A Wedding is the Portal to the Mystery of Marriage

Congratulations Meg and Tyler!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A mystery indeed.

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

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

Mothers are People First

Mothers are People First

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

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

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

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

The Women and Men who Love Emergency Physicians

This is my February 2017 column in Emergency Medicine News. Now, doctor, go hug your  husband or wife.

http://journals.lww.com/em-news/Fulltext/2017/02000/Life_in_Emergistan__The_Women_and_Men_Who_Love_EPs.20.aspx

When I go to work I take a lot of things with me. Everyone has their ritual, right? I take my backpack with my computer inside. I take my phone. I take charging cords, the true modern life-line. I take lunch. I carry a pen, flashlight and pocket-knife.
On a more abstract level, I take the wonderful education I received as a medical student and resident, coupled with my years of experience as a physician. I take my drug-store +2 diopter glasses, not only to read and suture but equally important, to look venerable and wise.
But I take something else. It’s certainly as important as all of the other stuff, if not more so in the long run. I take the love and support, encouragement and care of my wife Jan. Now mind you, this is not some hyper-sentimental claptrap. A spouse, for better or worse, is part and parcel, warp and woof of our lives. And in the best of circumstances (which I enjoy), my dear bride gives me encouragement, laughter, stability, passion and the not-so-rare kick in behind when I’m lazy, whiny or grumpy. (As I am so often wont to be.)
She reminds me of my priorities, reassuring me that I matter to her and the children however I may feel. She reminds me that feelings are often terrible lies. (A lesson we would all do well to remember.) In times past she has guided me through career changes because she could sense my unhappiness and dissatisfaction. This is because she loves me and knows what I need; often better than I do. In short, she is my most dedicated advocate.
While I work in the ED, she works hard to manage the children (rather, the teens who require more diligence than mere children.) She looks after the family finances, a thing which is useful in keeping me out of prison for delinquent taxes and in keeping the banker away from the door so that we keep our home.
And in order to keep me moving forward through busy, difficult runs of shifts, she ensures that I have things to look forward to with family when she does our ‘master schedule.’ Even though two of our children are in college, she tries to arrange family events around my days off so that I don’t feel left out. In addition, so that I can enjoy our life together for a long time to come, she takes me to the gym. She sometimes makes me plank. I hate to plank but I do it.
This might sound, to the modern ear, as if my wife is living out some sort of domestic indentured servitude. It is not. It is teamwork. It is unity. It is covenant. We are one. We have common cause in our marriage and offspring.
The result of her remarkable effort is that when I go to work, I can focus on my job. I can carry the love and care I feel at home into the exam room, into the resuscitation room. I am secure and happy. This makes me a far more effective, calm, satisfied physician than I would otherwise be.
Thus, I make the money that we share equally as partners. Not only in our personal corporation but in our lives. I don’t get paid for me; I get paid for us and for ‘clan Leap’ as a whole.
When I come home from work, I come home to smiles, hugs and a welcome-home kiss. I come home to laughter and dinner, or date-night. To stories of her day, and the many other lives she touches, in our family and beyond it.
Sometimes I come home to strategic family planning sessions. Occasionally I come home to a tired or angry or sad wife and it’s my turn to be the one in the supporting role. My turn to fuss at teenagers or call about car insurance claims. My turn to shoo her to bed early and manage things. My turn, on days off, to send her for sanity breaks.
Those of us who are married, or in long-term committed relationships (which we in the South call a common-law marriage) must admit that without our wives or husbands, this whole gig would be much harder, and much more lonely than it is with our dear ones. Furthermore, that the patients we care for are touched and loved on, vicariously, by those who love us. Their role is not subordinate but intrinsic.
Through me, through our marriage bond, every sick child in my care has my wife’s eyes looking down on it gently. Every struggling nursing home patient has some of her kindness. Every difficult, irritable complainer has her patience and every smart-aleck teenager (or grouchy consultant) has her raised eyebrows and crossed arms gazing firmly on their behavior.
All of us owe so much of our professional lives to the women and men brave and loving enough to stay with us through all of our stupid, arrogant, surly behaviors. And to those men and women, let me just say: you are as much a part of our practices as we are. Thank you for being the other half, the silent partner, standing invisibly by us as we do the hard work of medicine.
We couldn’t do it half so well without you.

New Year’s Eve With My Best Friend

This is my column in today’s Greenville News.  Official link not up yet at the News website, but I’ll post it when I can.

