We can not love that which we do know.

I have been blessed with so many things in my life, and owe God so much thanks, and yet, I often find myself skipping out on my prayer/scripture/quiet time.   As Christians, we are grateful for the amazing grace God has given us.  Our eternal life and blessings are given to us as a gift simply as a result of our faith.  We cannot “earn” it.  However, if we are truly grateful for his gift of life and love Him, it is natural that we should want to thank Him and to spend time with Him.   We honor God and demonstrate our gratitude love for Him by forming a relationship with Him and striving to be like Him.  We cannot love that which we do not know, and how can we know Him if we don’t spend time devoted to scripture reading and prayer?

Looking back at my life the past couple of months, I have not been consistent in my time alone with God and his Word.  I have been given wonderful family and friends, opportunities in education, gifts in athletics and much more.  I spend time working out, cooking, studying, reading, catching up with people on facebook, writing for my blogs, and yet I can’t seem to find 20 minutes out of my entire day to dedicate to God.    A lot of times my prayer time is nothing more than a simple prayer as I’m rushing out the door for work.  Living a Christian life and striving to learn what God’s plan is for us and the person he wants us to be is like anything else, it takes time and dedication.  Take running for example….you don’t master how to do a marathon by running a quick lap around the track now and then.  It requires consistent, daily training, which often involves warming up, stretching, and then getting into the bulk of your workout.  Our prayer time should be thought of the same way.  We need to “warm up” by quieting our minds from all the daily distractions and by asking the Holy Spirit for guidance.  God often speaks to us quietly.  We can’t learn a difficult physics concept if we’re in a busy room filled with all sorts of chatter and other distractions.  How can we expect to hear God and the promptings of the Holy Spirit if we are surrounded by distractions during our prayer time?

My challenge for myself the next week (and then which should hopefully become a permanent habit) is to plan for and literally put into my calendar at least 20 minutes every day where I quiet my mind of distractions and focus on God.

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What Does it Mean to be Spiritually Transformed??

Topic:  In response to Jackson Crum‘s sermon on the Book of James*

Location:  Park Community Church 

Date:  12/05/10

*You can listen to the sermon here:  http://www.parkcommunitychurch.org/media/

James 1:18-27:

18(AC) Of his own will he(AD) brought us forth by the word of truth,(AE) that we should be a kind of(AF) firstfruits of his creaturess.

19(AG) Know this, my beloved brothers: let every person(AH) be quick to hear,(AI) slow to speak,(AJ) slow to anger; 20for the anger of man does not produce the righteousness of God. 21Therefore(AK) put away all filthiness and rampant wickedness and receive with(AL) meekness the implanted word,(AM) which is able to save your souls.

22But be(AN) doers of the word, and not hearers only, deceiving yourselves. 23For if anyone is a hearer of the word and not a doer, he is like a man who looks intently at his natural face in a mirror. 24For he looks at himself and goes away and at once forgets what he was like. 25But the one who looks into the perfect law,(AO) the law of liberty, and perseveres, being no hearer who forgets but a doer who acts,(AP) he will be blessed in his doing.

26If anyone thinks he is religious(AQ) and does not bridle his tongue but deceives his heart, this person’s(AR) religion is worthless. 27Religion that is pure and undefiled before God, the Father, is this:(AS) to visit(AT) orphans and widows in their affliction, and(AU) to keep oneself(AV) unstained from the world.

Does going to church, reciting prayers, kneeling, singing, etc. once a week make us a “good” Christian?  Do we do it because it is comforting to us, or because we feel it will make us look better in others eyes?

For me, this week’s message was a warning to make sure that our hearts are in the right place.  Going to church and performing rituals in and of itself does not make us a Christian.  So many “Christians” and Church-goers can be hypocrites.  I know I tend to be harsh about this topic, but it’s just because I, in addition to other people I know, have been hurt and/or turned away from  Christianity because of the hurtful actions of people claiming to do things in the name of Christ.  Being a Christian should spiritually TRANSFORM us, Jackson stressed.  After becoming a Christian, there should be a difference in our character.  How do we know when we’ve been spiritually transformed? Jackson asked us to consider the following:

1.  Jackson asked us, “Are the rituals we perform for us or for God?  Who benefits, us or God?”

Going to church should not be done because we “have to” or because we feel a sense of comfort by going.  When one is spiritually transformed, he or she should want to go to church as a form of worship, because he is aware of and grateful for the amazing gift God has given us.  It’s not the ritual that matters, it’s the underlying reason that impels us to perform the ritual, and while we may be able to deceive others and ourselves by our actions, God knows what really lurks deep within our hearts.

