The Road Less Taken

Am I a closet liberal?

2006-09-12T08:33:00.000-05:00

You do not examine legislation in the light of the benefits it will convey
if properly administered, but in the light of the wrongs it would do and
the harms it would cause if improperly administered. -Lyndon B. Johnson,
36th US president (1908-1973)

While I am no great fan of Lyndon Johnson, I agree completely with this statement. Sometimes I fear that my friends think that I am a liberal in disguise when I advocate restraint in a situation where they think that the government should intervene. I am reminded of the situation in New York a couple of years ago where a couple was living in an abandoned car but still having children to be paid for with state welfare money. A judge ordered the woman to have her tubes tied and the ACLU fought to have the decision overturned. I found myself in the odd position of siding with the ACLU. While I think that what the woman was doing was distressing, I reflected on what might happen in another Clinton administration if government was empowered to intervene in people's lives in this manner. About the same time, I remember a proposal that families on welfare should be compeled to take parenting classes if they recieved public assitance. Again, this sounds like a good idea but can you imagine what sort of content would find its way into these classrooms.

"No revolution was ever fought because government intervened too little into the lives of its people." Who said that? I did--and please feel free to quote me. "I prefer the danger of freedom to the security of tyranny." That came from Thomas Jefferson (and I don't remember the exact quote). Restraint of government intervention carries a price. Freedom creates a certain amount of danger that people will not act responsibly. I accept that. In the end, LBJ was right. Authority and power given to the government should not be entrusted without first identifying the damage that it can do along with the good.

Why we clash

2006-07-10T07:28:00.000-05:00

I suspect that much rancor between people lies in a misunderstanding of the other, especially in ways that we do not even understand. I once wrote about vertical and horizontal thinkers. In addition to the ways we think, there are differences in our approach to time management that drive us crazy with each other. I am task oriented. My wife is time oriented. At the beginning of the day she will know what she has to do. If she has to be somewhere by 4:00 PM, she will know everything she has to do, in what order, and by what time in order to be where she needs to be when the clock strikes four. She gets everything done and does it on time. She is efficient. She gets things done at home. She is "time-oriented."

God bless my wife. She lives with me. I am "task-oriented." In my world, clocks and time do not exist. I wouldn't last a (fill in the blank with your favorite ambiguous time reference) at Federal Express. Put a task or a patient in front of me and the world shrinks to nothing more than what I am dealing with at the time. Time stands still. After a long while, I may get a sense of passing time. For the most part, the only thing that concerns me is doing whatever is necessary to fix the problem, diagnose the patient and formulate the plan of care, etc.

We used to drive each other crazy. I would be aggravated by her goading me along and she would be irritated by my lack of consideration of other tasks. I didn't care about the other tasks. When I finished what I was working on, I moved on to something else. I worked by a prioritized "Honey do" list and she worked by a timetable. My world is a vertical list and her world is a horizontal timeline. When I learned about the differences in working styles, the light dawned. I now understood the "beat the clock" mentality. (For those of you who have no awarenes of daytime game shows before the mid sixties, you will want to know that "Beat the Clock" was a game show built around getting contestants to do silly things under time pressure. Its name has survived as slang.) Now my dear wife began to understand my (seemingly) slothful approach to getting things done.

Things are now better at the Code Blue household. We each understand the leanings of the other (and our very different children). I try to meld my open-ended approach to the clock and my dear wife is more patient about the unstructured approach I take to doing things. There are many other landmines that we step on unknowingly. More about those in another post!

What lies beneath

2006-06-06T06:41:00.000-05:00

Wasn't that the name of a movie from a few years ago? What does lie beneath the surface? Fifteen years ago, I was working as a sales rep for a medical device company and calling on a Veteran's Hospital nursing home. Been in a VA nursing home recently? They house the ancient of the ancient. The institutional halls were inhabited by wheelchair-bound old men whose dementia took their ability to speak or care for themselves years ago. It was a pathetic and depressing site to see the warehousing of barely-warm bodies whose sole purpose in life was awaiting death.

On the way out, I passed a wall in the lobby. Adorning the walls were pictures of young soldiers in uniform in various situations. They were the pictures that inspire the noble images we hold of brave, young men defending our nation. I asked the receptionist about where the pictures came from. I was stunned to find out that they were the World War I era pictures of the men I had just seen minutes earlier in their now ignoble condition. I could hardly believe that the subjects of those vibrant pictures could now possibly be the vain imitation of human existence I had just witnessed. I looked at those pictures for the longest time.

There is hardly a day that passes that I do not think of those veterans. I encounter on a daily basis the elderly and the infirmed. I see people who are old. I see people who are morbidly obese. Had I a chance to know these individuals before years and pathology took their toll, my image of them would be different. We do not normally have that luxury. When we see someone for the first time, we see them as they are then. When I look into the sunken face of someone who weighs 350 pounds, I try to imagine what they would look like if they were normal weight. When someone is disfigured by illness, I look at their face and try to imagine what that "person" was like before they became a "diagnosis."

