The Dangers of Summer

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This was my most recent column in the Daily Yonder.  Unfortunately, the Yonder website is down or I’d give you a hot link.

It’s Spring now and all across the land things are bursting with life. Flowers are in bloom, yards are bright with new grass and the sun is high in the sky. My car was, for a while, covered in a thick, green coat of pollen. Carpenter bees are still turning my log-house into Swiss Cheese. It’s pretty out, the sky is blue and the days are warm. Blah, blah, blah. I for one don’t really like this time of year. And it’s mainly because warm weather brings me patients with all kinds of injuries; some of them pretty nasty.

In rural America, there are dangers that seldom occur to people in more populous, metropolitan areas. Ironically, though, rural folks often assume that life in the city is more dangerous. And indeed, murder rates are higher.

However, according to the CDC, deaths from unintentional injuries are 50% higher in rural than urban areas; https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html. These differences in death are due to several causes; rural citizens are further from necessary health care and are closer to large lakes and rivers, use dangerous equipment and firearms. Doubtless there are many factors involved in the difference.

Of course, some of the perils of rural life are just the result of living in close proximity to nature and all her deadly charms. In Spring and Summer, we encounter creatures that bite and sting. Just last year, while mowing our lawn, we must have run over yellow-jacket nests at least half a dozen times. By the end of the summer I just let the grass grow. ‘You win!’ I screamed to the little jerks, hiding in their holes. Whether it’s scorpions, hornets, wasps, centipedes, spiders or some other tiny monster, we simply encounter such creatures more in the warm months. And their various stings and bites, while rarely fatal, can cause dangerous allergic reactions. And make your spouse want to leave the area and move to a condo.

Fortunately, deaths from allergic reactions of all sorts are rare, and around 99 deaths per year in the US. https://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/death-anaphylaxis. Still, If you or your loved-ones are afflicted with such allergies, please talk to your physician about what to keep on hand; hopefully epinephrine injectors will get cheaper. And there are some other brands besides the ‘Epi-Pen’ that should be less costly. They just hurt a lot (the Black Widow) or make ugly wounds (the Brown Recluse).

Poisonous reptiles (Copperhead, Rattlesnake, Cottonmouth and Coral snakes) are also a feature of rural life in many areas. Those who ‘ooh and aww’ in city zoo reptile houses rarely have the singular delight of encountering these wonders in their own yards or whilst walking through the woods. But these creatures, while important to the eco-system, can deliver nasty wounds and in rare cases can be lethal. They’re certainly dangerous to your finances given the cost of anti-venin to treat the bites. So be aware as you go about working and playing in places where snakes are also enjoying the summer sun, or cool evenings.

Remember also that at least in the US, many snake bites occur because people are 1) intoxicated and 2) trying to mess with the snakes. And yes, ladies, this is a peculiar affliction of men that starts with ‘hey, betcha’ I can catch him!’ Actually, I have it on good authority that snakes don’t even like the taste of drunk people and would like to be left alone, thank you very much.

Now, other dangers of rural life have to do with the necessity of power-tools. In my own life, the chain-saw, weed-trimmer and lawn-mower are absolutely essential to keeping nature from simply over-running our house. But as the dear reader knows, these are things to be treated with great respect. Please use appropriate protective gear, like safety glasses, gloves, appropriate clothes and heavy shoes. Of course, those who work on highways or farms use much bigger types of tools and heavy equipment and have to be ever watchful. This is probably more true in Spring and Summer because that’s when farms are busy, roads need to be fixed, bridges repaired, pipes laid, power-lines connected, houses constructed and all the rest. God bless all those folks who make our lives better by doing hard, dangerous work on the hottest of days.

And of course, warm weather brings assorted recreational dangers. Hiking and camping are delights, but someone always manages to fall off of a waterfall or cliff-edge, break an ankle, sustain a laceration or encounter said biting and stinging creatures.
Bicyclists and motorcyclists look forward to warm months so that they can enjoy the open, dry road. But helmets really are important as is appropriate protective clothing, reflective material and good education. I’ve seen patients who left their tanned skin on 50 yards of asphalt. Nobody enjoys that.

Lakes and rivers are warm, and filled with persons who typically want to be dragged at high speed behind a power-boat while skiing, clinging to a large inflatable item for dear life, or kneeling on a wake-board. Likewise, fishermen head to their favorite spots (either in tournaments or alone for peace and quiet) and other aquatic persons kayak, canoe and raft the rivers that draw so many to rural America for vacations. All of which is fantastic! But remember to learn to swim, always wear life-jackets and follow local laws when doing all of the above.

Obviously there’s always the danger of heat exhaustion, heat stroke, dehydration and sunburn. We all have to remember to be careful to stay hydrated and remember that beer and caffeinated sodas don’t help. Also be reasonable about sun exposure and wear sunscreen to hep protect against skin cancers.