2.  To what or whom do we turn to to justify our actions and decisions?

Often, when I want something that deep down I know is wrong I look to others to justify my behavior…. “Well, so and so did this, so I can’t be that bad” or “She just went on a big shopping spree, so the fact that I bought these two new outfits for myself isn’t so bad.”  When we’re spiritually transformed, our standard for what’s good and bad should be based on what’s pleasing to God.  This is solid, everlasting.  Deciding whether things are good or bad based merely on cultural norms is subject to change and provides no strong moral foundation.  Please note, I am not saying being a Christian means we ignore culture and customs….this is far from the truth.  Doing activities and making decisions based fully on one or the other is equally wrong.  I.e. strictly trying to do what the bible says without being aware of the context it was written in and your current cultural context can be just as bad as basing your decisions solely based on your surrounding culture.  We must COMBINE the culture and context of a situation with what we know to be true.

Speaking for myself, I find this very difficult, especially living in a country where there are tons of messages all around us implying that abusing our bodies with drugs and excessive alcohol is ok, randomly “hooking” up is normal, that everyone must have fashionable clothes and a spiffy smart phone to be a normal part of society.  I mean, heaven forbid, people look at you weird if you still use a flip up cell phone!  I was feeling sorry for myself the other day when I decided I shouldn’t buy a pair of Ray-ban $120 sunglasses that I really wanted.  Really?  Our society is spoiled relative to the majority of this world, and I’m as guilty as anyone else.

I think for me, one way to analyze my decisions is to really take a step back when I find myself looking to others around me to justify my decisions, because this is a sign that I don’t feel right about and there’s probably a good reason why…

3.  The last part of the passage was about “tongues”  Do our words and thoughts reflect the kind person we want and ought to be?

Words carry significance because they are an indicator of what’s in our hearts.  When we gossip and criticize, what does that say about us?  I think it makes us look worse than the person we’re talking about.  When Jackson went over that part, in my head I was giving myself a pat on the back, because I feel that I am usually pretty politically correct and decent with what I talk about, but then he said, “And just because those of you may me more disciplined in controlling your tongue doesn’t make you any better if you’re thoughts are filled with criticism, anger, and jealousy”….

If God could broadcast our life and thoughts on a big screen for all to see, how would people react?  How would YOU react?  Would you be proud or ashamed?

IN SUMMARY: When you are spiritually transformed, your CHARACTER changes, not just your actions (although, if your character is transformed, naturally it will follow that your actions will also be transformed).  We can judge how spiritually transformed we are by considering the following:

Why do we do the spiritual rituals that we do?  Who benefits from them, us or God?

To what or whom do we turn to to justify our actions and decisions?

If our public and private thoughts and actions were broadcasted on a big screen for all to see, would we be proud or ashamed?

APPLYING TO EVERY DAY LIFE, CHRISTIAN OR NOT:

I think the above questions can be applied to anyone.  I think we should all be self-cognizant of why we do or say the things we do.  How annoying is it to be around someone who is always complaining (when it’s really a way of “bragging”) about how busy their schedule is?  Why do we feel the need to broadcast that to everyone?  Is it to make us feel more important?   Why do we find ourselves thinking critical thoughts about someone’s accomplishment?  Is it because deep down we’re jealous?  Why?  I point these out not to criticize others who may do this, but as a reminder to myself, because I can be guilty of these things.

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Quotes by C.S. Lewis

As some of you may know, I am slightly obsessed with writings by C.S. Lewis.  When I read what he’s written, I literally end up underlying every single sentence.  He was an articulate man of incredible intelligence and faith, who was born into a Christian family, became an atheist, and later slowly converted back to religion and subsequently Christianity, which is not unlike myself.

Many years ago when I was turning back to Christianity but still questioning a lot about the religion, I read his book Mere Christianity.  That did it….I was hooked.  Up until that point, I had been feeling God’s presence and starting to believe again based on prayer and personal experiences, but I still needed some sort of well-thought out explanation regarding the rational behind and the foundation for Christianity.  It is my nature to question things, and all of my years of training in a science/health field have taught me to analyze things.  Everyone’s different, but for me, handing me a free bible on the street, telling me some dude up in heaven whom I’ve never seen before loves me, and then expecting me to fall to my knees in gratitude will do nothing but scare me away and make me think you’re crazy, as I imagine it has for a lot of people.

So reading stuff by C.S. Lewis (mostly Mere Christianity), learning about the questions he struggled with as an atheist and then evolving theist, and understanding his well-thought out analytical arguments for his belief system, had a profound effect on me.