"What lies beneath"? It isn't always easy to get past 200 pounds of "baggage," or the altered mental status of advanced years, or mental illness, but behind everyone we see like the old soldiers of the nursing home is someone who was once young and healthy. "What lies beneath" is the "real person" now obscured by time and disease. If I am lucky, I will live long enough for people to look at me and see me as something less than attractive and I hope someone will look beyond the surface with me.

The next time you see someone whose appearance causes you to change the focus of your attention, linger for a moment. Try to see that person as they once were. Try to see the person." It may not make you "fall in love" with them, but it is certainly an interesting exercise when you start to see below the surface.

Don't Shoot Taylor Hicks!

2006-05-30T08:33:00.000-05:00

I followed with more interest than usual the crowning of our latest American Idol, Taylor Hicks. The gritty, southern bar singer with the Elvis Presley eyes snagged top spot in this year's competition. I believe that it was Paula Abdul who pegged the secret of his success. "No matter what song you sing, you always know who you are," she lauded on the last night of competition. That's it! I realized that my admiration of Taylor Hicks had less to do with what he sang than how he sang it. With each performance, my interest was more in his energy and the personal interpretation he brought to the song than the song itself. It wasn't the message, it was the messenger.

Pity the poor pundits on our local radio show who did not realize that. They made the mistake of saying that Taylor Hicks did not have his best performance the night they announced the winner. For this, they were vilified. Never mind that Taylor and Kathryn were both probably exhausted physically and mentally. Never mind that they spoke the truth. They said something less than flattering about Taylor. The audience was not defending the performance, they were really defending Taylor.

"Don't shoot the messenger," goes the old saw. We oft forget how closely the link can be forged twixt message and messenger. We are mindful of those who carry bad news. The soldier who brought the news of king Saul's death to Jerusalem paid with his life. We are less mindful of the fact that those who bear good tidings are just as likely to be looked upon favorably simply because of their message. Remember Philippides? Remember his message,"Nike!"? Legend has it that he carried the message of Miltiades' victory in the battle of Marathon to Athens. He reached the acropolis and uttered that one word before dying. His sacrifice to bring good news has beenmemorialized in the long-distance race ever since.

The corollary to both of these situations is the bearing that the messenger has on the message. Would you rather have a character reference from O. J. Simpson or Billy Graham? Can you see Ted Kennedy doing a PSA for MADD? Could Tom Cruise endorse Prozac? What if Einstein could endorse Sylvan Learning Center? Just as surely as a messanger can be shot for carrying bad news, a message can be deemed inherently good or bad based solely on our perception of the person who delivers it.

Roll on, Soul Patrol! We wish you the best. And as we watch you evolve from local boy to national star, let us pause to remember the lesson that you and the radio pundits taught us about the confluence of message and messenger.

2006-05-15T11:52:00.000-05:00

Please forgive me if I misspelled it.

This is the word from the Greek that is the ancestor of our words "deacon" and "diaconate." The word "deacon" implies "servant." While most of us will never be formally inducted into the diaconate, we are all servants of God. If we are servants, what kind of servants are we? Words occasionally lose some of their meaning in the leap from one language to another. Diakonos means "through the dust" and implies more than our simple word "servant." The image conveyed by the Greek word diakonos is that of a servant who raises a great cloud of dust in his haste to do his master's bidding. Alas, were you to see my record as a servant, you would think that the best descriptor for me would a word whose Greek origin implies "collecting dust" in stead of raising it. Any time I think that I am really working hard, I think of the mental picture of God's idea of a servant and smile. ;-)

Perpetuating Abuse

2006-04-27T06:32:00.000-05:00

This is a continued thought from my last two postings.

I am not an expert on abuse but there are some things I have learned. Abuse may not be genetic but it can be passed from generation to generation as modeled behavior and personality disturbance. I have talked to abuse victims who viewed the behavior in the home they grew up in as normal. Unfortunately, aside from just the modeled behavior, abuse can have a tragic impact on the mind of the victim.

Problems can start when the victim has two parental figures with extremely different interaction. The abusive parent creates an extremely negative self-image. The other parental figure may be worlds apart in their interaction with the victim and they will have some positive feelings about themselves. These polar images of themselves may be difficult to integrate into a single self-concept. As a consequence, the victim grows up not knowing who they are or, in some instances, wondering if they are even a person at all. This is the foundation of borderline personality disorder (BPD). The DSM IV criteria follows:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsively beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

4. Impulsivety in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

7. Chronic feelings of emptiness.

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

BPD rarely exists by itself. It is a common companion to depression and can easily be mistaken for bipolar disorder. I have spoken to several borderlines about their struggles. The things that have been told to me that stand out the most:

The mood swings that can send people into the depths of despair and anxiety.

Problems with controlling their temper. They sometimes know what they are doing when they do it but,"I feel so justified at the time," said one borderline. She, unlike some other borderlines, would feel guilty afterwards.

The "splitting." Just as they have extreme views of themselves internally, they tend to view the world through a prism of only black and white. Something or someone seems to be either all good or all bad. This view can change abruptly from white to black.

The lack of identity. Some borderlines aren't sure she they are or even if they really are a person. I asked one borderline who she thought she was and her answer came,"A very sweet person with a monster inside." She knew what she could be like when provoked.

