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!

Kudos to the Chemists, Engineers and Factor Workers who make medicine possible

Thanks, Osler, but Kudos to the Chemists, Engineers, and Factory Workers

This is my column in the January edition of Emergency Medicine News.

 

Depositphotos_19452511_s

http://journals.lww.com/em-news/Fulltext/2014/01000/Second_Opinion__Thanks,_Osler,_but_Kudos_to_the.6.aspx

Think for a second about the most treasured drug or device in your ‘medical bag.’  Or about the procedure you find most appealing, the disease or injury you most enjoy treating.  Personally, I really enjoy doing lumbar punctures, opening abscesses, placing IO lines and applying splints.  And because I’m an emergency physician, I am duty bound to say that I love to intubate…and I do.

I also enjoy doing nerve blocks, whether dental, regional or digital.  In fact, I did my own digital block on my very painful great toe, wherein there was an ingrown nail.  I endured it for about one month, believe it or not, but ultimately I was too cheap to go to my doctor or any other doctor. So I sat down in my bathroom with my wife and kids in attendance. Just before I started, I said, ‘I don’t think I can do this to myself!’  To which my insulin-dependent son, Seth, replied ‘Are you kidding me?’  The shame worked and the needle and bupivicaine left my toe tingling for at least 12 hours.

The point I want to make isn’t that I’m good at blocks or you’re good at chest tubes or any other such window-dressing or self-congratulatory drivel. The point is this.  I may be able to do a darn good nerve block.  But I didn’t invent syringes, I don’t manufacture needles and I haven’t the foggiest idea how to make a local anesthetic.

And as proud and puffed up as we may all be at times, with our advanced techniques and our nifty procedures and tools, the plain truth is that as physicians, we stand on the shoulders of some very brilliant people.  It’s all about perspective, you see.

I am reminded of my relative incapacity whenver I’m asked to check on a sick or injured person outside the device and drug filled walls of the emergency department; at church, perhaps, or at a party.  I’ll gladly check a pulse, feel for a fracture, assess breathing and neurologic status.  I’ll happily do chin lifts and jaw thrusts and even do CPR if needed.  But in the end, I call 911, or say ‘you better go to the ER.’  Because much of what I can do, and you can do, is dependent on a whole host of tests, drugs and devices that we seldom have tucked in our back pockets at any given time.

You see, our compassion for the sick and injured and dying has been around since the first ‘physician’ knelt beside someone he cared for, and decided to stay by their side to help them.  Our diagnostics have evolved since that time.  Our medical ancestors were darn good at looking, listening, touching and smelling, then pronouncing hope or doom.  I imagine, in an age in which we are increasingly separate from the bedside, that those same medical ancestors could give us a run for our modern (increasingly inflated) money when it comes to diagnostic prognostication.  But the things we use every day to increase or diagnostic skills (labs and xrays and cardiograms and ultrasound), and the things we use to save life, prolong life and ease suffering, well those things have changed dramatically in the last century.  And we surely do need them.

So we may go on and on about Osler and Halstead and all of the other greats of medicine. But we must also nod to Roentgen and Fleming, to Pasteur and to Salk and to untold others whose research, whose attention to science, allowed the evolution of what we call modern medicine.  And it’s not just those ‘oldies but goodies.’  Science and technology have exploded so rapidly and with such complexity that we would be hard-pressed to even begin to name the countless men and women who have lifted us up in order that we may practice medicine as we do today.

Think about the Sonar researchers who gave us ultrasound.  Think about the chemists and biochemists who gave us newer, better antibiotics; and those who are now exploring antibody directed therapies.  Consider the engineers who design systems to make plastic into the life saving tubes we place in airways or collapsed pleural spaces!  Consider the dietary researchers who gave us TPN, and the brilliant folks who designed radiation therapy machines, CT and MRI!  Stand in awe of those who laboriously invented machines to count cells, and lab media to detect Troponin levels, the products of blood clots or the hormone HCG.  Nod in gratitude to those who designed, then crafted steel and titanium for fractures; and those who created tiny coils and stents to be placed in small blood vessels.  Be thankful for those who took their knowledge of the human brain and their compassion for human suffering and created the amazing pain medications we have today; so amazing people will do almost anything to have them!  As a man whose wife survived a massive saddle embolus, I’m eternally grateful to the folks who devoted years to developing thrombolytics and anticoagulants; and to those who discovered how to make the chemotherapy agents she received for her cancer as well.