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I remember being an adolescent, ringing in the New Year with my family. My mother a nurse, and my father a pastor, we just weren’t big ‘party people.’ Their mantra (which is now mine) was ‘nothing good happens after midnight!’ (I have plenty of anecdotal doctor stories to back up that assertion, by the way.)
We’d shoot some illegal fireworks off, or fire a gun from the back porch at midnight, and we’d eat some shrimp as the ball dropped in far-off, sparkling, exciting NYC. Then mom and dad usually fell asleep early and I wished for something to do. They were busy folks, and reasonably tired, so New Year’s Eve wasn’t much different from any other night. My wife’s childhood memories were similar, as her parents worked hard and rested when they could. Furthermore, those were the ‘dark ages’ when the Internet wasn’t part of life, and communications to the rest of the kid world were restricted to the house phone and the postal service. (Can you imagine?)
So it was no surprise that Jan and I celebrated a remarkable event on December 31st. For the first time in 22 years, we spent New Year’s Eve together… with nobody else. No kids, no relatives, no friends. Zero.
We aren’t opposed to enjoying the holiday, mind you. Over the years of our dating and marriage we’ve had lots of wonderful New Year’s Eve celebrations, from small affairs with friends to dress-up evenings in crowded restaurants.
We’ve had many parties at our house on the hill, with plenty of food and fireworks, bonfires and chaos. We’ve had church youth group events where dozens of young people played capture the flag in the freezing cold, the night illuminated only by flashlights, after which shivering teens (and leaders) warmed themselves by the fire and passed out on the floor from fatigue.
Most years the attendees were simply bunches of our kids’ friends and our own, along with as many family as possible, whom we promised that the fun and laughter would outweigh the danger of stray bottle rockets, brush fires or jackets set on fire by sparklers.
But this year, all of our ‘children’ from ages 15 through 22 (not so much children now), had things to do, people to see and places to go. Based on our own experience as young people, we could hardly blame them. And rather than try to make them feel guilty, rather than be stuck on some dead-end, potentially toxic nostalgia, we said ‘be careful and have fun! Keep us posted where you are and what you’re doing!’
I had worked all day in the ER and arrived home, where Jan had a yummy meal waiting. I took dinner to our room where we settled in for a very, very uneventful evening. Good Clemson parents, we periodically paid attention to the score of the Clemson-OSU game. Good former homeschool parents and life-long nerds, we watched Tolkien’s Return of the King on TV. We weren’t cold, nobody around us was intoxicated, we didn’t have to drive anywhere and the wait for food was non-existent.
I seem to recall learning that Clemson had won, and the dark forces were pouring out of the gates of Mordor, right as I said, ‘I love you baby! Happy New Year!’ At that point the dark forces of fatigue enveloped me and I was out around 11:30. Jan, with more fortitude than I, stayed awake until after midnight.
Emotions are funny things. And we humans can keep lots of competing emotions in constant tension together. That night, even as we missed our children and thought back on all the beautiful, laughter-filled evenings of the past, we were buoyed up by the deep, underlying love and friendship that we have had since our first date almost 33 years ago. We rang out the old, and rang in the new together, with joy and contentment.
Parents everywhere should try to remember that as wonderful as our kids are, and as delightful it is to spent time with them and others, our marriages are the deep, holy bond that will remain, and see us to the end. We know there will be parties again. But party or not, the best New Year’s Eve, the best day, the best night, the best life, is the one we spend together.
How do the vows go? In sickness and in health, for richer for poorer, at parties or at home with only you? I do. Always.

Driving Country Roads to the ER

These days, I work most of my shifts about 45 minutes from my ‘house on the hill.’ At one of those jobs, the day shift starts at 06:30. Which means I’m rising from my bed at 04:30 in order to get on the road in time. I’ve started waking up at four, spontaneously, as if it were the most natural thing in the world.

I lay out my clothes the night before, so as not to awake my darling wife in her sleep. Sometimes I am able slip out without her knowledge. Others she wakes to kiss me goodbye. Then I go downstairs and put together some lunch, get the backpack and make my way out the door. I know that my wife and children are safe upstairs, as I lock the door behind me.