We have all heard the stories that strain our credulity to the breaking point. Man beats wife. Man apologizes and says he really loves her. Woman goes back to man. How does this happen? Mix a borderline with a codependent and it is easy. The borderline has a mood swing or, for some other reason, sees his wife as suddenly going from white to black. There is an outburst and he physically abuses her (although a lot of verbal abuse goes on as well). The outburst passes. He really does love her and really is remorseful (though not always, but it can really happen this way). The codependent wife does not have the self esteem not to put up with this and is convinced that the violence was her fault and she continues in her relationship with the abusive husband.

This is not THE way it always happens but it is A way that it can happen. A child is abused. He (Most abusers are men but most borderlines are women. Men tend to be physically abusive and women tend to be guilty of verbal and emotional abuse.) learns abuse as a normal pattern of behavior but also develops a polar self-concept and evolves into borderline personality disorder. The pattern can then repeat to the next generation.

Many people in abusive relationships (both the abuser and the abused) do not even realize that there is a fundamental problem, let alone what that problem is. I hope this post helps someone recognize what is going on in their life or the life of someone close to them.

The Living Nightmares

2006-04-20T07:12:00.000-05:00

There are things that haunt my dreams. My last post was on nightmares and my revelation as to just how prevalent abuse really is. I have heard patients say some amazing things over the years. I heard a patient who weighed six hundred pounds say that she just never thought of herself as being that fat. I heard a missionary with depression say that he doubted that even God could love him. A few months ago I had a woman sit in my office and tell me,"When I was in therapy, they told me that when my husband pushed me out of a moving car that I was being abused." Amazing!

After reading about abuse, a number of things stood out:

1. I am embarrassed to say that most of it is men abusing women or children.

2. Much unrecognized abuse is verbal and emotional abuse.

3. The abuser frequently does not recognize themselves as being abusive.

4. The victim frequently does not recognize themselves as begin abused.

5. The abuser frequently blames the victim for causing the abuse.

6. The victim frequently accepts the blame and feels like they deserve what they got.

7. The abuser has trouble setting limits on their behavior.

8. The victim has trouble setting limits on other people's behavior.

9. The abuser frequently grew up in a home where such behavior was modeled by a parent.

10. The victim has very low self-esteem and no sense of entitlement. They feel as though everyone else's needs come first and are uncomfortable when they do anything for themselves or some else does something for them. They frequently spend their lives pouring out their heart and soul into their family and their jobs. They find themselves disappointed that their spouse doesn't seem to return the effort that they are putting forth on their spouse. They feel like they are living the old joke about,"Marriage is a give and take relationship. I do all the giving and they do all the taking," and they wonder why the other person doesn't "get it." They keep trying harder and harder to make their spouse happy with the vain notion that one day they will win them over and their spouse will recognize them for who they are give them the love and validation that they need but aren't getting.

What I just described are traits of codependent personality. For an excellent discussion of verbal abuse and codependency, go to www.drirene.com.

Why do I write this? I write it in the hope that someone will see themselves and the revelation will come. After all, I am a nurse. I hate to see people in pain. I like to help people get better. There is help for codependent personality. The abuser and the victim can benefit from counseling if they are motivated, but recognition comes first. I am holding the mirror. What do you see?

Interpreting Nightmares

2006-04-05T04:53:00.000-05:00

I know what is coming when I hear the complaint of, "Nightmares." There is no physiologic cause of nightmares and bad dreams save a few drugs like antidepressants and beta blockers. A relatively small fraction of the complainants are men; most are women. The men almost universally experienced something violent like combat or an attack on themselves or they witnessed something traumatic. The vast majority of the time, the woman was abused or molested one way or another.

When I first started in sleep medicine and saw PTSD (post-traumatic stress disorder) in the patient's history, I sometimes made the mistake of asking,"What happened?" I discounted the first few stories I heard as unbelievable. After a number of stories from some very credible people, I began to understand. Steven King has nothing on some of the deeply disturbed people in this world. I finally quit asking. There are stories in my head I will never get rid of. I don't want any more. Some of the dreams they described are just as disturbing. I won't repeat any of them here. I don't want the memory reinforced by writing it out and some of these things don't need to be in anybody else's head. These days when I ask a woman if something traumatic happened to her, I tell her that a yes or no answer will be fine. Most of the time the answer is yes and most of the time they go on to tell me what happened without further prompting. Fortunately, they usually do not go into detail. Occasionally, I will find someone who has never told anyone about their trauma and I can steer them toward couseling. That is gratifying.

One day I may return to this topic and try to sort out how someone can be as abused as some of these women were and not know it. I've heard some amazing stories. For now, I want to share some thoughts on nightmares and dreams.

There are a number of theories on where dreams (good or bad) come from and how they are generated. The theory that I think holds the most relevance for many people is that dreams may represent emotional recall of some kind. Some people relive actual events in their dreams. For others, the visual images and the scenario will change, but the emotion of a prior experience is being relived. The next time you have a bad dream (especially if it is recurring), ask yourself what kind of emotional experience you are having in the dream. Have you had that kind of experience before or is it an emotion associated with something you are afraid of happening? We all want to focus on what the visual imagery may symbolize while overlooking the emotional aspects of the dream. This same theory may explain pleasant dreams as well.