And if the gentle reader wishes to avoid painful foreign bodies and sutures, here’s another bit of advice. Wear shoes all; all the time. Simple and to the point.

Spring and Summer are glorious in rural America. But the dangers are many; I’ve only skimmed the surface here. Please remember to be safe, think before doing, follow the laws, don’t drink and boat, drive, ride, ski, pick up snakes, work with power-tools or do just about anything else. If you’re going to drink, find a chair and sit in it. That bit of advice would keep many an ER quiet all night long. Also remember that everything I said you shouldn’t do when drinking is something you shouldn’t do while taking narcotic pain medications.

I hope everyone has a great summer, free of emergencies. And that you can still be around when that first breath of cool air dips down from Canada and a proper season comes back once more.

Just please, please, be careful out there, OK?

(If you’re interested, here’s another link to a nice discussion of the unique injuries common in rural America. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448517/)

Welcome new physicians! Watch where you step…

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Today is the day that new resident physicians begin their training all across the United States.  Today, our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (OK, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.  Anxiety-filled and debt-ridden, they will embark on four to seven (or even more) years of training to make them knowledgeable, technically proficient physicians.

I will occasionally wax poetic and philosophical for their benefit.  But not today.  Today there are practical matters.  Today I want to give them a few pointers, to ease their transition into the maelstrom of post-graduate medical training.

1)  Any flat surface that holds still, is free of gross body fluids and not used as a walk-way or cook-top will serve for a quick nap.  Practice sleeping in odd positions:  sitting upright, reclining at various angles, lying sideways or with your head cradled in your hands.

2)  In my day (always wanted to say that!) we filled our fresh, white lab-coat pockets with review books, algorithms, reference manuals, scissors and calculators.  And candy bars.  You, doubtless, have a smart-phone of some incarnation, which contains all that we had, as well as the Web.  Which means, where we had to play video games in the lounge and find answers in giant, antiquated things called attending physicians and books, you can look up fun facts on hyponatremia and instantly play Angry Birds, whether you’re on rounds, in the cafeteria or hiding in the call-room, pretending you didn’t hear ‘code blue.’

3)  Eventually, you may decide the lab-coat isn’t worth it.  Don’t be surprised.  Your kids will eventually wear it for Halloween.

4)  If you keep the lab coat, what with the extra space in your pockets, carry extra candy bars.  Or protein bars, or whatever it is you crazy kids snack on these days.

5)  Watch where you step.  Trauma patients and cardiac arrests are exciting!    But there’s almost always some body fluid on the floor when the shouting is over.  Try not to get too covered in blood early in your call night.  It’s sticky and gross.

6)  You know so much.  You don’t know anything.  Keep those two ideas in constant tension.  Odds are, your command of modern evidence-based medical research is extremely impressive.  Eighteen years after residency, I can still leave you in the dust when it comes to making decisions and knowing who is sick and who isn’t.

7)  See above.  Learn, as quickly as you can, who is sick and who isn’t.  Hopefully medical school helped; but don’t count on it.  If you know this simple thing, you will know when to go for help, when to panic (or not) and what to tell your upper level residents and attending physicians on rounds.  And you will become that greatest of commodities:  useful.

8)  Look professional, develop your own style.  Be comfortable.  My friend Sherri used to wear pearls on call, with her green scrubs.  They always made her appear elegant, no matter how much pediatric vomit had been hurled her direction.

9)  Patients can be frightening.  But remember what they told you at camp, about bears, raccoons and snakes.   ‘Don’t worry, they’re just as afraid of you.’  This is kind of true.  Except patients really aren’t afraid to ask for pain medicine or call attorneys, whereas you are afraid to do anything since you can’t believe you know anything yet.

10)  You may be more frightened of physicians than patients.  But remember, the people assigned to train you are smart, capable and experienced.  And they put their tentacles in their pants just like everyone else.  Ask them questions, listen and watch.  And remember what I said above:  be useful.  My surgery resident was fond of saying, ‘Help me, don’t hurt me!’

11)  You will soon have a thing called a paycheck.  It will have a stub that shows how much the government is taking from you.  Do not be surprised.  This happens to everyone.  It’s just that you owe a lot more money than most people.   Cheer up!  Everyone expects you to be rich someday, so they can complain about the fact that your rich.  (Whether you will be or not remains to be seen.)  Remember that no matter how little or much you make, never tell a contractor or car-dealer you’re a physician.  Tell them you work in customer satisfaction, or something nebulous like that.

12)  Crazy people, even really crazy people, are sometimes terribly ill.  Pay attention.

13)  Ill people, really ill people, are sometimes very crazy.  Pay attention.