But let us not be rude.  Consider all those who work in labs and factories, doing often dull and repetitive work in assembly and packaging, to satisfy our need, our desire, for drugs old and new, for needles and test-tubes, for Foley catheters and Word Catheters, for central lines and the drills to place IO lines.  And what about ultrasound?  Those machines don’t assemble themselves; and we certainly don’t put them together, do we?

Wait, there’s more!  There are those who are in design and marketing.  Those who sell and ship.  Those who track supply and try to make production more efficient.  There are untold numbers of men and women who give us the ability to ease pain and save lives.

Good heavens I could go on and on. But you get the picture.  What we do, in modern emergency medicine, is amazing and sometimes borders on the miraculous.  We have every reason to be proud.  But just as the college grad should honor the sacrifice her parents made for her, so we as clinicians must honor the gift, the effort, the brilliance and dedication of those who imagine, create and produce the very stuff that makes our work more than a series of apologies and misery.

Hats off to all of you!  And thanks for sharing your brilliance and dedication with those of us who can look our patients in their eyes and say, ‘I think we can fix this.’

Scanxiety and follow up on my wife

For all who have followed along, Jan is doing well.  For those who didn’t know, she had squamous cell carcinoma of the base of the oropharynx last year, and received radiation and chemotherapy. 

She’s doing well, eating, gaining weight, has a little saliva and pretty good sense of taste.  However, she has an insane husband/physician who hovers over her endlessly and always expects the worse.  That is, recurrence.

Tomorrow we go back to MUSC for a follow up PET scan.  I hate scans.  I have scanxiety!  I always expect the worst, despite the lack of clinical evidence to the contrary in the way she feels, acts, etc.

Cancer follow up is a terrifying thing.  Everyone who has been there understands.  I feel perhaps more terrified than when she was being treated. 

So for those of you so inclined, prayers would be much appreciate tomorrow and the next few days, so that we can have safe travel to the scan and a good report from it. 

It was a long year, and I pray God will be merciful to  us and keep us from having to go back into the abyss of treatment again.  The odds are good, but my innate physician fear is at an all time high.

I confess that this may not seem very faithful of me.  My dear friend, an atheist, even reminded me I needed to have faith.   But it’s always hard when it’s someone you love.  In particular, the woman I met at age 19, married at age 25 and by whom I have four beautiful children.

Please keep us in mind and pray for mercy!

God bless you all!

Edwin

PS  encouraging stories still appreciated, by the way.

Our gift, our calling, our sorrow (and greatest compensation)

This is my column in November’s EM News.

Our gift, our calling, our sorrow

Here’s the link if you’re interested.

http://journals.lww.com/em-news/Fulltext/2011/11000/Second_Opinion__Our_Gift,_Our_Calling,_Our_Sorrow.6.aspx

Here’s a link to the collection of my previous columns, as well.

http://journals.lww.com/em-news/Pages/collectiondetails.aspx?TopicalCollectionId=6

Thanks!

I recently sat by a man whose young wife was dying. Her cancer was taking her away from her husband and toddler. She was sleeping intermittently as the pain medication we administered did its work. Her husband’s eyes were red from crying and he could barely suppress a sob. He touched her and looked at me. I barely kept my own composure.

I wanted to avoid that room and that patient. A sick cancer patient was the very last thing I wanted to see. Of course, when I chose emergency medicine as a specialty over two decades ago, I didn’t realize that it was so much more than the excitement of trauma and toxins, cardiac arrest and assorted procedures. All those years ago the shiny thrill of lights and sirens and the delicious anticipation of drama filled my mind. Little did I know that I was entering a land of great suffering and pain, and that I would be party to, participant in, terrible losses.

I had no idea, as I looked forward to the rotor-wash of helicopters and the blood-stained scrubs that everything I wanted was associated with someone’s misery, someone’s worst nightmare. I certainly had no idea that I would care for so many people in times of pain that were less exciting, less titillating. That there would be old men saying goodbye to their old wives, or children and parents being separated. Or that I would have to learn to walk into rooms, like the one with the young man and dying wife, and have absolutely nothing to offer.