So tell me, just what were you really dreaming about last night?

The Emporer Still Has No Clothes

2006-03-30T14:56:00.000-06:00

One of the delights of being a parent is reading bedtime stories your child. Rereading some of those childhood stories as an adult brings out previously unseen meaning. Such was my experience with "The Emporer's New Clothes." In this story, two con artists come to town to sell the emporer new clothes. They pretend to hold up the most beautiful clothing to the emporer and his court. They expound the sartorial merit of the nonexistant clothing. They add that it is so special that only special people can see it and that only dull and stupid people cannot. Neither the emporer nor his court can see anything but no one will say so lest they be though dull and stupid.

The emporer buys into the scam and orders a wardrobe of this special clothing. After extensive preparation on nothing that any normal person can see, he parades down the main street of town. All the townspeople see the transparency of the sham but begin extolling the wonders of the missing wardrobe lest they, too, be thought dull and stupid. Finally, a little boy blurts out the truth that the emporer has no clothes on. The crowd attempts to silence him to no avail and he protests all the louder. Finally the deceit can stand no more and everyone finally admits the obvious.

Nothing has changed. Today the merchants of moral bankruptcy purvey their transparently empty wares. They wish to expunge God and morality from our culture in the disguise of separating church and state. They are ardent defenders of every kind of free speech as long as that speech does not disagree with theirs. They promote the taking of innocent life while fighting to save the lives of serial killers. And through all of the rhetoric, they claim the moral highground. They purport themselves to be the illuminati. They point the finger at those who disagree with their "enlightened" position and pronounce ththem to be "dull and stupid."

Sadly, like the townspeople, there are those who lack the moral gumption to shout the truth that the emporer still has no clothes. There are those whose priority is to be thought to be among the illuminati rather than see things for what they are and follow what is right. Do not be afraid to be like the little boy who shouted out this "naked truth" and told the word. In the end, the world listened.

My best original thoughts come from other people

2006-03-29T08:20:00.000-06:00

I once dated a young seminarian named Cindy. We had many conversations about God and the Bible. It caught me off-guard when she said something one day that forever changed the way I look at the Bible. She said,"People make claims for the Bible that the Bible does not make for itself."

This shocked me and shook me. What did it mean? What she said sounded right. Did this mean that some of the things I've been taught to believe since I was a child may be different than what scripture actually says? Does everything I believe have a strong biblical basis? Have I let something slip into my thinking that is denominationalism and not true biblical doctrine? One thing that was not shaken was my belief that the God who could speak the universe into existance and create living beings from dust was powerful enough to control what made it into His book and that He could speak to me through it if I listen.

This meant that I had to look at the Bible in a whole new light. I had to have the strength and the courage to look at the Bible with fresh eyes and try to see what it said without any bias from what I had been taught or from what other people said. The Bible is God's word to us. I wanted to hear what He has to say without other people's bias.

The next time you read the Bible, think about my girlfriend's statement. Open your eyes and ears to what you read without thinking about what you have been told a certain passage means. You will be amazed at the things you see.

She tagged me!

2006-03-16T12:03:00.000-06:00

My favorite blogger tagged me with a meme. Here goes:

Four Jobs I Have Had:

1. Cleaning crew at Oglethorpe Mall in Savannah, Georgia.
2. Attendant on a psychiatric unit.
3. Hanging custom-made drapes after school
4. Teaching night classes in a technical college

Four jobs I think might be cool to have:

1. Fighter pilot.
2. FBI Agent.
3. Venture capitalist.
4. President.
5. Independently wealthy.

Four Movies I could watch over and over:

1. Toombstone
2. The Shawshank Redemption.
3. Patton
4. Star Wars

Four places I have lived:

1. Birmingham, Alabama
2. Augusta, Georgia
3. Savannah, Georgia
4. Jackson, Mississippi

Four places I have vacationed:

1. Disney World
2. San Fransisco, CA
3. Washington, DC
4. New York City

Four TV shows I watch:

1. Fox News
2. The History Channel
3. The Apprentice
4. Everybody Loves Raymond

Four Websites I visit daily:

1. Keel The Pot
2. I surf around

Four favorite foods:

1. My wife's chicken casserole
2. My wife's spaghetti
3. The sandwiches my daughter makes for me.
4. Anything my mother-in-law makes

Four Places I would rather be:

1. At sea on an old sailing ship
2. Walking around London
3. Lifting off in the Space Shuttle
4. Skydiving

Four charities I wish I could give thousands (millions?) of dollars to:

1. My church
2. Underground Evangelism
3. The Gideons
4. The Anerican Cancer Society

The Answer to the Question

2006-03-15T16:07:00.000-06:00

I posed the question last week,"What is the link between the story of Balaam's ass and the birth of Jesus?"

The King of Moab had called Balaam to curse Israel. On the way to Moab, he had a change of heart when the angel threatened to part his hair with a sword. When he arived in Moab, he blessed Israel instead of cursing them. Numbers 24:17 records these words:

I see him, but not now;
I behold him, but not near;
A star shall come forth from Jacob,
A scepter shall rise from Israel,

This was a messianic prophecy. Of interest is the fact that the Magi of Mathew's record were probably from the same part of the world as Balaam. It may have been this prophecy that prompted them to make their journey in search of the king.

