A friend of mine is serving with this team. Keep them in your prayers, and consider donating or volunteering.
Alfred is 95 years old, and sits quietly in his wheelchair, rocking back and forth. His strength is gone, and his veins and tendons bulge through fair, translucent skin, stretched over muscles of long lost size and use. His greatest foe is gravity, which holds his lithe, bird-like form in the chair enough to cause sores on his hips, but only barely. It looks as if he might float away.
He remembers little, but smiles often. And his simple joys are coffee and sweets, pecan pie, banana pudding, chocolate cake These things, these beautiful, delicious gifts anchor pull him into in reality, and out of the reverie which possesses him for hours at a time as he stares out the window at passing seasons, and passing lives on the highway.
He is not bitter. Sometimes he sings, and sometimes he laughs. And she knows the name of his roommate, Jake, but forgets it weekly. He kisses the hand of his nurse, Kendra, who loves him like a grandfather and sometimes reads the Bible to him, drawing from the well-worn and underlined pages in his copy, which his children brought years ago. When the verses are read, he closes his bright, tired, grey eyes and leans back in repose, ready for the journey. But he cannot recall a word that was said; there is no need, for the are well carved into the stone walls of his mind, whether he remembers or not.
Alfred dwells, it seems, betwixt worlds. His muscles and bones, his frayed and frazzled nerves and short-circuited brain, his assorted plumbing and weary organs all remain in part, but not in youthful whole. His thoughts so scattered, his memories like abstract art, known only to the painter.
Perhaps, Alfred has already begun the journey. Maybe across the bar, there is a house where he lies asleep; or the beginnings of him, what will be fully Alfred. His memories are traveling there like files being stored. His wisdom and laughter, his busy hands, by which he farmed and worked, making and fixing, fathering and providing, and with which he cared for his dear Ruby before she went ahead. All of these pieces surely precede him and are being assembled by God’s angels, guided by the King Himself. Like bits of a great temple crossing the sea to be reassembled; but even better and more solid than before.
A shape is there, a form, a place prepared for him. All that is strong and good and well is becoming more and more real as he, every day, becomes less and less real in his room, in his chair, in his world where he sweetly greets the strangers that are his own children and grandchildren, and hugs them and kisses them with tears he could not explain, his love deeper than breath even if he does not understand it.
Do not fear for Alfred. He is, slowly and patiently, becoming more and more than we can possibly believe. He only appears to be less. He is, unseen by any of us, transforming before our eyes.
One day, Alfred will depart. He will leave the broken, failing bits of form behind, an empty shell on a beach, a shed snake-skin, old antlers. One day Alfred, finally and fully himself, will draw a deep, first, precious breath from air in a place he prayed to go, and open his new eyes on landscapes and visions and joys he could never in his best imagination hope to have. He will touch his own arms, firm and strong, and new blood flow through vessels that will never narrow. He will stand and be amazed. He will hear waves crash, or wind in trees, and the music of being truly alive at last.
And if all goes as he dreams (and it is likely his dreams are now visions), he will see God first, and his Ruby second and all the others who make the same trip and longed to see him again. And then all the journey and trouble, all the wait for finality, all the pain and loss will not only make sense, but be irrelevant to his new, redeemed, perfect life.
My Christmas column from Christmas Day, 2016
Merry Belated Christmas!
The Christmas Gift We All Desire
It’s here at last! What seemed to take forever for children arrives and passes like a shooting star for adults. But joy of joys, it’s Christmas morning! And a special morning since it’s Sunday. Families who attend worship services will, based on personal experience with small children, be up at zero dark thirty, as kids rush to the presents and the chaos begins.
Photos will be staged. (My parents made us stay in the hallway while they prepared the camera…Jan and I have since done the same, forcing children to stay on the stairs while we took our time tormenting them, they like horses headed to the barn for oats.) Families will have systems, as gifts are handed out in a manner devised to avoid wholesale riots.