I also had no idea that ultimately, I would paradoxically have something to offer. What can I call it? Is it expertise? Is it knowledge? Neither of those describe it. Was it insight into suffering? Was it some pithy remark about loss? Hardly. When I sat by him, and put my hand on his arm, all I could say as his wife’s heart raced, as her leukemia triumphed, as her life waned, was ‘I’m so sorry.’

I’m quite certain I couldn’t have done it the same way years ago, when I was in medical school or even (to the same extent) when I was a resident. It wasn’t that I hadn’t been trained well enough, or didn’t know the right words. It was that I hadn’t lived enough, and hadn’t suffered enough, to understand how very much I meant the words ‘I’m sorry.’

Living teaches us about love if we choose to learn; and ultimately, love teaches us to live in fear of loss. Maybe fear is the wrong word. Love teaches us, I suppose, to expect loss. If we are wise, we all learn (physician or not) that pain, death, suffering and loss are things which have a prevalence of 100% in the human patient population. Some types are more common than others, and certain things strike at different ages, but none of us will avoid them in the end.

So the great gift of emergency medicine, indeed the great gift of medicine in general, is that it introduces us to loss early in life. It immerses us in the thing we fear. Like some great cosmic aversion therapy, we learn by living; or at least by living with the things that make life so difficult.

The terrible thing, the beautiful thing, is the way we can become better and more compassionate by our proximity to pain. It is, as in the title of the book by Sheldon Vanauken, ‘A Severe Mercy.’ Our position as physicians leads us to places few now dare to go. Physician poet William Carlos Williams once said, ‘I was permitted by my medical badge to follow the poor, defeated body into those gulfs and grottos.’ I learned that line long ago, and it stuck with me.

Williams’ words are nowhere more manifest than in the trauma bays, the resuscitation rooms, the conference rooms or chapels we find in emergency departments. In those places we are called to give the great gift of compassion, of love, that is developed as we use our knowledge and skills, but is not predicated upon them. It is the kind of love that sometimes can offer nothing more than presence. Or at least, the willingness, the courage, to be present with loss. It is what Paul meant in Romans 12:15 meant when he said ‘Rejoice with those who rejoice, mourn with those who mourn.’ It is love, true love, to be there; just to be there.

We live in a world where many hold forth on issues, politics, philosophy and theology. But where precious few actually go into the places of suffering and meet the sufferers. But that is our job, that is our calling, that is our gift. Not the gift we give, brothers, sisters. It is the gift we receive.

This exposure, this opportunity to touch, hold, comfort, sometimes even to heal, it’s all our greatest benefit. It is our eternal salary, a great compensation we must never underestimate or devalue.

At the end of our own lives, as someone sits by us in some far distant hospital, we will probably have forgotten all of the money and vacations, benefit packages and retirement plans. Any power or influence we attained may well have evaporated.

But thanks to the way we touched others, God willing we will be able to approach our own passing with peace. Or at least, without surprise. And we will be able to look back knowing that, whatever else we did or didn’t do, we did all we could to comfort the hurting, the dying and the grieving. You can’t ask for much more than that in a career, can you?.

Beyond the Cure

This is my column in the latest SC Baptist Courier newspaper.  Link and text.

Have a great day!

http://www.baptistcourier.com/5691.article

Beyond the Cure

By Ed Leap

Published September 15, 2011

One of the things one learns as a physician is that disease, even when defeated, leaves damage. Surgeries to repair injuries result in scars, and sometimes permanent disabilities. Radiation leaves hoarseness, pain, and its own kind of scars both on the skin above and the organs below. Chemotherapy, which can save lives, also causes miserable nausea, hair loss and effects on the immunity of its recipient.

 Edwin Leap

Even when physicians succeed in eradicating a cancer, or rescuing a victim of trauma; even when they excise or drain an infection or repair a congenital defect, there is residual. The evidence of the struggle remains.

Sin is like that struggle with disease. Each and every human, throughout history, has been afflicted by sin. Every soul in the great span that stretches out and down time, backwards through the ages and forward into the present, has known sin�s predations. For we are all assaulted by sin, infected with sin, born with its marring mutation on the perfect plan of the Creator. Its effect is pervasive. Sin causes the decay of our bodies, the dissolution and confusion of our minds, and the frustration and misery of our souls. Of course, sin is not a disease, for we are complicit in it, so it is a limited metaphor but a relevant one.