Bible Question

2006-03-10T20:28:00.000-06:00

I love the hidden "pearls" in the Bible. I don't really like the term "Bible trivia." I will pose this question to the readers. I will give the answer next week some time.

What is the link between the story of Balaam's ass and the birth of Jesus?

You will need to read the whole story to find out.

Have a great weekend!

Code Blue

My doctor told me I was fat. I told him I wanted a second opinion so he told me I was ugly, too!

2006-03-09T07:46:00.000-06:00

OK, I took that one directly from Rodney Dangerfield. In the past week I have seen two patients who haunt me. Their initial management was bungled and they wound up in my office for a second opinion. I work in a major referral center and was trained by one of the leading experts in her field and I don't have any trouble recognizing when basic practice has been trampled. Unfortunately, most patients don't.

This is a brief and pointed homily: Don't be afraid to seek a second opinion. A good doctor is not afraid of another pair of eyes. If they are good at what they do, a second opinion will confirm it. If someone else can see a way to help the patient that they did not see, they are usually glad for the patient's sake and learn from that experience. That is the attitude of a true, competent professional. They are secure with what they do.

I once faced a very daunting medical problem of my own. I got three different opinions from doctors in three different cities (one so far away I had to fly there). I consulted national organizations related to my problem to find the leading experts in the field. After five years of searching, I found a clinic doing experimental minor surgery under an investigational permit from the FDA and my problem finally came to an end. It wasn't anything life-threatening but it sure improved my quality of life.

If you have a problem, don't give up or just take one doctor's word for it. There are so many people doing so many things in medicine today. Sometimes all you may need is another doctor or hospital across town. Sometimes you have to go half way across the country. It can be a daunting process even for someone like me who makes their livelihood in health care but don't give up on stubborn problems. If you don't find an answer to what is going on with you today, maybe you will find something tomorrow, next week, or next year.

The two patients I saw were lucky; they had not been harmed. Other patients take discouraging news from one doctor and never question whether there is a better solution. Don't be one of them.

When I was little, I liked to link paper clips together. And now . . .

2006-03-02T12:22:00.000-06:00

In the beginning was the Word, and the Word was with God and the Word was God. The same was in the beginning with God. By Him were all things made that were made. Then God said,"Let Us make man in Our image, according to Our likeness." So God created man in His own image, in the image of God He created; male and female He created them. Now the serpent was more crafty than any beast of the field which the Lord God had made. And he said to the woman,"Indeed, has God said,'You shall not eat from any tree of the garden?' " When the woman saw that the tree was good for food, and that it was a delight to the eyes, and that the tree was desirable to make one wise, she took from its fruit and ate; and she gave also to her husband with her, and he ate. And God said,"Have you eaten from the tree of which I commanded you not to eat?" The man said,"The woman whom You gave to be with me, she gave me from the tree, and I ate." The Lord God said to the serpent,"Because you have done this, cursed are you more than all cattle and more than every beast of the field; on your belly you will go, and dust you will eat all the days of your life; and I will put enmity between you and the woman, and between your seed and her seed; he shall bruise you on the head and you shall bruise him on the heel." He is a man of sorrows and acquainted with grief, pierced through for our transgressions, crushed for our iniquities. For a child will be born to us, a son will be given to us. The government will rest on his shoulders and His name will be called Wonderful Counselor, Almighty God, the Everlasting Father, the Prince of Peace. The Lord Himself will give you a sign: Behold, a virgin will be with child and bear a son, and she will call His name Emmanuel. In the sixth month, the angel Gabriel was sent to a virgin named Mary and he said,"Behold, you will conceive in your womb and bear a son, and you shall call his name Jesus. He will be great and will be called the Son of the Most High." The days were completed for her to give birth and she gave birth to her first-born son and wrapped him in swaddling clothes and laid Him in a manger. The Child continued to grow and become strong, increasing in wisdom; and the grace of God was upon Him. And Jesus said,"For God so loved the world that He gave his only begotten Son that whosoever believeth on Him should not perish but have everlasting life." And Jesus said,"Destroy this temple and in three days I will raise it up." Then they took Him to the place called Golgotha and they crucified Him. So they took the body of Jesus and wrapped it in a linen cloth and laid Him in a tomb cut into the rock, where no one had ever lain. Now after the Sabbath, as it began to dawn toward the first day of the week, Mary Magdalene and the other Mary came to look at the grave. And behold, a severe earthquake had occured, for an angel of the Lord descended from heaven and came and rolled away the stone and sat upon it. And his appearance was like lightning, and his clothing as white as snow. The guards shook for fear of him and became like dead men. The angel said to the women,"Do not be afraid; for I know that you are looking for Jesus who has been crucified. He is not here, for He has risen, just as He said. Come, see the place where He was lying. Go quickly and tell His disciples that He has risen from the dead; and behold, He is going ahead of you into Galilee, there you will see Him; behold, I have told you." And they left the tomb quickly with fear and great joy and ran to report it to His disciples. And behold, Jesus met them and greeted them And they came up and took hold of His feet. So who will separate us from the love of Christ? Will tribulation, or distress, or persecution, or famine, or nakedness, or peril, or sword? Just as it is written, "For Your sake we are being put to death all day long; We were considered as sheep to be slaughtered." But in all these things we more than conquerors through Him who loved us. For I am persuaded that neither death, nor life, nor angels, nor principalities, nor things present, nor things to come, nor powers, nor height, nor depth, nor any other creature, will be able to separate us from the love of God, which is in Christ Jesus our Lord.