Food will be prepared; in our home Christmas breakfast is bacon and cinnamon rolls. Cats will be watched carefully to avoid the climbing, and tipping, of trees. Mostly they will busy themselves with wrapping paper,licking and pretending not to be as excited as the kids. The dogs (at least our dogs) will look in through the glass of the door in puzzlement, and wait for partially eaten anything (and any chance at cat food).
Gifts will be opened, as parents and partners hope that they have given joy to those they love with this gift or that. There will be joy and squeals, hugs and kisses. Hours will be spent enjoying new items or searching through wrapping paper for batteries or lost instructions.
Those off to church will have to pry the kids away from their recently obtained treasures, or take some along. Older children will wear new clothes. Parents will fall asleep in chairs, as they were up until the wee hours wrapping, assembling items or simply enjoying the sweet wonder, the special silence of Christmas Eve. That stillness, in a dark house with tree lights, is every drop as precious as the big day itself. Personally I find a much greater connection to the whole nativity story on Christmas Eve, as if I were watching the tale unfold in a starlit lens to antiquity.
And yet. There are those families where the above is as fantastical as Santa and his reindeer. For some, for those in poverty, those with family members separated by prison sentences, those whose homes are the slave-quarters for addiction, Christmas will not look this way. Nor for those with loved ones far away in school, in work, in war. For many the separation from loved ones is the great gulf of death, and even sweet memories are painful reminders of what is no more. Still others find the day hard because of recent illness, injury, surgery, diagnosis of cancer. Our family walked through some of that too. However beautiful the wrapping paper and lights, however delightful the gifts, a pall hangs in the air and the thoughts turn to what was, or what might be, ‘if only.’
But that is, ultimately, the purpose of this day. It is not, it turns out, a day especially made for the joy of the now, nor for pets to get new sweaters, or adolescents to stock up on electronics. The joys and wonders of Christmas, from Santa to gifts, from feasts to surprise visits, are magnificent side-effects of the joy and purpose of the day. The day we remember the one born to set all things right.
The passage that I have come to most associate with Christmas (having lived life a bit) is not found in the Gospel accounts of Jesus’ nativity. It is found, oddly enough, at the end of the Bible, in Revelations, chapter 21. Dear old St. John reports:
‘And I heard a loud voice from the throne saying, “Behold, the dwelling place of God is with man, and He will live with them. They will be His people, and God Himself will be with them as their God. He will wipe away every tear from their eyes, and there will be no more death, or mourning or crying or pain, for the former things have passed away.” And the One seated on the throne said, “Behold, I make all things new.”’
That’s Jesus telling us that one day, things will be more grand than we can ever imagine; even better than our best dream of Christmas. He will meet our deepest needs and desires and banish suffering. Forever.
Now that’s a Christmas gift I can’t wait to open. Merry Christmas!
Merry Christmas! This is my December column in EM News. The Nativity in the Emergency Department.
I once wrote a story for Christmas in which the nativity happened in an old, beat-up hunting trailer behind a man’s store, somewhere in the South on a cold winter night. From everywhere and all around, rough people and businessmen and politicians found their way to it, situated as it was in a cluttered backyard of a poor but compassionate store owner. Mary and Joseph had a car that broke down, you see, and they were stuck. I doubt if it’s that original. I suspect Hallmark or someone has done this story over and over.
Yet it still resonates; it still bounces around inside my mind. I envision that cold night, and the star, and the people in my neighborhood, camo-wearing hunters and bearded bikers, the guy with the meth lab that blew up (no kidding), the men in the garage across the highway. I suppose it’s because the story fits everywhere.
As you might expect, I have this image of the manger scene set in an ED. I think back over my patients, and it makes perfectly good sense to me. I can’t decide if it’s a busy night or a slow one. But there are Mary and Joseph, maybe homeless. We do see the homeless, don’t we? And certainly the poor. “Doctor, we don’t have any money or anywhere to go. Can we stay here tonight?” We might try social work, but face it, they probably went home already. The poor are always among us.