14)  Medicine is inexact.  I promise you will make mistakes. Don’t live in fear, and don’t let error define you.  No one in medicine, or law, is capable of perfection.  Except for being perfectly insufferable, of course.

15)  If you poke things that look like they are filled with blood or pus, they will explode into your face; if you tend to hold your mouth open when you focus, well you know what will happen.

16)  Scalpels really are sharp.  Pneumonia and HIV and TB and Hepatitis really are communicable.  Psychotic patients really will try to choke you.  Medicine is dangerous.  Be careful out there!

17)  Human beings are really frail, vulnerable and hurting.  Be gentle and kind whenever possible.

18)  Have fun!  Don’t think of it as residency, think of it as a chance to spend most of your waking and many of your sleeping hours in a huge, cold-building where people are dying!

19)  Everyone is proud of you.

20)  Pay attention to what the nurses say.  They aren’t always right.  But for quite a while, they’ll be right more than you are.

21)  Only three to seven years to go!  Hang in there.  Remember, it’s no different from Boot Camp.  It just lasts much, much longer.

Barbie the Zombie Cat Walks the Day

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Barbie the black cat has lived with us some ten years or more.  A transgender cat ahead of his time (and through no actions of his own), he was a Christmas present to our daughter Elysa in a season when cats were few and far between (an unusual situation to be sure, given the reproductive tendencies of cats).  Elysa wanted a girl cat, but only a boy cat was available.  He was named, therefore, Barbie. That was during our daughter’s ‘Barbie phase.’  Since that time, Barbie has been the subject of any number of debates over pronouns.  He?  She? Him? Her?  Maybe if we had had the currently vogue zie or zir, it would have been eaZier.

At any rate, Barbie came with a matching cat, a brother gray with white paws, who was named Socks.  He belonged to Elysa’s brother, Elijah.  Socks, like Barbie, was extremely devoted to his child-master and often slept the night standing guard at the head of his bed.

Socks, alas, had a propensity to wander through open doors.  Once we found him in our woods, high in a tree and calling out in his most pitiful cat voice for rescue.  Jan talked him  down and ultimately he returned.  Several years ago, he wandered out again and was not recovered.   We mourn Socks to this day, good egg that he was.  We hold to the hope, faint as cat whiskers, that he will return one day, king of the forest, with the look of one gone on extended adventures.

Barbie, however, lives on.  And on.  Barbie has likely burned through at least nine lives and perhaps nine more.  You see, Barbie’s teeth fell out years (and years) ago. He/she has claws like well-honed sabers, but not a tooth to be found.  I dreamt, one night, that her/his teeth had grown back.  But it has not happened.

Some time ago we noticed that Barbie was losing weight.  Pick him up and he was a furry bag of bones, purring loudly but a wisp of a kitty.  A trip to the vet, with fears of cancer, feline AIDS, leukemia or worms, and I was informed that our cat was hyperthyroid.  That’s right, Barbie burns through calories fast enough to make a Sumo wrestler anxious about gaining weight.

As a consequence, Barbie is on medication.  Every day we shove a pill down his toothless gullet and he purrs like a madman as we do.  But because of his endless calorie burning, he learned long ago to eat.  And eat.  And eat. He eats non-stop.  Downstairs in the morning?  He sees humans and paws the glass back door frantically, as if to say, ‘Hello!  Hyperthyroid cat here!’  Jan has said we should put little cleaning pads on his paws and we’d have sparkling windows.

I feed him, we feed him, multiple times a day.  Cat food and scraps, all day and all evening, and still an open door leaves him frantically running for the house.  His ability to juke between human legs and come inside is the stuff of soccer legends.  His co-cats (later arrivals, half-Manx maniacs named Leo and Frodo), have no trouble gaining weight.  But they have learned the frantic food pursuit from Barbie and as soon as he begins to panic, so do they.  Despite the fact that together they could probably take down a deer.  (If you’ve had a Manx, you understand.)

So we have a cat of some 11 years at least, who lives in the yard and on the porch of a house in the South Carolina Blue Ridge foothills.  He is surrounded by any number of creature would should by all rights have eaten him by now.  (He is guarded by five dogs of increasing sloth but who still bark and smell doggish to predators.)   Said cat is nearly weightless and fully toothless.  And yet, he remains.

I think, sometimes, that he stays for Elysa. She is a rising junior and they love one another. Perhaps, he waits for his brother.  Maybe Socks said, ‘wait here, I’ll be back,’ and went to a foreign land to hunt mice and get rich.  Maybe he’ll bring back cat dentures of gold and diamonds.

We theorize that he has a happy dementia.  Some of us have postulated that he is actually dead, or the Walking Dead.  A cat who passed years ago and simply forgot to die.  Barbie the Zombie Cat sounds like a B-rated horror movie to be sure.