Amen

I hope God strikes me blind

2006-02-28T12:13:00.000-06:00

I read a recent post about the parable of the sower whose seed fell on various kinds of land with predictable results. The point of the homily was that we, unlike the sower, have unlimited seed to sow regardless of the outcome. I fear that I am sometimes in the business of predicating sowing on my assessment of the expected outcome. Nay, I am so generous with myself. Personal evangelism is a great weakness of mine. Were it not for the incorruptible nature of the seed, most of mine would meet its demise from dry rot before I broadcast it.

Yet in my mind reposes that moment in time when I dared share with another human being. I worked as a nurse in the county emergency department. Proselytizing was streng verboten. That was OK. I would see the endless parade of drunks and druggies and knew that they needed God more than anybody. I kept copies of The Four Spiritual Laws in my pocket and would slip them into patient's clothes when they got undressed for them to find later. On rare occasion I would summon all my inner strength and hand one to someone and say,"This is for you and smile," but never follow up.

One afternoon, I worked up a girl in her late teens. She was dirty, straggle-haired and barefooted. She had needle marks up and down both arms and was concerned that one was infected. I took her blood pressure and wrote down her complaint. I told her that the doctor would be in to see her in a little while and gave her the pamphlet and left. I saw her only twice more. I passed by the waiting area and saw her leafing through and reading. Later, I passed her in the hall as she was headed for the front door as I was taking a patient to x-ray. She looked up at me with such a smile and said,"Thank you." I smiled back. It was all I could manage.

On the day that I draw my last breath I will wonder whatever became of that young girl and I will be glad I gave her that tract. Pray for me that I will learn to share the Good News more freely. Today my contact is more with people who are spiritually dirty. Pray that God will strike me blind. Pray that when I summon all my courage that I will not be held back by thinking that the seed will fall on rocky soil and be of no use. Pray that I will always remember that warm summer night in a county emergency department that I had the courage to throw seeds on what I thought was rocky ground and discovered that I was just a poor judge of real estate.

Pinch me! Am I really writing about childbirth?

2006-02-23T06:49:00.000-06:00

My friend recently wrote me to let me know that an article she wrote will be published in a peer-reviewed journal. Her premise is that normal birth in the USA is skewed and that normal (or without routine medical intervention, as is usually the case in the US & Canada) childbirth activists should do more than they are doing to advance their cause and thus promote the health of women and babies.

I am an old ICU war horse and seldom ventured into L&D yet her message was so intriguing. I looked at her issue through a man's eyes. I do not share the same grasp of things as she but I would share my point of view with one whose outlook is not yet as jaded as mine. Her orientation is to the patient and the mercenary, Machiavellian ways of thinking have not yet corrupted her soul.

Follow the money. Health care is a business, too.

A doctor gets a higher fee for a section than a vaginal birth. While "Standards of Care" certainly guide a doctor's decision, so does money. They are still human and they will frequently do what you pay them to do and not necessarily what you want them to do. The insurance companies saved a bundle by giving doctors a higher professional fee for outpatient surgery as oposed to inpatient which is much more expensive. Hospitals built their own "outpatient" centers and everything was hunky dory. Even if you could develop a plan to incent doctors to promote home delivery, the hospital would miss the revenue and there would be enormous pressure on the docs to keep the patient in-house.

If you feel like your message is falling on deaf ears in the medical community it is because green ink impairs hearing. She is right. The demand for a change in practice must come from the consumer. So long as there is a financial incentive to practice in traditional ways, you will have a battle that is fought but never won.

Good luck.

Code Blue

A vertical thinker in a horizontal world

2006-02-22T07:05:00.000-06:00

In the spring of 1972, I was a freshman at Armstrong State College in Savannah, Georgia in a poetry class taught by Dr. Jim Jones. He was one of the best classroom teachers I ever had. He was brilliant and animated. He was also a card-carrying member of the ACLU and very liberal. One day he began to talk about the "world view" of then and now as a background for some Elizabethan poetry. Many years ago, people had a "verticle" view of the world. God was at the apex of all creation. The angels were below Him. Man was below the angels. Animals were below man. The earth was below the animals. Everything had a place above or below other things based on its relative value.

The beginning of the twentieth century saw the rise of Existentialism and Einstien introduced the Theory of Relativity. A new way of thinking that did not include God or absolutes arose and, ultimately, a whole new "world view." What evolved was a horizontal view of the world. In this view, no God and no values existed. This is the foundation of liberal thought today. Everything has become equal to everything else. Animals are elevated to the level of man. Trees are as important as people. Man has become a god and the ruler of a world in which right and wrong do not exist. There are neither "good" nor "bad" people in the world. Criminals should not be punished. Rogue nations and terrorists should not be resisted. We are not a people or a nation to be emulated. Governments, God's authority on earth, should not hold sway over people. Anything suggestive of God or moral value is to be expunged from our way of life.