SOME QUOTES BY CS LEWIS THAT I HAVE COLLECTED


“The great thing, if one can, is to stop regarding all the unpleasant things as interruptions of one’s ‘own,’ or ‘real’ life. The truth is of course that what one calls the interruptions are precisely one’s real life — the life God is sending one day by day.” ~The Collected Works of C.S. Lewis

“I have learned now that while those who speak about ones miseries usually hurt, but those who keep silence hurt more. “

“Pride gets no pleasure out of having something, only out of having more of it than the next man.”

“Crying is all right in its own way while it lasts. But you have to stop sooner or later, and then you still have to decide what to do.”

“The Christian does not think God will love us because we are good, but that God will make us good because He loves us.”

“I think that if God forgives us we must forgive ourselves. Otherwise, it is almost like setting up ourselves as a higher tribunal than Him.”

“To love at all is to be vulnerable. Love anything and your heart will be wrung and possibly broken. If you want to make sure of keeping it intact you must give it to no one, not even an animal. Wrap it carefully round with hobbies and little luxuries; avoid all entanglements. Lock it up safe in the casket or coffin of your selfishness. But in that casket, safe, dark, motionless, airless, it will change. It will not be broken; it will become unbreakable, impenetrable, irredeemable. To love is to be vulnerable.” ~The Four Loves

“Friendship is unnecessary, like philosophy, like art…. It has no survival value; rather it is one of those things which give value to survival.” ~The Four Loves

“When we lose one blessing, another is often most unexpectedly given in its place.”

“I pray because I can’t help myself. I pray because I’m helpless. I pray because the need flows out of me all the time- waking and sleeping. It doesn’t change God- it changes me.”

“What you see and what you hear depends a great deal on where you are standing. It also depends on what sort of person you are.”

“I am trying here to prevent anyone saying the really foolish thing that people often say about Him: I’m ready to accept Jesus as a great moral teacher, but I don’t accept his claim to be God. That is the one thing we must not say. A man who was merely a man and said the sort of things Jesus said would not be a great moral teacher. He would either be a lunatic — on the level with the man who says he is a poached egg — or else he would be the Devil of Hell. You must make your choice. Either this man was, and is, the Son of God, or else a madman or something worse. You can shut him up for a fool, you can spit at him and kill him as a demon or you can fall at his feet and call him Lord and God, but let us not come with any patronizing nonsense about his being a great human teacher. He has not left that open to us. He did not intend to.” ~Mere Christianity

“If you look for truth, you may find comfort in the end; if you look for comfort you will not get either comfort or truth only soft soap and wishful thinking to begin, and in the end, despair.”

“A silly idea is current that good people do not know what temptation means. This is an obvious lie. Only those who try to resist temptation know how strong it is… A man who gives in to temptation after five minutes simply does not know what it would have been like an hour later. That is why bad people, in one sense, know very little about badness. They have lived a sheltered life by always giving in.” ~Mere Christianity

“[To have Faith in Christ] means, of course, trying to do all that He says. There would be no sense in saying you trusted a person if you would not take his advice. Thus if you have really handed yourself over to Him, it must follow that you are trying to obey Him. But trying in a new way, a less worried way. Not doing these things in order to be saved, but because He has begun to save you already. Not hoping to get to Heaven as a reward for your actions, but inevitably wanting to act in a certain way because a first faint gleam of Heaven is already inside you.” ~Mere Christianity

“God allows us to experience the low points of life in order to teach us lessons that we could learn in no other way.”

“Aim at heaven and you will get earth thrown in. Aim at earth and you get neither.”

“My argument against God was that the universe seemed so cruel and unjust. But how had I got this idea of just and unjust? A man does not call a line crooked unless he has some idea of a straight line. What was I comparing this universe with when I called it unjust?” ~Mere Christianity

“Your real, new self (which is Christ’s and also yours, and yours just because it is His) will not come as long as you are looking for it. It will come when you are looking for Him. Does that sound strange? The same principle holds, you know, for more everyday matters. Even in social life, you will never make a good impression on other people until you stop thinking about what sort of impression you are making. Even in literature and art, no man who bothers about originality will ever be original whereas if you simply try to tell the truth (without caring twopence how often it has been told before) you will, nine times out of ten, become original without ever having noticed it. The principle runs through all life from top to bottom, Give up yourself, and you will find your real self. Lose your life and you will save it. Submit to death, death of your ambitions and favourite wishes every day and death of your whole body in the end submit with every fibre of your being, and you will find eternal life. Keep back nothing. Nothing that you have not given away will be really yours. Nothing in you that has not died will ever be raised from the dead. Look for yourself, and you will find in the long run only hatred, loneliness, despair, rage, ruin, and decay. But look for Christ and you will find Him, and with Him everything else thrown in.” ~Mere Christianity

C.S. Lewis

I could go on and on and on, but I will stop here with all the C.S. Lewis quotes. : )