But utimately, Barbie is just a reminder that life is good. No matter what nature throws at him, he rolls with it.  He is full of joy in his few small joys.  A bit of turkey, a cup of milk, a bowl of cat-food or even his medication and he is dancing on cat toes, tail high and happy.  But a little cradling in Elysa’s arms and he purrs like he has loudspeakers.  Hold him and he reaches up with his blade-embedded paw, not to strike but to caress as surely as any human ever touched another.

Life is hard, for people especially but also for the small creatures of this world.  But we should all be as satisfied, as joyous, as Barbie the hyperthyroid, toothless Zombie cat.

Long may he purr.

 

The Canine Pain Verification Team

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We’re all familiar with the dogs used by the blind, and more recently with dogs used to comfort those with PTSD. There are even dogs that identify low blood sugar in diabetics!

What I want is a ‘pain scale dog.’  Physicians who treat pain in the emergency department and elsewhere are often confused and frustrated by the pain scale, by its inherent subjectivity and by the abuse to which it is subject.

That’s why I want the Pain Verification Dog.  Let me illustrate.

21 year-old-patient presents to emergency department ambulatory.  He is healthy appearing but grimaces, saying ‘I pulled it at work.’

Me:  ‘What’s your pain scale, sir, if zero is no pain and ten is the worst pain in the world?’

‘It’s a twelve!  No kidding, maybe a 15!’

Me:  ‘Nurse, call the Canine Pain Verification Team!’ Dog enters room.  ‘I repeat sir, what’s your pain scale?’

‘Now it’s a 20!  I have to have some, what is it, it starts with a D and it’s all that ever helps!’

Me:  ‘Sir, that’s Axon. He’s highly trained and very sensitive to pain scales and he feels that you may be overestimating!’

‘Dude!  Get that dog off me!  I’m serious!  OK, OK!  It’s, it’s a ten!’

Me:  ‘Sir, I appreciate your situation; but Neuron disagrees.  What do you think?  Is it really a ten?’

‘I’m serious, I’m scared of dogs!  My back hurts and this is making it spasm!  OK, OK, it’s, it’s maybe a three, OK?  A three!  Can I get a Tylenol or something!’

Me:  ‘Sir, the pain scale dog team leader, Decem, says “good boy!”  Here’s a list of exercises and an Aleve.’

Now those are useful service dogs!

 

Good Fathers are the Ultimate Safety Net.

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This is my latest column in the Greenville News, published Father’s Day. Dads, we’re relevant at every point in our lives as fathers!  And even beyond…

http://www.greenvilleonline.com/story/opinion/2017/06/16/good-fathers-ultimate-safety-net/381733001/

This Father’s Day is a good time to remember that we fathers sometimes drive you kids crazy. We hover. We give unsolicited advice and undesired help. We say things like, ‘nothing good happens after midnight,’ or ‘please be careful out there!’ We view your love interests with suspicion, even if we greet them kindly.
Sometimes, we load your car with stuff you don’t want. A box of tools we think you might need or food you used to love (even if you don’t anymore). We keep your things for the sake of nostalgia, long after you have forgotten them.
We try to intervene when you’re in trouble; by calling your teacher or posting your bail. We would stand in front of you if you were being attacked by a bear or insulted by a stranger.
We are hard-wired to teach and protect you. We want you to succeed and be independent. But this desire lives in dynamic tension with our deep, aching hope that you will still need us all your lives.
For all of this and more, you should love and honor your father today. He has worried about you, hoped or prayed for you and provided for you for years. The slightest hug and kiss, the minimal ‘thank you’ note, the kind word of genuine appreciation, these are our paternal treasures.
But dear fathers, let me now reassure you that you are always relevant to your young. This is obvious when they are small, and bring you cards scribbled in crayon, clamber onto your lap for comfort in a storm, or hug you to ‘pop your head off.’ When they cling to your hand in crowds, ask you to read puzzle books for hours, or say ‘I love you big more.’
Over time it’s harder to know. The children become busy shedding their old selves, and some of their old emotional displays, so that leaving is easier. But you are always in their hearts.
You see, brothers, even when the toys are packed away, the videos taken, the photos saved, the tassels moved, the rings exchanged, the cars packed for leaving, the apartments and colleges and careers and deployments accomplished, you fathers, all of us fathers, still have things to do.
We can model love by showing them that our love for them is not contingent on their presence, their gifts, their cards; even their acknowledgment. This is love, that persists and simmers even when it is ignored, and is ever ready to rise up like a hot fire in times of need.
We can stay with their mothers. We can show them that marriage is about raising children, but also more than that. That the love that made them is the love that remains. That as long as we live, we are a unit; mom and dad, deeply in love with one another and with our progeny.
We can show them the power of purpose. That whether in work or retirement, life has meaning and joy, especially in service. That age need not be empty or dull. We can work, and volunteer, and give ourselves for the good of others so that they learn the lesson by watching, and one day emulate us.
We can give them, in our words and actions, the powers of a personal faith so that they can deal with loss, struggle, mistakes and suffering long after we exit stage left. And so they know that in a great, wide universe that there is meaning, forgiveness and redemption.
Finally, as regards our inevitable exits, we can show our children what it means to grow weak, and sick, and then to die, with grace and honor. This is the last lesson we can model for them, but one of the most vital. We can teach them, if we believe it, that there is reason for hope beyond this life, and reason to live this life well to the end. Others, who do not believe, can teach them that to look back on the good of their lives, and to know that their love and memory will live on in the lives of others they have touched.
In so doing, we not only teach them, we protect them from terror and despair when life’s final darkness passes over.
Children, love the old man and remind him of his importance. But dear old men, dear fathers, never for a second think that you no longer matter. You matter to the end and beyond.