The sin of conservatism was not recognizing and accepting the equality of women and minorities. The sin of liberalism is the destruction of morality with the vain hope of Utopian equality. There is a balance to be struck. As we understand the fundamental principles upon which the two lines of thought are built, let us be wise in our understanding of what we do and why we do it. Let us acknowledge the Author of all that is good and right and not put ourselves in His place. Let us recognize that everyone is "precious in His sight" and treat others as we would want them to treat us. Just as Adam "dressed the garden," let us be good stewards of the world that God has given us. Let us also look with clarity upon the siren song of absolute equality and be mindful that the song they sang came from a myth and those who followed it met with destruction. Let us be smarter than that.

Lucifer, Adam and Eve, and the neurophisiology of original sin

2006-02-06T12:15:00.000-06:00

At he urging of a friend, I just read an item on the neurophysiology of original sin. It was intriguing to think of how brain physiology may have influenced original sin. More intriguing was the parallel I began to think of between Lucifer and Adam and Eve. Consider these thoughts:

Lucifer was the highest of all God's creations in heaven and second only to God. He rebelled against God and was ejected from paradise. He was separated from God and faced eternal torment in hell. Later, God created man, His highest creation on earth, and he was second only to God in that realm. He rebelled against God and was ejected from his terrestrial paradise. He was separated from God and faced eternal torment in hell. The pronoucement of God's justice on Adam and Eve also carried the first hint of redemption and reconciliation--something not seen with Lucifer.

What are the connections between these two events and the subsequent redemption of man? Did God know that Lucifer would rebel? Why was there no redemption for him? Did God create man as a response to Lucifer's fall to replace the lost fellowship with Lucifer? Did Lucifer tempt Adam and Eve as an act of revenge against God? Would Adam and Eve have fallen if Lucifer had not been there to tempt them? Did God know that Lucifer would tempt Adam and Eve? Did He know they would fall prey to temptation when He created them? Is the story of Cain and Abel related to the stories of Lucifer and Adam and Eve? Was Lucifer's sin really THE original sin that was just passed on to Adam? Did God forsee all of this when he created the angels? And so on . . .

I had never connected these stories so closely until today. Maybe I am just the last one to get to the party? What are the answers to these questions? I think I know the answers to some of them. I also know that there are people much more thoughtful than I am. What is the answer? What do you think? Dear Reader?

The Procrustean bed

2006-02-03T13:34:00.000-06:00

I once heard the story of Procrustus, an ancient Greek(?) bandit whose sport was to not only rob his victims but force them upon his iron bed to a perfect fit. If they were too short, they were stretched. If they were too tall, their feet and legs were cut down to proper size. And so began the notion of being "Stretched upon the Procrustean bed." We laugh at the absurdity of such a philosophy while frequently committing the same attrocity in a more genteel way. How often do we approach a problem with prejudged notions of what the answer will look like? How often do we unwittingly discard intellectual honesty and objectivity in favor of a comfort zone? How often are we truly objective and follow with even-handed justice the path of the evidence regardless of its verdict? "But this above all, Horatio, to thine own self be true." Stripping away bias, faulty thinking, and comfortable answers is not easy but I would rather face the truth of any situation and grow from it that stagnate with self-inflicted deception.

What a man from Sudan taught me about freedom

2006-01-24T06:22:00.000-06:00

A patient just left my office. His name and accent told me he was not from this country. He told me that he was from Sudan and that after being put in prison for his political views on numerous ocasions that he fled the country and came here seeking political asylum--something I don't hear from people every day. He is supporting his family as a pizza delivery driver and he came to me as a referral from the hospital for the indigent in our county. I commented that I knew life must be hard for him here but at least he was free. What follows is a summary of what he said. I am using his words as closely as possible. I am not making this up.

"You people do not appreciate what you've got here. Great countries rise and fall but the world has an obligation to see that the United States is preserved. Americans are the most generous and hardworking people on the planet. When people are taking vacations in other countries, Americans are working. My problems started when I came to the United States to go to college. It was the first time in my life that I felt free and respected as an individual. When I went back home, the trouble began. I have been all over the world and everybody knows that the United States is the sentinel of freedom for the world. If the United States falls, it will be your politicians that ruined you."

It was an almost surreal experience to hear words like this come out of someone's mouth. Let someone from this country use this kind of language and they would be derided as a gingoistic nationalist. Our worst or perhaps most damaging critics are within our borders and we may fall from within but it was so nice to sit there and in those few moments hear those words on the lips of someone with his perspective and know that the freedom we enjoy is just as dear as we think. Let us all pray that we never come to appreciate it the way that he did.

On perseverance, "Remember the hit."

2006-01-21T06:05:00.000-06:00

Some years ago my daughter played softball. She had just moved up to the level beyond coach pitch where the girls started pitching themselves. Ashley was about nine.