If it’s a slow night, the nurses are stricken with a kind of magic. They fluff Mary’s pillow, and one of them (who used to do OB) notices the way Mary is breathing and holding her belly. “She’s going to deliver!” (For the purpose of the story, Labor and Delivery is full to capacity.) All of the nurses are hovering, getting ice for Mary and coffee for Joseph, who has not so much as the change to buy one.
If it’s a busy night, everyone is frantic, and when Mary says, “I think the baby is coming!” the staff roll their eyes, as if they needed one more thing between the overdoses and the chest pains, the weaknesses and the demanding daughter in the hallway insisting on endless attention for her aging mother.
But they do the right thing, don’t they? They almost always do. We almost always do. Before you can sing “O Little Town of Bethlehem,” the baby is there. He’s crying because they do that. And Mary nurses him immediately after the nurses clean him off. But the nurses, and the doctor who caught him (fumbling, frightened … he hates delivering babies), all of them are somehow breathless. The hair on their necks and arms rises up, chills run along their spines. It’s not fear; it’s wonder. Inexplicable. Another poor baby. So what? Everyone is crying. Nobody knows why. Mary just takes it all in as Joseph wraps his arms around both of them, still in the same dirty sweater, still disheveled.
Of course, there are no animals. And yet. If it’s slow, the sleeping drunk in the next room wakes and stumbles in to see. Looking down, he cries, too. He understands something so deep he can’t express it. Something he forgot about hope and love and parents and forgiveness. He reaches into his pocket, pushes $100 into Joseph’s hand, and goes to lie down again. He sleeps in lovely dreams.
If it’s busy, things suddenly move slowly. Things happen. The mumbling, confused lady with dementia (whose daughter is so demanding) speaks for a few minutes with utter clarity, and finds her way to the door of the baby’s room. She holds her daughter’s hand and laughs, and recalls the details of her own maternity. The meth addict, tweaking and rocking back and forth, sits on the floor and just watches. He is calm. He does not scratch or scream. He is transfixed by the inexorable wonder he always hoped to find in drugs, and by the possibility that he might be whole again, that he might have his own wife, child, and delight. The man dying of lymphoma, passing the room as he is wheeled up for admission, asks the nurse to stop so he can look, and the child fixes its tiny eyes on him. He still dies, but he does it in peace.
The cardiac patient’s chest pain resolves, and the febrile infant in the hall-bed (the one who looked so sick) begins to laugh, cackling, breathless laughter. His fever is gone. Only the babies can see the angels swooping round, touching, healing, encouraging.
I can imagine all sorts of things. An angry mayor, searching for the child. Or professors and priests and ambassadors looking for him later, giving him gifts.
But all I see now is the dawn. Mary is strong. She has no time to be admitted. Joseph says they have to go. They are loaded with formula and money, with snacks and blankets (and diapers). They are hugged and kissed by strangers, and everyone waves goodbye.
The next shift asks, “What was that all about?”
“Don’t know,” is the answer, “but I’m glad I didn’t miss it.”
And the chaos descends again, tempered by inexpressible hope, washed in love.
My column in the December issue of Emergency Medicine News. Merry Christmas to all and to all a good shift!
I remember the early trials of thrombolytics; not for stroke but for MI. During my residency we were still comparing tPA with Streptokinase. It was pretty incredible stuff. Now we’ve moved beyond that positively ‘medieval’ method of treating heart attacks and have advanced to incredible interventions in coronary and cerebrovascular disease. Furthermore, we are able to rescue more and more people from the brink of death with advanced medications and with techniques, like ECMO, that our medical forebears couldn’t even imagine. These days, people can say things like: ‘I had severe sepsis last year, but I recovered,’ or ‘A few years ago I nearly died of Stage 4 cancer, but here I am!’ Fifty years ago, twenty years ago, their families would have told their stories with sadness.