In much the same way, when we are changed by God�s grace, when we are saved, our healing occurs. When we accept Christ, the disease of sin is finished, the therapy successful. It is well represented in our baptism by immersion, our rising from death to life.

However, as with physical disease, the healing leaves marks. Even when it is expunged from us, scars remain. Even after it is removed, nailed to the cross and taken to the tomb in time and outside of time, the effects and marks of our sin may remain. A dangerous tumor is not removed without an incision An abscess is not drained without a puncture. And so, our salvation, our transformation, is not without effect, just as our sin was not.

As we move forward in faith, we are often tempted to believe that we were not made whole. When we see how easily we are tempted, when we contemplate the consequences that remain of our sinful actions (like depressions in the skin where tumors once were), we can easily hear our enemy say, like the charlatan he is, �You are not healed; you are still sick. You are not good, you are still wicked. God has no place for one like you! Unclean!�

But he is a liar, a false diagnostician, who would have us share his eternal doom � or at least wallow in his eternal hopelessness. He is beyond the cure. But our therapy came from the Great Physician, fully prepared to heal us, whereas the devil is unlicensed to practice.

Equally unprepared are we. When we assess ourselves as unlovable, unsavable, unhealed because scars and tendencies, patterns and �symptoms� remain, we must step back and look at the statistics on our cure. The salvation rate is 100 percent for those who submit themselves to redemption. (We physicians should do so well!)

Of course, it isn�t only the devil who speaks words of sickness. Sometimes we do it to one another. We judge harshly, and we fail to see the progress, however incremental, of those who were most horribly engaged with the misery of sin. They are not whole, but they are healing. They are no longer sinners, though they may sin. Their scars are fresh, their infection newly removed.

Focusing on scars may occupy us, and worry and fear may plague us, but they are worthless occupations that distract us from the wonder, the miracle of our transformation, our journey from death to life. Just as a mother whose child was snatched from death will see the child, not the wound, we must look at ourselves, and others, with thanksgiving and with blindness to those things which would cause us to doubt what transpired. For we are whole, even as we grow more in the knowledge and likeness of the one who rescued us from death.

One day our wounds will be gone. One day, the only wounds, the only scars we will ever see will be His. What a day that will be! Until then, rest assured that the marks are marks of healing, and the pains and struggles that remain do not negate our cure.

(My wife, for whom many of you prayed in the past winter, is healing wonderfully. Thank you for your intercession.)

Driving my wife to distraction

‘Are you feeling OK?’  That’s the question I ask my poor wife.  Day after day, sometimes hour after hour.

She is almost six months from her radiation and chemotherapy for oropharyngeal cancer, and from the pulmonary embolus that followed treatment.

The good news is that she is thriving.  Riding bikes, lifting weights, eating almost everything she wants and down to her college weight.  She is still a little hoarse, and sometimes still has discomfort with swallowing.  But otherwise, fantastic.

The bad news is that her husband (that’s me) is largely, how shall I put it, crazy.  Yep, that’s me.  I’m crazy with anxiety.  Crazy with memories of those dark days.  And even though I know, day to day, how well she is, I do what every good emergency physician invariably does;  imagine the worst possible complication or outcome.

As a physician, that skill helps me not to miss heart attacks, meningitis, strokes, ruptured spleens and dozens of other eventualities. As a husband, it makes me really, really annoying.

And as a Christian, it sometimes makes me seem quite faithless.  The scriptures are clear.  ‘Do not worry about anything,’ it says in  St. Paul’s letter to the Philippians.   Everyone, from God the Father to God the  son to angels, patriarchs and apostles says, repeatedly, ‘Fear not!’  In fact, it’s the most repeated command in the Bible.

However, I wallow in fear.  I don’t care for alcohol, I adore my wife, I have never used illegal drugs, (yes, yes, I eat too much), I try to speak the truth and not covet (though I really wish I could kill a deer now and then!).  So my true, pet sin is anxiety.

I suppose there may be some PTSD involved here.  When we come close to losing a spouse, it’s easy for the images, the memories to haunt us.  In addition, my work brings me in close proximity to many types of loss on a regular basis.  Maybe this is a recurring theme in health care providers or the families of those who survive terrible illnesses.  I don’t know.