The door creeks a little, or did until my son Elijah oiled it. (One always wonders why a teenage boy oils a front door…) Occasionally I lock it as I realize I left my keys inside, and poor, tired Jan opens the door for me patiently. On the front porch, by the soft yellow of porch-light or the shock of flashlight, I step over dogs freshly awakened from sleep, who look at me with gentle annoyance. The sharp-eyed cats sleep in more secret places, so are seldom seen in the morning. Other dogs (we have five), sleep on the gravel drive in the summer and seem confused as to how to react when my Tundra rolls towards them, slowly, and I roll down the window. ‘Get up, you silly dog!’ Heads and tails down they amble away.

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Up the long drive and down the road, I am suddenly all but alone on the two lane roads that lead me to Tiny Memorial Hospital. Despite the early hour, I am ‘awake, alert and oriented.’ The sky is dark, and in winter stars shine down when clouds don’t lay low against the earth. I scan the roadside for deer, their eyes reflecting the truck’s headlamps. Opossums sometimes shuffle across, along with squirrels and rabbits. (One day I saw a big, black bear on a hill by the road. He ran away as I stopped for a photo.)
I drive through forests, past sleeping houses and across a dark, still lake where sometimes, the light from a bass-boat shines across the emptiness where someone has fished all night…or started very early. Or a campfire on the shore still burns as their line rests untroubled in the water.

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It is so early that I drive past gas-stations and convenience stores still dark and locked, the ‘closed’ sign reminding me to keep on moving. The air, even in summer, is cooler and in winter, positively cold. Winter is my favorite, I think, with the heat of the truck turned out, and the chill wind blowing past.

I think as I drive. And I pray. And I listen to the news, a recorded sermon, a pod-cast. Many mornings I turn on an oldies station from the North Carolina mountains; in the loneliness of the drive the music of Sinatra, Johnny Cash and others, make me feel I’ve gone back in time.

I cannot talk on the phone (hands free or otherwise). I pass through places where cell-signals are only a dream, and often even radio reception is poor. Remote areas, mountainous places, lonely and beautiful places defy cell signals and seem to say ‘look around! What else do you need!’ Even at 5 am, I agree.
Eventually I am near, and I find a fast-food joint for the obligatory chicken biscuit and tea, because, well, the South and all. And then I roll into the ER parking lot, lock things up and head to work.
Because this is no urban trauma center, the early morning is sometimes very slow and relaxed. A few patients may be waiting for turnover, but often none. I can sit and think, I can ask about the previous night. I can ease into work. My drive has already prepared me, but it’s nice to have a few minutes peace in the department before the chaos of the day begins. I text Jan. ‘Here safe, love you,’ and she answers. ‘Love you back, have a great day.’
There are those who don’t have to drive long distances. For most of my career it was about 15 minutes to work. And there are those who have long commutes through traffic, and through the waking body of a large city, people and cars just starting to fill its veins and arteries. Sometimes I am jealous. It can be lonely where I am.
But I think I’ll keep it for now. There is a solemnity, a serenity to my mountain and lake commute, with animals heading to bed and people not yet rising, with my own thoughts and prayers to myself.

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And I suppose that if there were a better way to prepare for the madness, badness and sadness of the ER, I don’t know what it is.

Never Stop Discovering Your Spouse

Elysa photos 007

This is my most recent Greenville News column.  Inspired, of course, by my amazing wife Jan.  All my love baby!

http://www.greenvilleonline.com/story/opinion/contributors/2016/06/05/ed-leap-never-stop-discovering-your-spouse/85286660/