What we do is amazing. The science behind our saves, coupled with our training and passion, make medicine all but miraculous. I am proud of what I know, proud of what I do. I am so impressed with my colleagues. And I am often awestruck by the scientists and engineers, without whom we would be apes poking bodies with sticks (good-looking apes in scrubs, mind you).
If we could, at the end of our lives, look back at the gifts we gave to the sick and injured, we would see that they far outweigh our errors and mistakes, our losses and failures. And yet, for all our modern innovations, we have limits. We can ask and answer a constellation of questions, and we can fix untold numbers of problems. But there are questions that defy us, and problems that leave us shaking our heads.
In spite of our pride in science, and our common dismissal of all that is ‘unscientific,’ suffering remains, and we can’t answer why. Who knows this better than those of us who have dedicated ourselves to emergency care?
For all of our miraculous saves, men and women, boys and girls, still suffer horrible injuries and have cardiac arrests, fatal pulmonary emboli. They still die at the scene of car crashes. They still develop mental illness and kill themselves. Addiction still separates families and leaves parents weeping for children, lost from life or lost in the jungle of drugs and desperate lives.
Despite the extension of life we offer so many, even the healthiest men and women will, at some point, leave one another and pass away from this life. And, knowing this fact does nothing to ease the pain of the loss. The most ancient husband or wife still shudders and weeps with the loss of a spouse the way a newlywed would; perhaps more bitterly, knowing love more deeply at 85 than ever they did at 25. And yet, for all our scientific wonders, we can’t say what lies beyond this life.
What I’m saying is that for all our medical wonders, there are just questions we can’t answer, and things we can’t fix. And it is likely that our science, however wondrous, never will have that capacity.
We know it. It’s why we cry after failed resuscitations, and why we call our children when they travel, frantic to know they have arrived. It’s why every EMS tone terrifies the parents of teens and every scan of a loved one is terrifying to those of us in medicine. We can’t control the troubles of this life nearly as much as we think.
Mankind has always known this. Ancient physicians, as limited as they were, did their best and wanted more. They saw the dangers of this life, and their own incapacity, with what was likely more immediacy than we. And sick, injured humans have always known the fear of loss, the questions of suffering, the pain of death.
Into this ‘vail of tears’ we proceed every shift. This is why I often tell young physicians that they should read and understand more than medicine. I favor religious faith, natural to mankind as it is. But if they decline religion, they must have a philosophy. Or they should read great novels, stories, poetry; or reach into the depth of music for some kind of solace in this mess of the unknown.
But let me say this, now that December is here: Christmas comes to offer hope to the hopeless and answers to the hardest of questions. There are those of us who believe its message with all our broken hearts. But even those who find it a charming myth can surely see beauty in the story of God (however you perceive God to be) become man. God suffering with men and women and rescuing them. God come to give a hope of forever to humans trapped in mortality. This is especially poignant to those whose lives have been a succession of one devastating loss after another. It is comfort beyond medicine for them to believe in a God, come to forgive their wandering ways, answering them in the midst of their cutting, suicidal, self medicating cries for rescue. No pill is as good as God come to make every loss whole, and heal every pain in eternity. No resuscitation comparable to God come to die and defeat death.
The pain of this life is enormous. We try so hard, but we can do only so much. The manger in Bethlehem is, if nothing else, a beautiful story to remind us that just maybe, there is healing for the wounds that lie beyond our science. Perhaps the very dream that there is meaning, that there is hope, is a suggestion that there is more there, more here, than meets the eye.
And maybe, the manger is even more than a distant dream, more than a quaint bedtime story, glowing as it does in the chaotic night of human suffering that darkens our ER’s and trauma centers.
Whenever I see the opening scene of Lion King, when Simba is presented to all the animals of the plains, I get emotional. Not because his character is a cute, sneezy fuzzball, but because of the reaction of all of the other beasts. As the music rises to climax, and Rafiki the wise mandrill presents the future king to his subjects, the animals do something that seems decidedly ‘non-Disney.’ Certainly it doesn’t appear ‘modern.’ All of the animals on the ground, looking up at the cub, begin to growl, roar, trumpet, jump, shriek, stomp the ground and, in the end, bow down silently in honor of the newborn king of the beasts. It gives me chills every single time. The kingdom is giving honor to the king.
