hospital was a teaching hospital—one of the best in the country. This meant I was in the hands of some of the best physicians around. It also meant I rarely if ever saw just one doctor at a time. Usually four or five of them would come in together—residents and attending physicians. They’d take turns listening to my heart—often two at a time—and almost all of them would say something like “Wow. That’s quite a murmur.” as they stepped aside to let another sortie of stethoscopes come in for a landing.

On the third day of my hospital stay, a small team of cardiologists came in to see me and broke the news that there was a possibility I might need heart surgery. If that bacteria had attached itself to my heart valve, it might have done some damage. They wanted to have a better look. That was what brought me in for the echocardiogram.


I am a pastor. I spend time tracing my way through the old, old story of God’s redemption—from the foundations of the world to where I and the people I minister to live today. I pray. I study Scripture and try, by God’s mercy and help, to communicate what’s there in such a way that it hides itself in the hearts of the hearers. I counsel people. And I administer the sacraments. A sacrament is an outward physical sign of an inward, spiritual reality. I can think of no better word to describe what happened there in that radiology lab than to say it was sacramental.


The nurse covered the wand with the warm gel, like a priest preparing the elements. As soon as she touched it against my side the sonogram screen, which up until now had been blank, filled with indecipherable swirls and streaks of gray. Then, as though coming into a clearing, we saw what we had come to see—my heart beating in real time right there on the screen. Neither of us said anything. She made some notes and took a few measurements and I just watched in amazement as it pulsed away with clock-like precision.

I could see the distinct chambers on the right side of my heart contract and relax. I watched the tricuspid valve open as my aortic and pulmonary valves shut. Then, as quickly as they shut they opened again as my tricuspid closed. This was what my heartbeat looked like. The valves worked in perfect union, each functioning in their intended role to draw blood from my lungs and send it through the rest of my body. I doubt I will ever forget the wonder of what I saw on that screen.

The radiology nurse stayed on the right side of my heart for what felt like a few minutes measuring and taking notes before moving over to the left side. That’s when I saw what had brought me in to see her. I saw my mitral valve—the valve that lets the oxygenated blood into my left ventricle, the heart’s main pumping chamber. Once the left ventricle is full, the mitral valve is supposed to close up tight to keep the blood from regurgitating back into the heart. That’s what is supposed to happen.

When we saw my mitral valve, my nurse stopped taking notes and measurements, and we both just watched it in silence. My mitral valve looked nothing like the others I had just seen. Those looked like tiny little gates opening and closing to a metronome. But my mitral valve looked like two pieces of spaghetti flapping around with no apparent purpose or design. This wasn’t right. She knew it, and I knew it too.

I said, “That’s my murmur, isn’t it?”

She kindly rebuked me. “You know I’m not supposed to read this for you. That’s for your doctor.” The force of her response was an overreaction to what she was seeing and we both knew it.

I told her, “I’m not asking you to read it for me. But you and I both know a murmur brought me here and all I’m asking you is if that’s it.”

She eased up, “Yeah. That’s it.”

“It’s sacramental,” I said as she went back to her measurements and notes.


The physical reality there on that screen told me two things: there was a problem with my heart and there was nothing I could do to fix it. I thought about the spiritual parallels. If I left my heart alone, who could say what would come of me. But to fix it I needed help, someone who understood the heart, how mine worked, how it was meant to work, what specifically in mine was broken and what of it could be redeemed.

I thought about how the Psalms say we’re fearfully and wonderfully made. Wonderfully, our bodies are filled with redundancies that keep us alive when parts of us are failing. After he had a chance to look over my echo, my cardiac surgeon told me I might as well not have a mitral valve for all the good mine was doing. My other chambers and valves were working four times harder than normal to make up for it and they were under constant pressure, stretching and squeezing to compensate. But they were getting the job done, and probably had been for years now, he said. Might for years to come too. Maybe.

Fearfully, we’re also fragile. My particular blood-born bacteria latched on to that misshapen valve and chewed it up. One doctor, while talking to me about how active I should be until surgery said, “You need to understand that the heart you have now is not the same as the one you had before you got sick.”

I said, half-joking so I could digest what he just said, “Wow. If this had happened a hundred years ago…”

“You’d die. No question.” he said, finishing my sentence.


But this is not a hundred years ago. This is today, and today I live a few miles away from one of the best hospitals in the world with a team of physicians and surgeons who have seen guys like me come through their operating rooms many times. They tell me that while it is major surgery for me, it is very routine for them in the sense that the surgery I need is one they perform often.

Still, to think that I with my failing heart can fall as I did into the hands of someone who not only understands how to fix me, but then has the courage to dare to open up my chest and do it is a fearful and wonderful sacramental thought that points me to the unmerited grace of God and reminds me that this has been done for me once before.

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