Graduation, When we Shoot Arrows at The Enemy

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.

 

Can we Change our Minds?

It’s easy to be excited about facts when they support our own opinions. It’s nice to believe that uncomfortable facts are fake. Likewise, it’s comforting to believe that everyone who disagrees with us is ignorant. When the truth is so obvious, we say, how could anyone but an uneducated bumpkin deny it? And yet, it seems that much of our knowledge is incomplete and that our deeply held beliefs may be more fragile than we imagine.
I was thinking about this recently when I listened to a podcast about evolution. It was a discussion about some events that happened last November at the venerable Royal Society in London. It turns out that some well-respected scientists think that perhaps evolution isn’t just due to ‘random mutation and natural selection over time.’
According to some researchers at the meeting, our DNA is even more amazing than previously believed. It appears that external stressors change the way plant and animal DNA works so that creatures adapt much more rapidly than we thought. This doesn’t necessarily mean evolution is wrong; but certainly our understanding of it is probably incomplete.
This poses a challenge to some beliefs that have been held in exactly the same way by scientists, and the lay public, for a very, very long time. Can we handle the change in paradigm? Could we ‘adapt’ if we suddenly found out that evolution is a bit off? After saying for years that it was a not a theory but a hard fact?
The science of medicine changes all the time. For the past 20 years, physicians in training were taught that they should never hesitate to boldly give narcotic pain medication to patients who asked for them. Because after all, ‘why would anyone mislead their doctor?’ And who were physicians to judge? We were told, ‘you can’t create an addict in the ER.’
Except, according to some pesky researchers, it appears you can. Some people can become addicted after a very short course of pain medication. They’re just wired that way. And now pain pills and heroin are killing people in staggering numbers. Our venerable, white-coat clad instructors were wrong. (What? Physicians and professors wrong? Perish the thought…) And now we have to face the facts and change our behaviors as doctors.
New, intriguing information presents itself all the time in many areas of study. The bacteria in our guts may have to do with obesity and mental health. Litter boxes may contribute to human mental illness due to a parasite cats sometimes carry. Socialism in Venezuela is a disaster. Foreign aid sometimes worsens international crises. Who knows what’s next?
But what if we discovered a slam-dunk gene for religious faith that was so powerful that those who had it couldn’t help but believe? Could their detractors still regard them as simpletons or haters? What if we learned that the absence of that gene made for equally solid atheists? How would we believers treat them? What if some transgender people really have a body dysmorphic problem like anorexia? Or that there is a genetic marker that indeed makes them identify with another gender? What if discussing it isn’t hatred, bigotry or compromise, but compassion? What if we find, someday, that the science of climate change isn’t settled?
Obviously science advances. We love that idea until it bumps into us. What do would do when science, or new historical information, or some other new finding puts our personal beliefs in question? Can we let go of our political correctness? Or religious rigidity? Can we stop calling our opponents rude names? Are we OK with new facts when they contradict ideas dear to us?
It’s hard to let go. But just as we look back on our ancestors and smile about their quaint beliefs, someone will eventually do the same to ours. It will likely be the case that we were wrong about many things in ways we could never have imagined.
As times change and knowledge grows, we should all be a lot kinder in the way we view the opinions of others and cautious in the way we view ours own. Today’s unassailable fact could become tomorrow’s flat earth. A little humility, a little willingness to open our eyes and the courage change our minds, are probably in order all around.

Back Pain, a Prisoner and a Lenten Reminder of Mercy

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She was large, and heavily tattooed.  She was in a striped uniform with handcuffs, her feet shackled. She sobbed because of her back pain.  Her life a long history of mistakes and bad choices; alcohol, drugs, criminality.  Her family, husband and children, a victim of her lifestyle, her addictions, her misdeeds.

They can’t have narcotics in jail, and in fact, narcotics don’t have much role in back pain, we’re finding.  But in jail, she lay on a thin mattress on a concrete pad.  Getting up and lying down were, she said, agonizing.

Was she lying?  Her drug screen positive for amphetamine, it was possible.  The officer with her said, ‘I’ve known her for 15 years.  This is her. Crying and moaning. But what if she really has pain?  It’s tough doc.’

It’s tough for sure.  Knowing as I did that if she went back to jail, she might really be suffering. Knowing, also, that she had a reported history of heart disease even though she was only  in her 30s.  Knowing that she would surely come back with chest pain or back pain, legitimate or illegitimate, if nothing were done.