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Our Actions Reveal What We Believe

Topic:  In response to JR Kerr’s sermon on the Book of James

Location:  Park Community Church 

Date:  11/21/10

James 1:22-22:  22 But don’t just listen to God’s word. You must do what it says. Otherwise, you are only fooling yourselves. 23 For if you listen to the word and don’t obey, it is like glancing at your face in a mirror. 24 You see yourself, walk away, and forget what you look like. 25 But if you look carefully into the perfect law that sets you free, and if you do what it says and don’t forget what you heard, then God will bless you for doing it. 26 If you claim to be religious but don’t control your tongue, you are fooling yourself, and your religion is worthless. 27 Pure and genuine religion in the sight of God the Father means caring for orphans and widows in their distress and refusing to let the world corrupt you.

At my church, Park, we are currently going through the Book of James.  Yesterday JR Kerr gave the sermon.  Both him and Jackson are excellent pastors, but I especially love listening to JR preach.  I think that because he’s in his 30s, he relates well to the population of predominantly young professionals at our church.  What I especially like, though, is how he’s completely blunt and has no fear in roasting us all (as Kia would say it ; ).

I don’t go to church because I want to feel comforted, at peace, or feel good about myself.  There are plenty of other ways to do that.  When I go to church, I want to be challenged to strengthen my walk with Christ…I want to be challenged in my beliefs and way of thinking.  I want to indepthly reflect on my character and God’s character.  I want to walk out of there with intent to improve myself, to continue to try to better understand God’s will, and to live in line with his plan.

So back to the sermon from this week.  The most important message I took away from JR’s sermon was how our actions will ultimately reveal our beliefs.   It’s a simple statement to understand but a much more difficult concept to grapple with when we apply it to our own lives.  So many of us have ideals about what we want our identity to be, how we should live our lives, and what our goals are, and yet so many of us are either A) hypocritical, and/or B) we’re simply not committed enough to these ideals and goals to put in the sacrifice that’s expected of us to achieve them (I say “we” because this includes myself, too).

Let’s address A, hypocrisy: If we claim to be Christian and/or are broadcasting whatever our beliefs are on others, does the way we live our life truly reflect that?  I’ve always felt that actions speak louder than words, and during my time of agnosticism I was really turned off by Christianity in part because of some unfortunate circumstances in which people promoting Christianity did not seem to be very Christian-like—don’t get me wrong…none of are perfect and all fall short, but we should continually be actively trying to change ourselves and correct our shortcomings.   It’s the direction we’re headed rather than the specific spot on the road we’re at in our walk with Christ that matters—an obvious example include those who believe abortion is equivalent to murder and yet believe murdering a physician who performs abortions is ok.   Another one, in my opinion, are Christians who banish and/or make gay and lesbians feel uncomfortable attending a church.  I am not going to go into a discussion about whether homosexuality is a sin or not, but whatever your beliefs are on that issue, treating anyone differently because of their sexual orientation is NOT Christian-like, and it pains me when I see that happen.

Many examples of hypocrisy, however, are much less obvious.  For example, someone who claims to be humble and to care for the poor and yet does charity work with an underlying motivation to boost their resume and/or look good in front of others.   I’d be lying if I said that wasn’t at least part of my motivation for doing volunteer work in high school and college!

Addressing B:   Are we really committed to what we say we believe?  Are we really willing to make the sacrifice? Most of us like the idea of an intimate relationship with someone, but are we really willing to make the “sacrifice” that’s involved?  We want to do well in school and our careers, but are we willing to put in the hours of studying that’s involved?  Do we say family and friends mean the world to us, but let other things take priority over strengthening these relationships?  Are we always “too busy.”

I fall way short in this area.  I am very often selfish with my time.  I like the freedom of being able to plan my time and spend it as I desire, which often gets used up on studying and on athletic and other personal pursuits.  I owe soooo many people phone calls (Sara, Sarah, Melanie, my grandparents, my sister, etc.)….so many people mean so much to me, and yet my actions often don’t show that.

Financial discipline is another thing I struggle with and am apparently not committed to when you analyze my actions and purchases.  I am a physician resident and owe the government, my school, and especially my parents a ton of money, and yet I still don’t find myself sacrificing as much as I should. This past month (I hate to admit this) I had to borrow some money from my parents because of recent traveling and car expenses amongst other things, and yet, I almost bought myself a $50 shirt from lululemon the other day (it was such a cute corral shirt with crossing straps on the back! I BARELY was able to resist, but I did!).  I’m not criticizing or judging anyone for the purchases they make–I spend a ton of money on “luxury”/not needed things–I am merely criticizing myself for almost buying something I didn’t need after just having to ask my parents for some money.