I get the same feeling when I read about Aragorn in Tolkien’s Return of the King. He is the suffering servant, the mysterious wanderer of many names who travels the wilderness for years, growing stronger and wiser, protecting the innocent. He ultimately confronts evil and tyranny on fields of battle before he is crowned. No longer Aragorn, he is King Elessar, the latest in an ancient, nearly lost line of nobility, returned to rightful rule at last. It is an image of joy and hope, as the King ascends the throne and all’s well with the world; or at least Middle Earth. I want Elessar to be my king too.
Just as I always loved tales of Arthur, who may or may not have existed as we have been told, I enjoy stories of the not-at-all mythical Alfred, the only king of England ever to be called ‘The Great.’ He unified smaller kingdoms into one, promoted Christianity, order, justice and education. This despite many troubles, including invading armies and a chronic intestinal illness that left him wracked with pain.
There’s just something about kingship. I know, this is America and we don’t have kings. (Well, not exactly.) But deep in my heart, I want a king. I want a good king, a just king, a holy king. I want a king I can kneel before, serve, live for and if necessary, die for with joy in my heart.
This isn’t about misplaced patriotism, or some rejection of democracy. Monarchs are perilous things. But the king I want deserves to be king. Not only is it his birthright, he has earned the crown through fire and battle. He knows his people and has gained his kingship by love and sacrifice. The king IS the country. He loves the people and wants only the best for them. The king I long for, ache for, not only lives for the country but would die for it and his subjects.
Which brings us, round about, to Christmas. Hidden beneath the camouflage of fat Santas, elves, sentimentality and commerce, Christmas is the Christian celebration of the coming of the King. Not held high, but born low. Sought by poor shepherds and wise men, also searching for a king. Feared by another king, Herod the Great. Condemned by Pilate (not quite a king but close). Born among the people he lived a most ‘unkingly’ life on earth, living his few years as a common man, who was nevertheless most uncommon. He worked, healed, taught and rebuked the great. He told his followers that he came to serve not be served. That was the model for his reign. He announced his Kingdom with a thundering whisper, like no king mankind had seen.
The prophets knew this: ‘…of the increase of His government there will be no end…’ The apostles did too: ‘Then, opening their treasures they offered him gifts, gold, frankincense and myrrh.’ The carol writers understood it. ‘Come adore on bended knee, Christ the Lord the newborn King.’ That word, lord. We use it so flippantly as just another church code-word. But the lord is the one to whom we owe devotion, the one with authority. Our ancestors in less democratic times understood. ‘Thank you Lord. Help me Lord. Have mercy on me Lord. Send me Lord.’
Christianity is far more breathtaking than its detractors, or even many adherents, realize. For it celebrates the coming of the King and his Kingdom. Same king, past, present and future. The King that puts all other kings, counsels, parliaments, presidents and ministers to shame and flight. And gives the word King it’s proper meaning for all time.
If that’s not a reason for a celebration, nothing ever was.
Dear physicians, PAs, NPs, nurses, medics, assorted therapists, techs and all the rest:
The great thing about our work is that we intervene and help people in their difficult, dire situations. We ease pain, we save lives. Our work is full of meaning and joy. However, we sometimes make mistakes. But remember, in the course of a career you’ll do far more good than any harm you may have caused.
I know this issue lingers in many hearts. I know it because it lies in mine. And I’ve seen it in other lives. I said this once to a group of young residents and one young woman burst into tears. I never knew the whole story, but I imagine there was some burden of pain she was carrying for an error she had made.