Graduation, When we Shoot Arrows at The Enemy

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http://www.greenvilleonline.com/story/opinion/2017/05/25/its-time-launch-our-arrows/343820001/

We have a quiver full of arrows in the house. Over and over again, the kids and I have used the target arrows it holds. Many of the arrows are worn and dinged, and some fletchings have come loose. (I have no idea how many rest beneath the grass or are stuck into trees in the woods.) The remaining arrows are sentimental to me, but still see use now and then as the mood strikes us.
Since yet another of my children prepares to graduate high school, I found myself thinking of Psalm 123: that says ‘like arrows in the had of a warrior are children of one’s youth. Blessed is the man who fills his quiver with them.’ Jan and I are about to launch another ‘arrow.’ But not at a target. Our son Elijah is being launched into the great battle of life. And as I heard a preacher once say regarding that passage, ‘what do you do with an arrow? You shoot it at your enemy.’
I am unapologetic about the martial metaphor. We live in a time of conflict, contention and danger. And no matter what one’s political, cultural or spiritual alignments, the fact remains that our children go forth into difficult times.
There are physical dangers, of course. The cowardly murders in Manchester, England remind us that violence lurks in the world and no amount of lovely colored buildings or candlelit, hug-filled marches will impede those who find its use expedient.
Cruelty is timeless and knows no borders. Slavery is still widespread, in the world at large and even in the US in the form of sexual and financial exploitation. Women of every race and creed are treated horribly in many lands. Globally, children die of starvation, dehydration and assorted diseases that we can easily manage in even the lowliest American hospital.
War continues to raise its endless Hydra-head. Gang violence robs necessary, beloved young people of their potential and their lives. Domestic violence and child abuse are rampant; especially in SC, sadly enough. Addiction is an entire war in itself, demanding aggressive action to save lives and families.
There are also political dangers. On both sides of the political aisle, there is fear that the glorious traditions and safeguards of the Republic may be imperiled. Each thinks the other is wrong. But each is concerned about something; each side has a sense of unease.
There are many battles to fight. Some compassionately advocate for equality of groups marginalized by race, gender or sexual orientation. Others battle for preservation of freedom of conscience, for the precious right to believe and act based on faith and tradition rather than cultural trend.

There are battles for abortion and against abortion, for open borders and for more regulated immigration. Climate change pits economic interests against environmental, both making important arguments for the future. Behind each lies the war of objective truth versus the cheap manipulation of spin and emotion.
Hardly a pep-talk for graduation, is it? But that’s the lay of the land. Graduation is beautiful and thrilling and all of us try to stifle our tears and cracking voices as we applaud our young people and give them hope.
But I want to give all of them, my own incredible son included, more than pretty images and vapid platitudes about ‘following your dreams.’ I want to say this: ‘It’s tough out here; we’re ready for reinforcements so get with it. Welcome to the team. Keep your heads down.’
I find that a more useful and thrilling thing than what graduates are all too often told. I want to see them launched at the problems of the world, in the full knowledge that it isn’t safe, that it isn’t easy, that they have a purpose in all the struggles and that they are needed. We need their courage, their insight, their creativity. We need their brilliance, their success, their strong backs, their loving hearts.
We live in a culture of increasing self-interest. Young and old spend too much time reflecting on their own wounds, victimization and identity politics. These things pull us apart rather than uniting us in the fray.
Dear graduates, look up and look around! Show us how to rise above ourselves and live well, how to glory in the struggle, how to win (or lose) with compassion and love, and also with ferocity and risk when necessary.
We loose you, dear arrows at the various enemies we face.
Strike true.
And congratulations, Elijah and all.

 

A Wedding is the Portal to the Mystery of Marriage

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Congratulations Meg and Tyler!