JR asked us, “When was the last time you devoted 20 minutes to Quiet Time (i.e. scripture reading and prayer) for 7 days in a row?” and then “When was the last time you spent 20 minutes watching TV 7 days in a row?” Ouch.  Roasted.  Although I’m not a big TV watcher, there are plenty of other things I waste time on.   For example, I’m apparently not as devoted to God as I am to my computer.

So much to work on! So many areas of my life I need to be more disciplined with if I want to focus on the things that I claim to be important to me. I’ll finish with a related bible verse from one of my favorites passages (Matthew 6) and then some quotes that JR addressed in his sermon.

Matthew 6:21:  Wherever your treasure is, there the desires of your heart will also be. When I read this, I interpret “treasure” to include whatever we spend our time or money on.  We can only truly worship one God/thing.  What we devote a large percentage of our time and/or money on is a reflection of what’s important to us.  Is it God and relationships, or is it career, clothes, athletics, drinking-related activities, TV, facebook, etc.?

Quotes shared by JR Kerr during the sermon:

“I have always thought the actions of men the best interpreters of their thoughts.” ~John Locke

“Cheap grace is the grace we bestow on ourselves.  Cheap grace is the preaching of forgiveness without requiring repentance, baptism without church discipline, Communion without confession…. Cheap grace is grace without discipleship, grace without the cross, grace without Jesus Christ, living and incarnate.”  ~Dietrich Bonhoeffer (The Cost of Discipleship)

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When Hope is Gone

This was originally posted on my other blog on 9/12/10.  It is about a patient I had with a terminal illness and her reaction as she faced death head on.

Details have been changed or left out.

“What are you doing back here?!”  I jokingly asked Mrs. Davis as I popped into her hospital room.  Mrs. Davis was this sweet, optimistic, chatty 70-something year old widowed lady that I had taken care of a couple of months ago last time she was in the hospital.  Her friendliness and cheerful demeanor had made her one of my favorite patients.  She was back in the hospital because she was having progressive difficulty breathing.

Mrs. Davis had been overall relatively healthy until she started having some slight difficulty breathing a year ago.  She was diagnosed at that time with a condition that was called Idiopathic Pulmonary Fibrosis (IPF).  When someone has IPF, the space between their lungs and capillaries (interstitium) becomes progressively thickened and scarred (fibrosis), making it difficult for oxygen in the lungs to diffuse into the capillaries.  In addition, the scarring and thickening of the lungs makes them less elastic, which makes breathing more difficult for the patient.  Sadly, idiopathic pulmonary fibrosis is a fatal condition, and to date, no proven effective therapies are available. The estimated mean survival is 2-5 years from the time of diagnosis.  People can progress faster than this, though, and I was concerned Mrs. Davis may be one of those unfortunate persons.   She looked worse than she did the last time I saw her; she was more pale and had a bluish hue to her lips and nail beds.  I was concerned by how low her oxygen levels were getting.  No matter what we did, we couldn’t keep her oxygen levels from dropping dangerously low.

Mrs. Davis, however, was quite oblivious to the severity of her condition, and I began to feel that we should discuss with her her disease and prognosis and then address different care options.  Once she was equipped with more information regarding her prognosis, would she still desire to have the primary goal of her care be to do whatever therapy and intervention is necessary to keep her alive?   Or once she knew how her disease would continue to progress, would she choose to pursue a level of care that has a primary goal of her improving her quality of life and symptoms?  If she chose the latter, additional resources would be available to her if she enrolled in hospice care, which specializes in improving a patient’s quality of life when their life expectancy is 6 months or less.

After talking to the general medicine doctor, we decided that regardless of whether or not she overcame this flare up, her disease was progressively getting worse and there was a reasonable chance she could succumb to it within the next six months, so we should discuss her prognosis and bring up the option of hospice care with her.  I put in a consult for the hospice care coordinator to stop by and discuss what options were available for someone in hospice care….they are trained for these discussions and do them regularly, so I felt they would do a better job than me at describing the care options and goals of hospice.  In regards to discussing her prognosis, I decided to sit down with her tomorrow morning.  It was four o’clock in the afternoon, and I figured hospice would come by sometime tomorrow, since I had put the consult in so late.

The next day when I walked into Mrs. Davis’ room for my regular morning rounds instead of seeing her normal upbeat face, she looked completely panicked.  She grabbed my hand and said, “I’m going to die.  Oh my god, I’m dying ….I’m going to die.”
I was speechless.  Did hospice come by before any of us had carefully discussed her prognosis with her?  Did the general medicine doctor discuss it in too blunt of a way?   I couldn’t calm her down.   It was like she was in an unremitting panic attack.