June is here, and while it certainly isn’t the only month for weddings, it is a popular one. This month, many young men will have a brand new thing called a wife, and many young women a thing called a husband. Both are perplexing, and both are wonderful. As such, I have some insight to share.
Gentlemen, what you have before you after the vows are said and rings exchanged, is a woman of your very own. She has been thinking about this her whole life. In fact, she has been unconsciously (and consciously) evaluating men as husband material since she first realized that there were boys in the world other than her father and brothers. She chose you. (Don’t question it, just be glad…she knows you’re imperfect, trust me.) And what she wants is your love and devotion. She wants you to stand by her and be faithful. She needs to know you won’t run away when things get tough. She needs to know that you still think she’s amazing when her life is a hot mess and her hair won’t do anything right and she just cries for no reason. She does not expect you to figure it out or fix it, as much as you want to do that.
The great wonder is that she just wants you (you among all other men on earth!) to share life with her, hold her, protect her and get old with her. She could have had people better looking, smarter, stronger or richer and every smart husband realizes this. She wanted you to share her mind, heart and body. She probably wants to have your baby. (It’s a compliment of the highest order.) Something about you drew her in to your orbit. Observe this advice, honor her dreams, speak kindly and treat her gently, love her lavishly and you will never in this life find an ally more true or comfort more wondrous.
This beautiful thing before you is yours; and she should be your favorite hobby, best friend, greatest confidant. She will give all of that back and more. But remember what the Little Prince said: ‘You are responsible forever for what you have tamed.’
Ladies? What you have is a man, also of your very own. As a young man, he didn’t probably didn’t think about weddings or marriage as much as you did. But deep inside, he wanted it. He wanted a woman to care for. Good men like caring for things; we protect, we defend, we provide. It’s our wiring. On some level, even as you wove your spell he ‘hunted and gathered’ you. In a hilarious expression of the whole process, ‘he chased you till you caught him,’ as my wife used to say. He is sometimes slow to understand things natural to you. Like feelings. He is sometimes uncomfortable with lengthy discussions of emotions. He is fascinated by your feminine ways, tears, declarations of love and complicated rituals. He struggles with bra-straps and is confused by make-up, skin products and your many shoes. But in all his simplicity, he is far more complex than your friends (or society) lets you believe. He is in awe of you and if you are kind to him, encourage and respect him, he will do anything you ask just to make you happy.
He needs a little space sometimes. And honest to goodness, there are times when he says ‘I’m not thinking about anything,’ and is telling the absolute truth. We men go to that place sometimes, even though your multi-tasking brains can’t fathom it. Let the man have it now and then. Just a little down-time. He’ll be back.
Your husband, properly treated, will love you and the children with a devotion that comes fairly close to worship. And when he says ‘you’re beautiful,’ don’t tell him no, don’t deny it. He really believes it because you are his, and he’s amazed that you agreed to marry him in the first place.
Husbands and wives, his whole process is an incredible mystery. Two people, two complex creatures, with dreams, hopes, wounds, bad habits and all the rest come together and make, as the Bible says, ‘one flesh.’ Two humans who barely know themselves choose to know another and love them for life.
As you pass through the portal of the wedding into the new life called marriage, may you never stop discovering the unfolding, life-long wonder that is your spouse.

Make Time For Romance Every Day

Happy Valentine’s Day!

http://www.greenvilleonline.com/story/opinion/contributors/2016/02/13/make-time-romance-every-day/80177498/

It Doesn’t Have to be Valentine’s Day to Date Your Spouse.

My wife and I have had some wonderful Valentine’s Days in the past. I remember the first time I tried to cook for her. A friend let me borrow her apartment. I cooked steaks and had the whole romantic thing set up for Jan, with flowers and all.

When I was in residency, our hospital had a yearly February ‘Sweetheart’s Ball,’ and all of the residents would be excused from work while the faculty took over our roles in the hospital. I’ll never forget how lovely my wife looked in her black party-dress, dark curly hair down around her bare shoulders. Wow. Anyway, back to the point. We have had a lot of delightful romantic times on and around February 14. But as the Day is now upon us, I’d like to offer some advice to the young, and even old, couples out there.

First of all, romance may seem spontaneous but it requires attention and effort. Sure, there are moments of wonderful emotion that sneak up on us. But if we don’t take time with our spouses, romance can be a tough sell. For instance, men, if you ignore your honey for the entire football or deer season, a bouquet of roses at the last minute will earn you a sweet, sarcastic smile and not a lot else.

Likewise, for the ladies, a man won’t feel romantic if he isn’t appreciated throughout the year. If he feels berated and belittled, the last thing on his mind will be sweeping you off your feet or twirling you around the dance floor.

And to both men and women, make an effort! No, our love mustn’t be predicated on appearances. But for heaven’s sake, try to dress up for special times together! It’s a sign of respect. And no, guys, it doesn’t mean your nice John Deer hat. It means leave it at the house. Ladies, yes, it means perfume and lipstick and that dress you know he likes to see you wear. I may be a Neanderthal, but it’s just how things work for most of the men and women in the world.

Second, build on the basics. What I mean is, date one another! I don’t care how long you’ve been together, married or not. Schedule, intentionally and regularly, date nights or date days. This isn’t complicated. It’s about time talking, listening (attention men) and holding hands. Some of our absolutely best dates have involved a quick snack of appetizers and a much needed trip to the grocery store. Freezer section flirting is the best!