This past weekend we celebrated the wedding of our dear friends Tyler Jordan and Meg McCall.  It was an event filled with the the grace of  God, expressed in a truly perfect Spring evening, in the love of parents, friends and the blessed couple.  It was conducted in all the glorious, meticulous yet casual elegance of the South Carolina coast.  All of our children were in the wedding party (along with many other wonderful folks). I was privileged to be able to deliver this short reflection at the wedding.  Thanks to Meg and Tyler for including me!

A wedding is a beautiful thing. It is a celebration, and in life’s troubles we celebrate too little. At a wedding we smile, and cry. We laugh and dance, we eat and drink and send a new couple on their way into life. A wedding is an event where others witness and affirm our vows, in order that others may help hold us to our promises. Wedding ceremonies are much valued in our time, and we spend great amounts of time and treasure to make weddings beautiful and memorable, to make wedding dreams come true.

However, despite its beauty and wonder, the wedding is not an end in itself. It is a gateway which serves to fuse two into one. When a man and woman walk through that gateway, through that portal, they enter into a beautiful mystery.

Beyond the vows, the veil, the ring and the kiss lies previously unseen, unknown garden of their common life together. That life is a new creation waiting to be unveiled and explored, shaped and molded hour by hour, day by day, year by year over a lifetime. In so doing they are living in the spirit and tradition of Adam and Eve all over again.

St. Paul says that this is a great mystery. In Ephesians 5:31-32 he says, after a profound explanation of the relationship of husband and wife, ‘For this reason a man shall leave his father and mother and hold fast to his wife, and the two shall become one flesh. This is a profound mystery, but I am talking about Christ and the church.’ We’ll circle back to that last bit in a moment.

Here Paul uses the Greek word Musterion, which means ‘a mystery that can be revealed or discovered through God’s revelation.’

The mystery of marriage is not ineffable, because God who created it is constantly teaching us through it. It is not beyond comprehension. It does, however, require that we be committed in order that we understand its riches and metaphor. It cannot be approached tentatively, with one foot in to test the water, but all in, with all our hearts.

To comprehend the mystery of marriage we can only cross the portal, and in faith and hope and love leap headfirst into the unknown. And it is an unknown.

Dating and courting and all the time we spend together before the vows are exchanged are critical. They help us to learn who it is that we can indeed spend a lifetime loving. But something different and mystical happens when we take the plunge of matrimony. Suddenly, the world takes on a different light in the power and energy of the fusion of two into one.

Through the mystery of marriage, through the great unknown garden of life together, we learn small things. That our beloved is beautiful to us first thing in the morning and last thing at night. That our beloved is a human with frailties, failings and annoying habits, but that they are no worse than our own. We wonder, at times, why they stay with us; at others why we stay with them. And then we all laugh at the fact that we both ask the same questions.

We learn that the one we committed ourselves to is cherished and precious like nothing we ever grasped or imagined.

We learn to be humble and thankful in times of joy and gracious and hopeful in times of suffering. We learn the mystery that those words, so often spoken about richer or poor, sickness and health, take on very real meaning in the hot forging fires of life.

We learn that whatever else may fall apart, whatever else may evaporate before our eyes, whatever trials life visits upon us, if we are together we can endure.

Marriage is the first place where we perhaps truly understand what it means to love someone so much we would rather see ourselves suffer or die than have it happen to our partner.

It is hard to impress upon the young, but in a marriage properly tended, in our own small Garden of Eden, love only grows deeper and wider with every passing year, every financial struggle, every wrinkle, every illness, every success and every day, or night, spent together.

Ultimately we find that looks and wealth come and go, but as we are made more and more into one, the greatest gift is their hand in ours, their warm body sleeping next to our own. This is an ageless, timeless blessing.

This is part of the mystery. The discovery that love is not contingent. That it is not contingent on youth or beauty, success or power. That it simply grows; possibly deepest in trouble, despite how we all hate to pass through it.

Over the years and decades, we become mysteriously intertwined. We are made one by our vows, but we are transformed into one by time, by shared stories, by shared goals and struggles, by neurochemistry… for all we know by genetics as each physiology impacts the other.

If you doubt me, ask those people you know who have loved long and well. It is hard to put into words, but in marriage, in time, the things we thought valuable and desirable fade away, and we desire our beloved above nearly all.

So much so that we cannot fathom, especially in youth, the phrase ‘tell death do we part.’

But that’s where the mystery delves deeper and more wonderful. What we are learning in the mystery of marriage, as wonder after wonder reveal themselves, is that our marriage is a microcosm of the love of Christ for the church.

It teaches us to love unconditionally as he does. It teaches us to love without fail, with no term limits or expiration date. It teaches us to love when we are wounded and when we are hopeful. It teaches us to forgive and love more and more. And it teaches us that all of this is an end, THE end, in itself. We do not love for meals or laundry, for support or company. We love because in love we reach God.