I felt awful.  Why had I been so eager to rush out of the hospital yesterday?  Sitting down with her to discuss her condition wouldn’t have taken more than twenty minutes…instead I had gone home and went about the rest of my day carefree while she–who had been healthy a year ago and happy and bubbly on a regular basis—experienced a head on collision with her fate and was left traumatized.  Or maybe we were too quick in determining what her fate would be.  Maybe we should have given her a little more time to first see if she would recover from this acute episode, which may have changed our perspective on the time line of her disease progression.

Mrs. Davis got in touch with her out-of-town daughter over the phone.   They together decided to go the hospice route.  The next day when I arrived at the hospital, I discovered Mrs. Davis had been moved to a different floor since she had changed her code status and no longer needed her vitals monitored 24/7.  I was hoping she would be more relaxed.  Unfortunately, this was not the case.  She seemed even more agitated than before.  After talking to the nurse, I realized why:  she thought they had moved to a new room to die.  She was so fixated and panicked about the thought of dying, that it was affecting the way she perceived every action and comment.  It was also affecting her breathing.  Because she was panicked, she was much more restless and was constantly breathing at a fast pace, which was not helping her oxygen levels.

Her daughter arrived from out of town that day.  The next morning I learned that she and her daughter had stayed up all night lying next to each other and talking.  When I saw Mrs. Davis, it was evident that many tears had been shed; she still looked panicked, but it did appear as though some weight had been lifted off of her shoulders.  I listened to her heart and lungs and then hung around a bit longer talking to her and her daughter.  They shared with me some of their funny stories from the past.  Mrs. Davis then shared with me some of her not-so-fond memories and then looked over at her daughter and continued on by saying, “but overall, I think I did a pretty good job.”  I laughed and said I agreed.

I still had to see some other patients, so I said I’d stop by a little later when I was done to see them and determine what they had decided (her daughter was going to look around the area for a good place for her mom to live at and get care during the next couple of months).  I left their room and started heading over to the other end of the hospital to see my next patient.  I was just about to start examining my next patient when my pager went off.  Ugghhhh, I thought.  “Hold on,” I told my patient, “I have to answer this page.  I’ll be right back.”  I left the room to call back the number I was paged to.

“Hello, It’s Julia returning a page.”

The nurse on the other line said, “She passed.”  It took a second for me to register what she had just said.

“Wait, what?!”

“Mrs. Davis….she passed away.  We need you to come and confirm the time of death.”

“But I just left her room 15 minutes ago!”

I rushed back to her room in a state of shock.  Yes, she had a serious condition that we felt she was likely going to pass away from sometime over the next several months, but no one felt she would die in just a few days!

I arrived in her room, went through the motions of examining her one last time and then announced her time of death.  I turned to her daughter, who had remained at her side since I had left the room, hugged her and said I was sorry as I struggled to hold back the tears.

I couldn’t stop thinking about Mrs. Davis the rest of the day.  Was it her sudden change in mood and state of panic that had lead to such a quick demise?  If I had more carefully heeded to the advice of the cardiologist (“all she needs is some TLC”) and had done a better job of discussing her prognosis and goals of care, would she still be here?  Did I strip her of the one thing all of us need in our lives….hope?   If we had chosen not to discuss her impending death with such haste and to instead continue our efforts at getting her through this acute episode, would she have kept her hope and positive outlook on life and subsequently gone on to live several more weeks or months?  The one good thing is that her daughter was able to come into town and be at her side during her last few hours of life.  Perhaps her condition was in fact a lot worse than we all thought and that by going over her poor prognosis she was able to make sure she saw her daughter one last time and have her by her side during her last breath.

Although this happened several months, I still think of her from time to time and how the power of how one’s outlook on life can have such a profound impact on someone, and how we in the medical field have the ability to affect that in someone.  I also think about how there will come a day when each of us will take our final breath here on earth.   It’s inevitable, and we should live each day with that knowledge, make the most of our time, and treasure each moment.

Therefore, since we have been justified through faith, we have peace with God through our Lord Jesus Christ through whom we have gained access by faith into this grace in which we now stand. And we rejoice in the hope of the glory of God.  Not only so, but we also rejoice in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not disappoint us, because God has poured out his love into our hearts by the Holy Spirit, whom he has given us.  Romans 5:1-5

And now these three remain: faith, hope and love. But the greatest of these is love.  1 Corinthians 13:13

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The Unexpected

This was originally posted on my other blog on 5/23/10 and is about a sudden, unfortunate and sad set of circumstances for a young patient and her family.