I don’t know how many times we’ve wandered the romantic aisles of Lowe’s, looking at things we’d like to have in the house someday, or talking about repairs we need to make. Heck, my Jan loves yard work and a trip through the riding mowers is as good as a walk through the jewelry store. (Take that boys!)

Third, grow and stay active together. Find a hobby or activity you love, or you can agree on, and make it a date. It may be biking or fishing, taking an art class or volunteering for the church or a service organization. It might be fixing up the house or cleaning the attic. But do it together and talk. A lot. Couples thrive on communication, so never forget that. We’ve found, over the years, that movies may be fun but that afterward, we didn’t have any time to talk. Couples need to decompress, process, discuss and dream. They need to talk about what the kids are doing, and on some dates, need to make a vow not to talk about the kids at all, but only one another.

These days Jan and I have ‘workout dates.’ We go to the gym, work hard to stay fit (for ourselves and one another), then get lunch afterward. Believe it or not, if you eat properly, it isn’t as silly as it sounds. Ice cream and cake after workouts aren’t the same, by the way. (OK, maybe every fifth or sixth.)

It’s a time of red-roses and chocolate candy, dinners by candle and champagne; but mostly in theory. For much of the world, Valentine’s Day will be an exhausted kiss after the children are bathed and in bed, or holding hands during night-time prayers.

Fortunately, romantic dates come in many varieties all through the year. Just be sure that however you do it, you do it with the singular goal of loving your spouse better with every passing day.

Don’t Freak Out! Be Calm in 2016…

Here is my column in this week’s Greenville News.  Enjoy!  (And call your grandparents…they love you.)

http://www.greenvilleonline.com/story/opinion/contributors/2016/01/10/dont-freak-out-calm-2016/78362386/

A common theme in the emergency department is this one: ‘Doc, I freaked out and came straight to the ER!’ I wish I knew how many times someone has said something similar to me. ‘The baby had a fever so I freaked out.’ ‘I fell and got a big bruise and I was afraid I had a blood clot so I freaked out.’ ‘I saw a spider on my leg and I freaked out so here I am!’

I’ve wondered about this for a while now. I have a theory. I believe that some of the freaking out that leads people to the ER results from the absence of sufficient grandmothers and grandfathers. It isn’t that those dear folks aren’t out there doing their best. It’s that families are often mobile or broken, disconnected from all roots. So the collective calm and wisdom of the ages, often found in grandparents, is often difficult to obtain.

I remember any number of my childhood injuries consoled, bandaged and painted with Merthiolate by my grandmothers. What I don’t remember is anyone freaking out. Not even when I nearly impaled my foot on a makeshift spear whittled from a broom handle.

In addition to ‘the grandparent’ issue, we really don’t do a good job of teaching young people about sickness, injury or even health outside of birth-control; even though life involves far more than reproduction.

The medical world of freaking out, however, is a microcosm of a greater problem. We seem to be a nation that ‘freaks out.’ We freak out over weather, politics, culture, relationships, celebrities and whether or not our own social media posts or pictures are getting enough traction. We freak out when life is difficult and we freak out when we’re bored because life is so good. And when we freak out, we go looking for someone to keep us calm, cover our wounds and give us hope.

Maybe we freak out simply because we watch too much television, where every medical event is a screaming, chaotic blood-fest. Or it could be that we spend too much time on the Internet, where every insect bite is deadly and every bit of swelling is (of course) the sure-path to cancer. Sometimes we freak out because of what we put in our minds. A patient once told me, in tears, that he thought about death all day. It turns out his television viewing exclusively involved shows about murder.

On the other hand, perhaps it’s more than being educated (by school or grandma) about all the the things which should make us ‘freak out’ or not. Maybe it’s a matter of how to deal with anxiety and uncertainty in general. I have observed over the years that children from chaotic home-lives are much more anxious when we have to stitch their wounds, start IV’s, give them injections or any other stressful, frightening procedure. Those who come from homes filled with consistency and calm can often be managed with simple reassurance. It could be that calm was the most important salve applied by grandmothers.

I believe in preparing for crises. I became a physician in large part because I didn’t want to be powerless in the face of medical emergencies. I say we teach young people as much as we can to prepare them for life’s troubles, whether they involve open wounds or flat tires. Knowledge is power, as they say.