And there is one more thing. This love of Christ for the church will carry us beyond. The painful mystery of separation in this life is not in our power to overcome. But it is in his power. And that is the promise.

Our love for our spouse will be interrupted one day. But it will go on for all eternity in the Kingdom of God as every tear is dried and every sorrow comforted. And in that place we will see the kind of love for all that we in our mortality took a lifetime to learn for only one.

A mystery indeed.

And today, we are witnesses as the story of wonder and mystery begins once again in these two young lives about to become one..

So let there be joy and laughter in all our hearts as we witness things far beyond our comprehension and realize that mystery is all around us today.

Mothers are People First

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Mothers are People First

This was my Mother’s Day column in the Greenville News.

http://www.greenvilleonline.com/story/opinion/2017/05/12/mothers-day/101521348/

I have been graced by a long line of mothers. I had two grandmothers who loved me dearly, and who (though they have passed from this life) remain dear to my memory. My own mother Sharon was, and remains, a wonderful woman who raised me gently and with endless help and encouragement. My mother-in-law Carma has ever been kind to me, and treats me like a son.

My wife Jan is an incredible mother, who has dedicated her life to our children, going so far as to homeschool them for many years. She is indulgent and patient with them and they are always in her thoughts and fervent prayers. She is a Godly mother like all of the mothers in my life.
Having praised these women, let me say something shocking that we forget all too often on Mother’s Day. Although we seem to have a ‘cult of mama’ here in the South, mothers are just people like all the rest of us. They are capable of love and hatred, they can be supportive and destructive. They may lift their children up or tear them down. (Both the stuff of various books and movies.) They have good and bad days, and decades. Mothers were once mere girls, then they were lovers or wives. Along the way they accumulated hopes, dreams, stories, successes, failures and wounds of their own.
Because they were not born mothers, but become mothers, they bring all of these things with them when they bear, or adopt, children. So into the wonder and chaos of motherhood they bring their humanity. And humans, mother or other, are imperfect.
These imperfect people we call mothers are often subject to some nasty treatment. Sometimes, we confine them to their maternal roles. As if all they are capable of is producing and raising kids for the future. Jobs? Degrees? Achievements? Passions? Irrelevant, as some women are subordinated to motherhood by their families, and are not encouraged to attain the full glory of the various reasons for which God put them on the earth.
On the other hand, modern society often says to moms, ‘sure, you can choose to be a full-time mother, but what a disappointment you’ll be to all of the women of the world! Career and education are so much more useful and interesting than caring for mere children! What a waste of your potential!’ As if raising human beings, loving and caring for them, were no more exciting or important than having fish in an aquarium. While ‘choice’ is a powerful mantra, the choice some women make to focus on motherhood is sometimes unfairly viewed as failure.
The third option is perhaps cruelest of all. It tells mothers to be everything. Raise perfect children, and feed them lovely, healthy meals, engage them in all activities and make them super students. Simultaneously, rise meteoric through the corporate world! Never say no to a new project, a new goal, a better job! Stay thin and beautiful and do all things as they appear in glossy magazines. ‘Bring home the bacon, fry it up in a pan,’ or else be a pathetic loser.
Mothers, meanwhile, struggle with just being people. Like everyone else they have fears and anxieties, sorrows and addictions, illnesses mental and physical. Some mothers are close to ideal, others will wound the ones they bore. Some, overwhelmed by their own troubles, simply cannot raise children, while others make it look effortless. There are those mothers who are stars in business, government, professions, athletics or other fields. And yet, all too many never have good jobs or educations. Some mothers land in jail.
The thing is, mothers are are neither gods nor angels. And it is cruel of us to expect them to be either. They will not always accomplish everything they dream of and sometimes their children will be less than they had hoped despite their best efforts. Sometimes children will be disappointed with their mothers, fairly or not. This is reality. This is life in a fallen world.
In the end, we should celebrate the many gifts and sacrifices of all mothers. Simultaneously we must remember that mothers deserve, as do their children, to be loved for who they are. And given grace despite who they are.
So love your mom this Mother’s Day! But along with dinner, flowers or the assorted gift offerings you bring, give her the freedom to be perfectly imperfect. Just like you and just like me.
Happy Mother’s Day moms!