Ultimately, after two visits, she seemed worse.  She seemed to have difficulty standing.  Her sobs continued.  Her officer and I sympathetic but worried about being tricked.  She was given pain meds and transferred for an MRI.  Maybe there was something going on in her spinal cord. Maybe a hematoma, maybe an abscess.  Who knew?

Here is the conundrum of compassion, as it were.  The compassionate will be cheated, fooled, and lied to.  This is life in the ER. This is life on earth.  The right thing is often, in the rear-view-mirror, exactly the wrong thing, as those who fool us laugh and drive away.

But we have the last laugh.  Because the right thing is just that.  The right thing.  And it’s a great lesson here in the Lenten season.  To show kindness, to give mercy, to expect to be the butt of the joke, the patsy, these are all the ‘price of doing business,’ when our business is being like Jesus.

I believe she had pain, but even if she lied to me, even if she gamed me, it’s OK.   I’m not offended.  She was vulnerable. She was wounded. She was broken.  She was a prisoner. And here’s what Isaiah, God’s prophet, said about captives and prisoners.  And notice, no mention of guilt, or of punishment deserved or earned.  Isaiah 61: 1-3

The Spirit of the Sovereign Lord is on me,
because the Lord has anointed me
to proclaim good news to the poor.
He has sent me to bind up the brokenhearted,
to proclaim freedom for the captives
and release from darkness for the prisoners,a
2to proclaim the year of the Lord’s favor
and the day of vengeance of our God,
to comfort all who mourn,
3and provide for those who grieve in Zion—
to bestow on them a crown of beauty
instead of ashes,
the oil of joy
instead of mourning,
and a garment of praise
instead of a spirit of despair.
They will be called oaks of righteousness,
a planting of the Lord
for the display of his splendor.

Jesus said the same thing at the beginning of his ministry.  Luke 4: 16-21.

Jesus returned to Galilee in the power of the Spirit, and news about him spread through the whole countryside. 15 He was teaching in their synagogues, and everyone praised him.

16 He went to Nazareth, where he had been brought up, and on the Sabbath day he went into the synagogue, as was his custom. He stood up to read, 17 and the scroll of the prophet Isaiah was handed to him. Unrolling it, he found the place where it is written:

18 “The Spirit of the Lord is on me,
because he has anointed me
to proclaim good news to the poor.
He has sent me to proclaim freedom for the prisoners
and recovery of sight for the blind,
to set the oppressed free,
19 to proclaim the year of the Lord’s favor.”[f]
20 Then he rolled up the scroll, gave it back to the attendant and sat down. The eyes of everyone in the synagogue were fastened on him. 21 He began by saying to them, “Today this scripture is fulfilled in your hearing.”

In this passage is healing and liberty.  And nobody is a ‘jailbird’ or ‘scumbag’ or ‘crook’ or ‘junkie.’  Jesus wants to offer this to all.

This Lenten season, can I do any less?  I, a captive of sin as all of us are, delivered and healed? I with blind eyes, seeing clearly thanks to my redemption?  God knows if I lie to him, if I try to trick him. And loves me anyway.

And if it takes showing mercy to the meth-using prisoner with back pain to honor the mercy I received, well it’s a small price to pay.

Edwin

Halfway Betwixt Worlds

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.

Forever.

 

 

The Christmas Gift we All Desire

My Christmas column from Christmas Day, 2016

Merry Belated Christmas!

http://www.greenvilleonline.com/story/opinion/contributors/2016/12/25/commentary-christmas-gift-we-all-desire/95788966/

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!

The Nativity in the Emergency Department; my December EM News column

Merry Christmas!  This is my December column in EM News.  The Nativity in the Emergency Department.

http://journals.lww.com/em-news/Fulltext/2012/12000/Second_Opinion__The_Nativity_in_the_Emergency.9.aspx

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.

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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.

The Questions we Cannot Answer

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My column in the December issue of Emergency Medicine News.  Merry Christmas to all and to all a good shift!

http://journals.lww.com/em-news/Fulltext/2016/12000/Life_in_Emergistan__The_Questions_We_Can_t_Answer.13.aspx

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.
Merry Christmas!

The King is Here. Merry Christmas!

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http://www.greenvilleonline.com/story/opinion/contributors/2016/12/11/commentary-king-here/95198746/

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.

Malpractice Isn’t a Sin

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!

Merry Christmas!

Edwin