But just in case you too have lingering anxiety or guilt about some error you made in patient care, I feel it necessary to say this: neither honest errors nor even malpractice are sins. They are mistakes, born of confusing situations, fatigue, inadequate experience or knowledge, overwhelming situations, the complexity of disease and the human body, social situations, systems problems, general chaos. Born of your own humanity and frailty. Your ‘shocking’ inability to be perfect at all times, and in all situations. They do not make you evil, bad, stupid or even unqualified. (PS If you’re not actually a physician but pretending to be one, you’re actually unqualified so stop it.)
As a Christian physician I have contemplated this over and over and have come to the conclusion that God knows my inadequacies and loves, and accepts me, regardless. He has forgiven my sins. I embrace that reality every day. He forgives my pride, anger, sloth, greed, lust, all of them. But he doesn’t have to forgive my honest errors. Because they are not sins. Go back and read that again. Your honest errors are not sins.
Mind you, all of the brokenness of this world is, in my theology, the result of ‘Sin’ with a capital S. (Not in the sense of minute, exacting moral rules, but in the sense of the cosmic separation of the creation from the Creator.)
So, my mistakes, my failures are born of Sin, but are not ‘sins.’ If my mistakes, if the harm I may cause, come from rage, vindictiveness, cruelty, gross negligence, murder, drunkenness or other impairment on the job, then they could reasonably be due to ‘sin.’ But even so, those sins can be forgiven, and washed away with confession and true repentance. (Not platitudes or superficial admissions of guilt, mind you, but genuine heart felt ‘metanoia,’ the Greek for repentance, which means ‘to change direction, or change one’s mind.’)
If you are not a believer, join us! But if you aren’t interested, I love you too and want you to move forward, not burdened by unnecessary guilt. If you are a believer, and a practitioner, remember that Jesus (The Great Physician) set the bar pretty high and doesn’t expect your perfection, only your honest, loving best.
Mistakes, even mistakes that rise to malpractice, are not sins. But even if they rise to sin for reasons listed above, they are no worse than any other. Which means Jesus atoned for them as well.
Move forward in joy. You were forgiven before you even started worrying about it.
Now go see a patient. The waiting room is full of people who need you!
I posted this last year. But every year it moves me again. Merry Christmas. Of note, the author was a Catholic martyr, killed in 1595. http://www.poetryfoundation.org/poem/174450
Robert Southwell, SJ
There fared a mother driven forth
Out of an inn to roam;
In the place where she was homeless
All men are at home.
The crazy stable close at hand,
With shaking timber and shifting sand,
Grew a stronger thing to abide and stand
Than the square stones of Rome.
For men are homesick in their homes,
And strangers under the sun,
And they lay their heads in a foreign land
Whenever the day is done.
Here we have battle and blazing eyes,
And chance and honour and high surprise,
But our homes are under miraculous skies
Where the yule tale was begun.
A child in a foul stable,
Where the beasts feed and foam;
Only where He was homeless
Are you and I at home;
We have hands that fashion and heads that know,
But our hearts we lost—how long ago!
In a place no chart nor ship can show
Under the sky’s dome.
This world is wild as an old wife’s tale,
And strange the plain things are,
The earth is enough and the air is enough
For our wonder and our war;
But our rest is as far as the fire-drake swings
And our peace is put in impossible things
Where clashed and thundered unthinkable wings
Round an incredible star.
To an open house in the evening
Home shall all men come,
To an older place than Eden
And a taller town than Rome.
To the end of the way of the wandering star,
To the things that cannot be and that are,
To the place where God was homeless
And all men are at home.
(Gilbert Keith Chesterton)
With thanks to:
Not only do GKC and I share a name (my first name is Keith, as is my father’s), he is truly one of my great literary heroes. If you aren’t familiar with his work, please look it up. His biographies of St. Francis and St. Thomas are very good, and his fiction is always fun; even his serious Christian work is a pleasure. He was a great influence on C.S. Lewis. Oh, and he carried a sword cane and pocket pistol with which to defend his treasured wife. Thanks, GKC, for your gifts to us!
This is a book of columns about Christmas and Easter that I put together with the SC Baptist Courier two years ago. It’s still available and I think you would enjoy it!