Note, the details of this story will be changed to protect the identity of those involved:

Things had started off particularly calm during one of my calls in the ICU (intensive care unit).  I was looking up some trivial stuff on one of the computers in the unit when I heard the overhead speaker system be turned on.  Uh oh, I thought.  The majority of announcements done overhead are usually done to alert people of a patient in critical condition either in the ER or somewhere else in the hospital.  I held my breath and waited in suspense to hear what news was about to be delivered.  “Respiratory Stat to the ER.”  Crap, I thought, this meant the person arriving had likely arrested (i.e., there heart had stopped and they were getting CPR) and/or they were unresponsive and unable to breath on their own.  This announcement mobilized those involved in intubating someone.  For those not involved in the medical system, when someone is intubated, a tube is put down their throat into their trachea.

This tube is then connected to a machine, which does the breathing for the patient.  This is called mechanical ventilation.  A mechanical ventilator can be used in a variety of situations.  It is used every day in the OR.  Whenever someone gets “knocked out” with general anesthesia,” they are temporarily connected to a breathing machine for the length of the surgery until they wake back up.  In the ER, however, a mechanical ventilator is saved for those in serious condition who can’t breath on their own.  After the initial emergency is over, it is also capable of keeping someone physically “alive” even after they are “brain dead.”

When the respiratory team is called to the ER, one of two things usually happens.  The patient either dies or they get intubated and sent up to the intensive care unit, where I was currently working, so after I heard that announcement, I decided to head down to the ER and see what was going on.

As I walked into the ER, I saw the paramedics quickly wheel in a young, pale, unresponsive blonde-haired women whose heart had apparently stopped beating and was now only weakly beating after several rounds of CPR had been given by the paramedics in the ambulance.  “Organized chaos” then broke out in the ER as often happens in these situations…nurses and techs were running around grabbing tubing, needles, bottles of medicine, diagnostic equipment, etc.  Other health care personnel such as myself were getting ready to evaluate the patient and perform CPR if the patient “crashed” again.  After the patient appeared to be somewhat stable, I stepped back, since it was already crowded in the room and technically my role was to care for the patient if she made it to the ICU.

I looked at the thin, thirty-something year old women and shook my head in frustration.  What is wrong with these people?  I had instantly assumed that this patient had either tried to commit suicide by intentionally ingesting a lot of pills of some sort or had unintentionally overdosed on recreational drugs, such as cocaine.  This was because, when a young, otherwise healthy person has a heart attack or stroke, drug use is often high up there in the differential. Cocaine can cause one’s vessels to spasm and constrict, restricting or cutting off blood supply.  When this happens in the heart or the brain, it can cause a heart attack or stroke.  Also, for whatever reason, we had recently had a lot of patients admitted to the ICU as a result of over intoxication or drug overdose.  (I find this extremely frustrating because first of all, it’s sad to see the pain and grievances it causes family members who care for them.  Second, it’s a horrible use of resources.  A day in the ICU costs thousands of dollars.).  So, as I looked at all the effort going into reviving this young women, I of course hoped that they would succeed in keeping her alive, but I also felt a twinge of frustration at the situation as a whole.

After she was successfully intubated, I walked over to the “family” room to find the patient’s family and update them on the situation and to find out more information about the women.  I stepped into the room, closed the door behind me, and met the worried eyes of her husband, who was trying to keep himself composed in front of their two young daughters.  I sat down across from him and told him that his wife was alive, but in very serious condition.  As I inquired about her history, he told me that she drank occasionally but never used any drugs.  He went on to tell me that that morning she was complaining of a severe headache unlike her typical migraines, but had taken some advil, lied down, and felt better.   Hmmm, weird, I thought.  The possibility of a subarachnoid hemorrhage entered my mind, but the typical presentation of someone with a subarachnoid hemorrhage is a sudden onset of the “worst headache of my life” that does not go away.  The husband continued on with the story and told me that a little bit later, he heard her collapse in the kitchen.  He ran over to where she was and found her lying on the floor, not breathing.  I gathered some more information from the husband and then told him I would keep him updated.

I returned to the hectic ER room and saw the patient being wheeled out of the ER in route to the radiology department to get scanned.  I followed her over to the radiology area and awaited anxiously for the images to pop up as the CT scan scanned her head and body.  “Shit!” I literally said out loud when the first images of her head were loaded onto the computer screen:  all the areas between her sulci and in the subarachnoid space were lighting up white.  White on a CT scan in this area = blood.  She had in fact suffered a massive subarachnoid hemorrhage.

I was in shock by the site.  Subarachnnoid hemorrhages usually result from either trauma to the head that tears one of the vessels or from an aneurysm or AV malformation.