But I believe we can help the ‘freak out’ crisis with two other things. The first is by keeping families connected and involved, so that the young can see how adults handle stress. It’s important to model this for our kids, well into their 20s.

The second, however, is a little harder. I believe that everyone needs a belief system to bear them through hard times. As modern, technological and scientific as we have become, we have yet to escape our deep need for hope and meaning, for transcendence in the face of trouble. And yep, I’ll say it; for a God who will calm the storm or calm us in the storm and be waiting on the other side of it, in this life or the next.

Life is hard and scary. But there’s way too much freaking out. And with the right application of grandma, knowledge and God above, maybe we can spend 2016 with just a little less freaking out and a little more hope.

 

The Leap Physician Satisfaction System

This is my column from the November issue of Emergency Medicine News.  Observations on keeping physicians professionally satisfied, healthy and happy.

http://journals.lww.com/em-news/Fulltext/2015/11000/Life_in_Emergistan__The_Leap_Physician.7.aspx

The Leap Physician Satisfaction System

I have never been the director of any professional group. I have, however, been directed. As such, I have a few tips for those who are directors and administrators. I give you my ‘physician satisfaction system.’ It is arranged in no particular order.

In every physician break-room or lounge, there should be a wall for photos of girlfriends, boyfriends, children, spouses, parents, dogs, cats, horses, boats, new shotguns or whatever makes those doctors happy. Emphasis on children and spouses, boyfriends and girlfriends, moms and dads. See below.

Post this where physicians work. ‘If you have a husband or wife, please avoid having a girlfriend or boyfriend. It is unfair to your spouse and children. And it is very, very expensive, as hobbies go. You’re better off with a boat.’

In every physician break room there should be: 1) a recliner 2) a refrigerator with snacks and drinks 3) a television with cable 4) a computer with Internet and without the silly hospital fire-wall. Pay for it yourself if you must.

Know your doctors. The best way to do this is to talk to them. It’s tough to really talk on a shift. The best way to do this is away from work. A quarterly group dinner is a nice touch. Or simply, ‘hey, let’s go to lunch one day and catch up.’ You have to mean it though.

Remember that a married doctor is a unit. When there are important decisions to be made (into which you and your partners are allowed input) invite your doctors’ husbands and wives to give their opinions. You’ll be grateful for the wisdom a loving spouse brings to the table. And remember, nobody is more motivated to make the group money than a spouse with a mortgage to pay and babies to raise.

If you really want to score points, send a card or note to the group spouses now and then. Thank them for their service, their encouragement, their patience. Ask them how their family is doing. Remember that being married to a physician ain’t exactly a pony ride. Everybody needs a kind word.

Attend weddings, celebrate births, have anniversary parties. Visit the sick in your group. Send condolences. Mourn at funerals. Laugh and cry. If you take the time to know them, it won’t be hard. They’ll be family.

Lead…from…the…front. If your docs tell you nights are really hard, work a string of nights. If they tell you that someone on staff is really hard to consult, talk to that person yourself a few times. (Tell those difficult doctors to back off and play nice.) If everyone hates the EMR, do everything you can to make it work for them. Never ask your ‘troops’ to do something you won’t. Never, ever.

Be fiercely partisan towards your guys and gals.

Help your doctors develop long-term plans, including an exit strategy. Don’t talk about it, do it. We can’t all go into urgent care or academics, but we can plan for a slow, steady withdrawal as the years go by. Encourage wise decision making, especially in the young Jedi.

Develop a sabbatical. Encourage your doctors on sabbatical to travel, take a class, enjoy sleeping in their own beds. It may be the longest time they’ve slept all night with their husbands or wives consistently in years. It may be the first full reset of their circadian rhythm since medical school.

Watch your doctors closely. It’s easy to become overwhelmed, depressed, anxious. Help them through mistakes. Let them decompress. Let them be sad. Don’t chastise, teach. Find a local counselor in case they need to talk about that death, that tragedy, their personal demons. Doctors kill themselves sometimes. Try to keep it from happening.

Identify the strengths in your doctors. Some are born leaders; let them move in that direction. Some are brilliant clinicians, use that. Some are great with people. Let them mentor. Some have hobbies or interests that make them better physicians. Celebrate the unique individual gifts that every partner brings to the table. Now and then, use these to remind the hospital what a unique and valuable team you have.