All I know is that driving my poor wife nuts with my constant queries, my hovering, my stares (however well-intentioned) and my never-ending medical assessment of her every physical characteristic.

I suppose I just want to say, to anyone in a similar situation, it’s hard not to do it.  Especially for those of us in medicine, worry is kind of our job.  But when we take it home, it’s not very functional.  And it can easily drive our loved ones crazy, even as it drives us crazy inside.

And to those of us who profess Christianity, well worry is a tough affliction to overcome.  The world is full of hurt.  The world is a place of loss.  Life hurts. But we are promised that one day, all will be well. And that along the way, in every storm, we will have a guide.  Psalm 91, among many others, is clear.  The resolution of our worries, rational and irrational, may await eternity, but it will come.

The great challenge, in the interim, is simply learning to live day to day without a constant fear of catastrophe.  And with a daily resolution to enjoy every moment, without the poison of anxiety; real or imagined.

Please continue to keep us in your prayers as time heals the wounds, physical and emotional.  And let me know if I can return the favor.

God bless you,

Edwin

A rest for the heart

This is my column in July’s EM News.  Have a restful day!

http://journals.lww.com/em-news/Fulltext/2011/07000/Second_Opinion__A_Rest_for_the_Heart.10.aspx

We travel to Hilton Head, SC, every spring for an ‘end of school-year’ vacation. It is a tradition that started several years ago; one which our family treasures. We plan months ahead, when we arrange lodging. Then, as the date draws closer we have to restrain ourselves from jumping up and down at odd, inappropriate times. The beach calls to us in an inexplicable way.

We live in a beautiful county, surrounded by mountains and lakes. It is, in itself, a worthy destination, perfect for biking, hiking, fishing and/or kayaking. But when May rolls around, our eyes turn to the east, and we long for the sand and sea. It is one of the special gifts of South Carolina, that highland forests and crashing surf are half a day’s car ride apart.

The morning we leave, the car is packed, the snacks tucked away, and we drive through the local Chick-fil-A for drinks. Then my dear wife immerses herself in a novel, her i-Pod turned to her music collection (eclectic as when we first met, running the gamut from Prince to Loreena McKinnet, from Aaron Copeland to Veggie-Tales). The children slip off their shoes and drift into games, or their own books and music before boredom takes them to sleep.

I am left enjoying the singular pleasure of driving across the state of South Carolina, listening to what I please on that most antiquated of devices, the radio. It is easy to navigate, South Carolina. The car can practically drive itself. It is not distracted by boiled peanut stands, or fireworks stores. However, it knows to stop in Columbia, mid-way to the ocean, so that we can plunder a book-store in search of beach reading.

The book store assault is part and parcel of our beach trip, and has achieved many wonderful ends, not limited to expanding our children’s minds and diminishing our savings account. So, bellies full from some high-fat lunch, eyes bright with new titles to devour, we return to the highway and follow I-26 on down the road.

The mountains of South Carolina are, of course, not truly mountains. But we see them that way; and by comparison to the flat expanse of the lower parts of the state they positively tower over everything. Sadly for native West Virginians like us, they vanish rapidly as we drive from Columbia on, and the flat Piedmont lies before us, shimmering in the sun.

Before we know it, swamps appear, filled with turtles and alligators, snakes and hogs. Their murky waters edge right to the side of the highway as we roll along. Soon, Gullah ladies sell sweet-grass baskets at rest-stops. And then it happens. We turn onto Route 278 and cross the bridge onto Hilton Head Island. Shouts of joy erupt from the car as we see the rigging of shrimp boats, and the expanse of the ocean beyond the inlets, stretching away to Africa far beyond the roll of the horizon.

We find our way to the condominium we have rented, and as it is usually evening, I leave the family and go out to forage. I am, after all, the hunter/gatherer. Usually, I hunt down pizza, or as in the case this year, gather up boxes of Chinese food for general consumption, after going to the grocery store for chips, soda and laundry detergent. It is a task I anticipate with pleasure, year after year.