The season started off all right and she got a few hits but then something happened. She stopped swinging when she got up to bat. She did well in the batting cage but never swung at the ball when she got up to bat. She struck out a few times and found that if she just stood there that she would usually walk and get to base that way. This was not a lesson I wanted my girl to learn.

The coach and her mother and I encouraged her. Finally, she did what we asked and began to swing again. Her first at bat when she did was strike one, two, three, you're out. I walked down to the dugout to encourage her. She saw me coming and met me at the end. Her little hands gripped the wire in the chain-link fence that separated us and tears streamed down her cheek as she looked up at me and said,"Daddy, did I do good?" My eyes began to moisten and a lump the size of a basketball began to form in my throat. It took all I had within me not to break down and start blubbering myself. Somehow I managed to stammer back,"Yes, Dear. You did." I went on to tell her that she didn't have to hit the ball but we did expect her to try.

It was a long season. Ashley hit well her first few times at bat but then went cold and couldn't even get a foul tip. And she was not happy about it. She was discouraged. This was another lesson I did not want my girl to learn. Children need to succeed and the season was coming to a close.

The last game of the season arrived.

Based on her place in the batting order, I knew that she normally had about three times at bat in a game. Her first time up came and went as usual with another strikeout and she returned to the dugout. I had to do something. I went to the dugout and called Ashley over. "Hey, Ash! I'll give you ten dollars if you hit the ball the next time up!" She seemed excited. This looked like a good idea. Unfortunately, it garnered nothing but the same result. Her mother and I were about to gnaw our nails over the prospect of our daughter ending the season in effort without success. Somewhat over my wife's objections, I went back to the dugout and upped the ante to twenty dollars. A few minutes later, Ashley stepped to the plate in the bottom half of the last inning to finish her season.

My memory of what happened will be the neatly framed black and white image of the viewfinder of a video camera. I saw the swing and heard the metallic "ping" of ball making contact with aluminum bat. I saw the ball arc its way out of my view and heard the cheers of the crowd ascend with the rising ball and the emotion welling up inside of me. She did it! She did it! The ball landed in shallow center field--far enough for Ashley to safely reach first base with ease. It took a minute for me to get her attention and give a "thumbs up." She flashed back a smile bigger than she was when she saw me. I can only imagine how she felt as she stood there surveying the field from a new vantage point.

Years have now passed and Ashley is a now a freshman at our state university on an academic scholarship. Getting there wasn't easy and she has faced many things that seemed just as daunting as swinging at that ball but she overcame them all and now knows that she can overcome any obstacle she wants to even when the answer is nowhere in sight.

Ashley wants to become a pediatrician and be a missionary to Africa. If that is in God's plan, I hope she makes it. It will be hard to let her go so far away. I won't be there to help her. But even though I'm not, whenever she faces a challenge that seems too hard to handle, I hope she will always remember that cool spring day on a softball field and my voice echoing through the years telling her,"Ashley, remember the hit!"

Navigating the health care "System"

2006-01-20T07:06:00.000-06:00

My goal in life is to talk about important things that others do not talk about. I would love to change the way people interact with the health care system. I spend so much time just telling patients how to get through this mystical mess of a system. A major problem I see in the way we interact with our providers is that we do not prepare for visits and think everything has to be communicated verbally. I don't know about you, but I am much more better at composing my thoughts in writing when I can sit and think.

I have much to say but I will start with something very fundamental: Keep records. Everyone should have a written health history that you update and take to your doctor every time you go. This is especially important if going to a doctor for the first time. If you don't do ANYTHING else, carry a list of your medications. This means the name of the medication, the strength (how many milligrams, etc), how many you take and how often, and what it is used for (some medications can be used for hypertension, coronary artery disease or high blood pressure). Include over-the-counter medications. If you are taking an aspirin a day, include it. Also include herbs. Herbs are used by people for their pharmaceutical effect. Make no mistake, just because they are "natural" products does not mean they are safe. Many herbs that have pharmaceutical effect will interact with other medications just like many other prescription medicines. If it goes into your body, it needs to be on that list.

The next thing is the problem list. Everyone should have a list of your major medical problems (hypertension, elevated cholesterol, asthma, lupus, allergic rhinitis, etc). A note on when it was diagnosed and relevant information would be helpful.

The last thing I will talk about today is the "Chief Complaint." This is the motivating reason behind an office visit or a visit to the emergency department. You may, of course, have multiple complaints but your doctor will want to know, in essence, "What motivated you to come to see me?" In theory, there are several things your doctor will want to know: location, quality, quantity, setting, alleviating or aggravating factors, timing, and associated manifestations. (I think I got that right. I'm sure I'll hear about it if I didn't.) All chief complaints do not fit neatly into this box but being able to give this information without being prompted is solid gold.

OK, I lied. I have to talk about one other thing. Be mindful of the provider's time. I have the luxury of being able to take time with my patients. Getting to know people from the poverty-stricken to the rich and famous is one of the joys of my job but please be sensitive to the clock. When asked a question, answer it but don't stray too far off the path into "story telling" as patients sometimes do. Think about what you have been asked and try to make sure that what you say answers the question. It is easy for me to ask additional questions but hard to find a way to tactfully interrupt.

More on navigating the system later. God bless all of you