Emergency Medicine: a Model for Unity

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This is my April EM News column.  I hope you enjoy it!

http://journals.lww.com/em-news/Fulltext/2017/04000/Life_in_Emergistan__A_Model_for_Unity_and.12.aspx

How do you define yourself? How do you describe yourself? In the past, I have tried to avoid immediately categorizing myself by my profession. I always agreed with The Little Prince:

“Grown-ups love figures…When you tell them you’ve made a new friend they never ask you any questions about essential matters. They never say to you ‘What does his voice sound like? What games does he love best? Does he collect butterflies?’ Instead they demand ‘How old is he? How much does he weigh? How much money does his father make?’ Only from these figures do they think they have learned anything about him.”
-Antoine de Saint-Exupery, The Little Prince.
Taken from https://www.goodreads.com/work/quotes/2180358-le-petit-prince

And yet, we do this constantly. Physicians especially love to divide ourselves into groups. Each group has its own characteristics. Most of those reading this (but not all) are EM docs (ER docs if you’re older), also known sometimes as ‘pit docs.’ There are internists, or fleas. Surgeons, or cutters. Anesthesiologists, or gas passers. Pediatricians, or pediatrons. Radiologists, or shadow doctors. Orthopedists, or carpenters. (I kid!) This is a natural division as our specialties are our big, nerdy fraternities and sororities. They are the places we learn to make our living, establish habits of thought and behavior, create world-views and life-long friendships.
Unfortunately, it goes much further than specialty. We are divided between rural and urban, and there are significant problems in that chasm, as physicians in urban teaching centers sometimes have little knowledge of the stark limitations of the rural setting when we call for help or transfers. ‘You don’t have a surgeon? You don’t have an ICU?’ Likewise, rural physicians often forget that even ‘the big house,’ eventually reaches capacity and can’t take transfers; and the presence of the large center (or a helicopter) is no excuse for sloppy care on the outside.
We are also demarcated by into ‘community vs academic.’ In my medical wanderings over the past few years, I have found that this is a point of contention with many community physicians. Research, treatment pathways, algorithms, check-lists and new imperatives seem to constantly emanate from academic centers and flow to the community hospital and its citizens. Community physicians, many of whom have lived through countless swings of the medical pendulum and associated policy changes, are often reasonably skeptical of the latest study, the latest rule about pain medications or sepsis protocols. They feel cut-off from what they perceive is a connection between academics and policy-makers, and they feel particularly excluded if, later in life, they have an interest in entering academia, which seems like a closed club.
Physicians are also increasingly divided by gender and sexuality, as we see various physician advocacy groups pop-up. That’s fine, I suppose, so long as it doesn’t split us further apart but serves as a source of encouragement and connection for the members of those groups. (It becomes toxic when it is used as an exclusionary tool. I was told once that my opinion in a debate was less relevant because I was a ‘straight white male.’)
However, our divisions seem to be at their worst when it comes to politics. And it’s a pity, really, because we have such potential to be models for the rest of the world. I have seen physicians argue politics in person and online. I have been part of some of those debates, and it can be very, very ugly. I have recently withdrawn from most political dialog because it wastes time, causes anger and accomplishes nothing.
But I will give this ‘opinion’ and stand by it. I’ve worked with physicians who were Christian like me, Muslim, Hindu and atheist. I have worked beside ardent progressives and hard-core conservatives who make me look like a socialist (and that’s tough to do). I have worked with physicians who were gay and straight, rural and urban, academic and purely clinical. I’ve laughed and cried with them, eaten with them, encouraged and been encouraged by them. And I’d do it all over again. Because when it comes to our job, our real job of treating the sick, easing suffering and saving the dying, all of our differences evaporate into vapor.
So identify yourself by whatever category you wish. But never forget that we can serve as a model for unity, a model for the greatness of all free people, when we do our jobs well, and do them together for the good of others.
Now, what’s your favorite food? What’s your hobby? Tell me about your wife, husband and children. Because those categories interest me more than all the rest.

Pandora’s Pill Bottle. (A poem about the narcotic epidemic)

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Pandora’s Pill Bottle

‘Patients who suffer from painful conditions
Should always be treated by caring physicians,
Who never forget to give good medications
For problems from fractures to awful menstruation.’

‘The fifth vital sign is your bright guiding light
The pain scale will lead you to do what is right,
So doctor remember to show some compassion
Since giving narcotics is now quite the fashion!’

Thus we were told for a decade or two
As patients stopped breathing and turned rather blue.
But hospitals loved their new high survey scores
And doctors were turned into pill-writing whores.

Yet things are now changing across the whole nation.
There’s blame all around and new drug regulations.
‘What were you thinking? What were you doing?’
‘How could this happen? Someone will start suing!’

In ER’s and clinics and every location
We docs shake our heads with increasing frustration.
We did what they told us despite all our fears
And Pandora’s Pill Bottle spilled out for years.

The pain scale betrayed us and caused too much trouble
The fifth vital sign is a big popping bubble.
The statistics we’re reading have left us quite nauseous.
So we’re trying new things to save lives and be cautious.

Dear doctors it’s you that must make these decisions!
Push back against administrative derision!
And when those ‘above us’ make policy errors
Stand in for the truth to prevent further terrors.