Admittedly, the first time is dicey. I return to the room after nearly being lost in side-streets of plantations whose street names are a hazy, retirement community blur. Did I turn at Shipyard, or at Ship’s Mast? Is the house at Shelter Cove or Pirate’s Cove? Ocean Breeze street, or Ocean View Landing?

Ultimately, I find my way home and open the door, laden with food, greeted by hungry teens and children happy to see Papa ‘home’ again. Which is what my daughter calls our temporary lodging, after a five minute dissertation on how she knows it isn’t really home, but it’s home for now, ‘so is it OK if I call it home for now?’

The next day is for ‘the rental of bike.’ Hilton Head is flat as the pancakes at IHOP, so biking around the island is a common pastime for visitors. Our bikes include two tandems for Jan and I to ride with Elysa and her little girlfriend, who (when the bikes arrive) both shriek with happiness. All seven of us glide among the Palmetto trees on shady bike-paths, as older boys attempt to injure themselves by riding like maniacs.

We spend our days divided between the beach, the pool, the room and assorted restaurants. We read, I write, we nap, we laugh. This year, our trip was a respite from school. However it was more. It was a grand celebration of the fact that Jan, wife and mother, survived not only chemotherapy and radiation for her pharyngeal cancer, but also bilateral pulmonary emboli with a saddle embolus.

This year, every grain of sand, every breeze, every seagull or dolphin in the wake was a blessing of normality. This year, every meal together was a kind of quiet feast as the stress flowed out of us, slowly, awkwardly, but surely.

The air was cooler than normal, and the water was sometimes like ice. But as we looked with warmth on one another, as we sat quietly by the ocean, digging in the smooth sand, we all realized once again how very important it is to escape, to regroup, to recover the blessings of routine joys, so powerful and so necessary to our collective sanity as a family.

Into the chaos and stress of all our lives, professional and personal, it is imperative that we introduce escape, calm, order and even simple traditions. They do not heal all of our hurts, and they cannot repair all of the damage we sometimes sustain as we move from year to year, challenge to challenge. But they go far towards healing and restoration.

We may not be able to control the patient volume of the emergency room, we may not be able to predict compensation from quarter to quarter, or how the patient satisfaction scores will go. We certainly cannot anticipate or stop all of the perilous events we will face as families. But we can retreat and regroup. We can spend some time away, without the constant reminder of the stresses we endure every day. We tell the sick to rest; and a vacation is a kind of rest for the heart.

And few things allow me to do that as effectively as a trip to the beach, by way of the bookstore, with my wife and children.

Devotions for Doctors…and patients! Facing illness as family, and with faith.

Trained as an emergency physician, my entire career has been spent pondering, searching for, often finding and managing the worst possible eventualities in my patients.  Chest pain is, first and foremost, a heart attack or pulmonary embolus.  Abdominal pain is appendicitis, a ruptured tubal pregnancy.  Fever with headache is meningitis.  And neck pain from a car wreck is an unstable cervical spine fracture.

So it has taken enormous effort to ‘dial-down’ my response to my wife’s recent cancer, treatment and recovery.  I drive her to distraction with ‘how are you feeling?’  I pester her endlessly to eat.  I have imagined every bump or cough a metastasis.  I have envisioned all the worst outcomes imaginable.  I endlessly ‘catastrophize,’ as one pastor put it.  And yet, God has seen us through so much.  She is thriving, six months from her diagnosis and three months from her last chemotherapy and radiation treatment; almost three months from her life-threatening pulmonary embolus.

We have been through follow-up exams, and scans.  Tense phone calls from tumor boards, anxious moments waiting for radiologists to make pronouncements.   And now, one more thing remains.  Tomorrow she has a little surgery to repair her scar.  And she has a little scope and biopsy to follow up on her slightly abnormal PET scan.  Despite the way my anxiety can run wild, despite the way that Satan gnaws at me with the barbed sword of fear, I know two things.  Rationally, I know that it is likely she will have no problem, and no residual malignancy.  She was treated as aggressively as one could imagine.

But I also know this, I have to know this:  she is in God’s hands.  This is no easy thing.  I am a kind of  ‘medical doubting Thomas.’  ‘Unless I put my hands on the report, unless I see the scan myself, I will not believe in God’s provision.’  But I have to move beyond that.