Take pride in your group. A logo and t-shirt would be a nice point of pride. Brag about your doctors. Tell the local newspaper about them. Help them be invested in the community, treasured by the community.

Praise your partners, both to their faces and to others. Write down the good things they do for future letters of reference.

Give your team permission. Permission to succeed, permission to fail. Permission to try new things and sometimes, permission to leave it all behind.

On really busy nights, call in pizza from home. On terrible nights, come in and use your authority to make things happen more smoothly.

There are a lot of schedules, in a lot of ED’s, with holes in the schedule. If you don’t want your entire group to realize this, and leave, and then come back making more as locums than they did before, then be their advocate.

We have a hard job. But with the right leader, it can be wonderful even when it is hard. It’s up to you, directors, to set the tone. Good luck and Godspeed.

We Should Value Life Until The End. (My latest G-News column)

This is my column in today’s Greenville News.  I understand why people ‘want everything done’ when they’re old.

http://www.greenvilleonline.com/story/opinion/contributors/2015/11/15/we-should-value-life-until-end-ed-leap-thanksgiving-health-care-costs/75585450/

It’s a well known reality of health care economics that Americans spend a lot of money in the last year of life. I suppose that almost goes without saying, since serious illnesses and injuries that result in death are costly, at whatever age they occur. Being hit by a car and dying means you were hit by a car… in your last year of life. And that two weeks in ICU before you die is, obviously, expensive. But this truism is usually applied to Medicare dollars in the care of the elderly. This group often has protracted illnesses that require costly treatments, specialty care, hospitalizations and home-health; despite the fact that the improvements in outcome or length of life are often pretty limited.

When I was a young physician (younger…that’s better) I sometimes jumped on the band-wagon and wondered why everyone wanted so much for so little gain. I was always surprised when elderly patients didn’t want ‘Do Not Resuscitate’ orders, or other ‘advanced directives’ to limit care. I would sit with other young physicians and we would ask each other, ‘what does he hope to gain?’ Or of the family members ‘why don’t they just accept the inevitable?’

That was then. I have taken care of the elderly for my entire career. And over the past year, especially, I have worked in some communities with especially high numbers of senior citizens. That, coupled with the fact that I see things differently since I’m, well, less young, has given me new insight. So let’s re-frame the question. ‘Why don’t the elderly want to simply give up and die without a fight?’ To which the answer is, ‘they’ve lived long enough to know that every second is precious.’ Perhaps more importantly, they know that all of the people in their lives are precious.

I have watched elderly couples, 70s, 80s, 90s, and the way that they hold hands. The way they brush the hair from one another’s faces. I have heard them whisper ‘I’m here’ in the emergency room and ‘I love you,’ in the ICU. I recently listened as an older patient called his wife on the phone from the hospital. ‘How are you? Well you sound fantastic! I’m fine’ He encouraged her and comforted her, and wanted to simply hear her voice. They were anchors to one another in a treacherous, frightening world.

My son once reminded me of a saying, which I here paraphrase. ‘We die twice. Once when we breathe our last, and once when someone says our name for the last time.’ The elderly get this. They want to be with the people they love and to be remembered by them. And in particular, those with spouses hold on because that gray, infirm, frail woman or man whose hand they hold is the last repository of an absolute treasure trove of shared memories and stories. No one else knows the same subtle jokes, the same turns of phrase, the same looks that betray fear or joy. Nobody else remembers their trips to the beach or the way their children sounded when they splashed in the pool during vacation. Nobody else knows how to hold their hand just the right way. And no one else understands the importance of touching feet in bed under the sheets, or remembers their favorite restaurant now closed, or grasps the importance of that inexpensive ring worth more than a ten carat diamond.

Friends and children and grandchildren also hold such memories for the aged, or they hope to fill their descendents with those memories before they leave so that, for just a little longer, the stories will survive. They want their love, passion and experiences to remain, and not just in a box in a corner of an attic, that may or may not survive the purge when the house is sold.

The elderly want to fight death the same way we all do. Because life is incredible. And in fact, we should want them around. They have navigated many decades and many challenges. They have wisdom and they have perspective to spare and to share.

This Thanksgiving, if you want to really grasp the holiday, sit down with your older friends, uncles and aunts, grandparents and parents and ask them what they’re thankful for and what they love. (And watch the way they love.) Because odds are, you’ll learn something magnificent and hear some stories that deserve to be treasured.

Then, those ‘end of life’ expenses might suddenly make more sense.