Her bleed was too large to be attributed to a fall in the kitchen…she likely had had a congenitally weak vessel in her brain that had burst.  My heart sank.  Her prognosis was now even worse than we had originally thought.  I felt horrible for her and her family.  If she lived, she would never be normal again.  I also felt guilty about my own thoughts and feelings.  I was mad at myself for having jumped to the conclusion that her condition was a result of illicit drug use.  Then, as I further analyzed my feelings, I felt even worse about what my guilt implied about my own way of thinking and prejudices.  The fact that someone’s grave condition was a result of a drug overdose shouldn’t dampen the sadness of the situation.  Sure, people make an active choice about whether or not to use drugs or alcohol, and that is frustrating, but it’s not the simple.  Clearly the majority of them don’t intend to end up in the hospital on life support.  There a lot of deeper reasons that people turn to drugs.  Whenever a young person ends up in the hospital, regardless of the reason, it is absolutely devastating.

We brought the patient back to the ER and examined her again.  Her pupils were fixed, her reflexes were gone….she was essentially brain dead.  The ventilator had taken over the job of her brainstem and was keeping her body physically alive.  As I looked at her, she looked so calm and peaceful, as if she was merely taking a nap, but I knew that if the ventilator were turned off, her body would die.

The situation was a reminder of a couple of things to me.  First, of how fragile life is, and how quickly one’s life and the lives of his/her loved one’s can change.  One minute you’re in the kitchen getting the food ready for dinner, or driving in your car listening to music, or biking down the street admiring the nice weather, and then the next second you’re in critical condition from either a brain hemorrhage, a car accident, a fall from your bike, etc.  It can happen to any of us, and it can happen to any of our family or friends.  Appreciate every second with them.   Second, always keep an open-mind, and don’t be quick to pass judgments and make assumptions.

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Falling Through the Cracks

This was originally written October 24th, 2009 while on the internal medicine service.  This was transferred from my other blog and is about a young homeless patient who died shortly after admission to the hospital, without a single friend or family member at his side.

During my last night on call, I admitted this homeless, cachectic man who had come into the Emergency Department. When I entered his room to interview and examine him, my attention could not help but be drawn to the left side of his chin, where there was a gigantic, necrotic tumor extending about 7 cm beyond his jaw line. From reading the chart, I know it was a stage 4 cancer. When cancer spreads beyond it’s original location, it is considered stage 4, or “metastatic,” which in the far majority of cases (as was the case for him) means it’s terminal. He had been homeless for the majority of the past 17 years, and so he obviously had no type of health care. He was sarcastic and cranky, but I couldn’t blame him given his condition:

Me: Do you drink (we have to treat people who drink alcohol differently to prevent w/drawl, which is why we ask)
Him: yes

Me: How much, a couple of beers a day?
Him: A couple of beers?! I start drinking at 7 in the morning and continue until 5 or 6 at night or whenever I run out of money.

Me: Smoke?
Him: I’ve been smoking for 22 years, and I’m not stopping now! (and why should he at this point?)

Me: Well, you want me to order you a nicotine patch…you can’t smoke in here.
Him: What? Fuc*. I can’t smoke in here? They used to be able in hospitals. Fuuuucccc***, oh, and just to warn you, I curse all the time.”

Him: I’m fuc*in hungry. Can I get something to eat? Actually, can I get 2 desserts?
Me: (I’m thinking, please eat! he weighs less than I do) I’ll order you three if you want.

Anyways, long story short, he came in because he was bleeding profusely from this huge tumor and needed a blood transfusion. Later that night, we got called to his room, because his tumor had started bleeding again. Shortly after getting that under control, we were called to his room again because he started having trouble breathing. Because the tumor tracked all the way into his mouth, we think he aspirated on some of his blood. His condition continued to worsen. He was continuing to have trouble breathing, was in pain from his tumor and overall poor state of health, and was becoming agitated and confused. We felt that he may not make it through the night or the next day.

I found his brother’s number in his cart and called him to tell him that his he was likely not going to be able to breath much longer on his own. The brother was friendly but didn’t show much remorse: “Well, I agree with what he told you, he didn’t want any measures taken to extend his life (the patient was clear about this the other day, clearing stating that he just wanted to go)….I haven’t seen much of him the last 15 years because he’s been homeless, but I’ll do my best to get there.”

When I left the next morning post-call, he was struggling to breath, but he was hanging in there. Later that afternoon, I called the nurse’s station from my apartment to check and see how he was doing. “He passed earlier this afternoon,” she told me. No one was there from him. He had a friend from church there when we admitted him (he had been staying occasionally at a church shelter), and I was under the impression that his brother may have briefly stopped by earlier that day, but that’s it. He was only 44. How sad to pass away with no one at your side who cares for you or that you’re dying? It saddens me that there are so many people in this world who fall through the cracks..

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