I have learned, thanks to this trial, my wife’s wisdom and the Word, that when God says He will rescue us from every trial, that He will ‘keep us from dashing our foot against a stone,’ when He says, ‘The angel of the Lord encamps around those who fear Him, and delivers them from all their troubles,’  He means it from a larger perspective than we can comprehend.  When He says He ‘forgives all our sins and heals all our diseases,’ it is true.  But the meaning is beyond the temporal.

If not, then every believer whose loved one dies of cancer can only rage against a lying, faithless Father.  And each of us, who will universally face the 100% morality of this life, will have cause to be angry with our Creator.

Some will be healed of their diseases, and we can pray for that, and we should pray for that.  I do it every, single, solitary day.  ‘God, Father, please heal my wife.’  So far, He has been faithful to that plea.

However, some will not.  And I do not claim to understand why, nor do I hope to judge God with what Pastor Mark Driscoll calls, ‘three pounds of fallen brain.’  But either way, all of us will find our  ultimate healing in the next life.  So when we trust God, as I am learning, we have to fall back into His arms, trusting that either way, now or later, with immediate joy or joy postponed, we will find the healing we so desire for those we love…and for ourselves.

I was told by a wise man that we were facing this trial because ‘you can be trusted with it.’  I am only now beginning to understand.  And despite my deep-seated, doctor-educated terror, I am seeing that God’s provision dwells mightily in some of the worse circumstances, and that if we would be a ‘light in the darkness,’ we have to be in the darkness.

God deliver us into new light, each and every one!

Please say a prayer for Jan’s surgery tomorrow.

Yours,

Edwin

So, how is Jan doing you ask?

Thank you all for your prayers for my dear wife.  I haven’t update lately, so here’s the latest.

We went to MUSC in Charleston a couple of weeks ago for follow up, some 12 weeks after completion of chemotherapy and radiation.  Jan’s exam looked very good.  Nothing going on in her tongue or throat except some generalized edema.  Healthy looking cells, unlike the scary white ones we saw back in December.

‘Hallelujah, thine the Glory,’ as the song goes!

She also had a PET scan.  It took a couple of weeks for the final reading and review by the tumor board at MUSC.  But the results were pretty good.  The left side of her neck was clear (that’s where the original malignant nodes were found).  The right side of her neck was clear except for one lymph node which was unchanged, and which did not ‘light up’ as if it were malignant.

On the base of her tongue there was some PET scan activity,  but there are a few options.  The tumor board felt that she should have another thorough scope under anesthesia to see if any areas needed to be biopsied.  However, they also felt it could have been a scratch or other area of non-malignant inflammation.  She has been eating pretty aggressively, so that’s a thought.  Likewise, she had a very pronounced inflammatory response to her radiation, so in my simple opinion, it may still be ‘cooling off.’

On the positive side, there were no distant areas of concern; that is, lung, liver, etc. all looked good.  And, she’s swallowing better and feeling better every day.  No obvious masses in her throat or on her tongue.

So, as with all cancer follow-up, it’s one more ‘wait and see.’  Wait on the scan, wait on the exam, wait on the biopsy, wait, wait, worry, worry, pray, pray, pray!

It’s hard to imagine that much is going on considering how active she has been and how healthy she feels.  But we must be cautious.

Also, if all goes well she can cut back her blood-thinner (Lovenox) at the end of this month and take it only once daily.  That will be fantastic!

As I write, she’s in West Virginia visiting family.  Before she left she had an excellent work-out in the gym.  Last week she taught VBS.  And every day she says to me, ‘don’t worry, I feel fine!’

Worry is my cardinal sin.  I’m learning, by increments, to battle it.  Just last night I was talking to a patient about not letting bad thoughts control her with anxiety.  (I feel qualified to address that topic!)  And today, the verse that came to mind was this:

I thank my God every time I remember you. In all my prayers for all of you, I always pray with joy because of your partnership in the gospel from the first day until now, being confident of this, that he who began a good work in you will carry it on to completion until the day of Christ Jesus.  Philippians 1: 3-6

Of course, Paul isn’t specifically referring to physical healing, but I believe that God began a work of healing in Jan and will see it through.

So we’ll keep everyone posted!  Please continue in your prayers for my darling.  And for me, so that I will be lifted up in hope, not weighted down with anxiety.

God bless you all for your love and intercession!

Edwin