A Terrible Lie, A Broken Heart.

Tears streamed down her face and her body shook as she sobbed, “I don’t know why I am still here!” I have heard these words come from the mouths of old patients who had become too frail to live independently and who felt that they were no longer had anything of value to offer their families and loved ones. I was surprised to hear them come from a mother who was barely 30. She had so many years ahead of her, so much love to give and so many people to give it to. I wondered what could have led to such despair.

It was remarkable that she was in my office at all. Less than two years earlier she had been diagnosed with ovarian cancer, a diagnosis that typically comes with a grave prognosis. The fact that she was still alive and better yet, free from any signs of disease should have been cause for celebration. For her it was a source of guilt. She felt she had been given a wonderful gift and had done little to earn, deserve or honor the gift she had received. As a result she was overcome with guilt and shame and was battling a severe depression.

“I keep thinking there must be something important that God wants me to do, some reason that He allowed me to live, but I just can’t figure out what it is,” she said. More tears flowed. I rose from my chair and gave her a hug. She was in so much pain. What could I say?

As I sat and pondered her circumstances I realized that she had fallen prey to a terrible lie that has invaded our culture, a lie that is particularly common in people of faith. She had been deceived into a false definition of significance, a definition that had blinded her to her value and to the purposes of God. She believed that lives of significance are measured by remarkable accomplishments and world-changing deeds that are easily visible and readily recognized by others. God had given her the gift of life and she was wasting it. I took a breath and addressed the lie.

I told her that God’s greatest works are not done through big events and huge miraculous achievements. The greatest works of God are the result of small acts of faithfulness repeated over and over again in ordinary life. I reminded her that every time she loved her child, prayed for her child and encouraged her child was a time that she was accomplishing something wonderful in the eyes of God. I told her that if she raised her son to be a good man who loved others that she would be doing something unique and amazing, and that in looking for something dramatic and profound she was most likely overlooking the great things that God was already doing in her life.

I wish that her story was rare but it isn’t. We live in a culture where everyone wants to be the next American Idol, Master Chef or Republican presidential nominee. We forget that it is not possible for everyone to be the best, for everyone to be rich, successful or famous. We forget that God is not impressed with earthly accolades or recognition. What matters to God are the things that cannot be seen. God sees our hearts and measures us according to their content. Faithfulness is more important than success.

Michael Horton, in his book Ordinary, addresses this aspect of our culture, describing the current generation he writes,

They say, “I want to make something of myself, to leave my mark”- or more altruistically, “to make a difference” in the world. But when we make these desires the object of our life-quest they become idols. Like all idols, they overpromise and underdeliver… We do not find success by trying to be successful or happiness by trying to be happy. Rather, we find these things by attending to the skills, habits and - to be honest – the often dull routines that make us even modestly successful at anything. If you are always looking for an impact, a legacy and success, you will not take the time to care for the things that matter.

My prayer for my patient, and for myself, is that we will live in the awareness of the truth that the most important things we do usually go unnoticed by the world. This does not mean that God is not working. The world may not pay attention when a mother hugs her child or wipes away a tear, or stand and applaud when a father kneels and prays for his family or turns down a promotion so he can spend more time at home, but the God who sees everything does.

God Himself said it best in His admonition to the prophet Samuel, “The Lord does not look at the things man looks at. Man looks at the outward appearance, but the Lord looks at the heart.”

-          Bart

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Facing Death at Forty

She is in her early forties. She is thin and appears fit and healthy. She isn’t. She can’t walk much more than 100 feet before crippling chest pain sets in. She can’t work and she can't exercise. She recently tried to walk to the corner store on her own but passed out on the way. Her cardiologist has told her she is never to walk alone again. It is too dangerous.

She has lived this way for a few years now, cursed with coronary arteries that spasm for no reason, constricting so severely that she has the crushing pain of angina, the sensation that she is having a heart attack. She lives in constant fear that her heart might stop at any time, that one day a heart attack will actually happen.

There are many medications for coronary spasm but she has not been able to tolerate any of them. They all work by dilating blood vessels which means they lower blood pressure. Her blood pressure is low without medications and even the lowest dose of the standard medications results in dangerously low blood pressure. She has seen multiple cardiologists who have discussed her case with multiple other cardiologists but no solution has been found. She continues to suffer. 

I did some online research on coronary spasm and came across an article on the subject written by a cardiologist an hour north of us. I reached out via email and asked the doctor if she would be willing to see my patient in consultation. My patient scheduled a visit as soon as she could. She came to see me a few days before the consult to go over her records. As I reviewed her history I was once again moved by the challenges she faces.

We talked about how hard it was and she shared with me how important her faith is in helping her get through each day, that she reminds herself continually to trust in God. We talked about the reality that God does not heal everyone and that we may not find an answer or a cure. He does not always grant our requests.

With this in mind I reminded her of one of the central truths of our faith- this life is not all there is. Eternity awaits. We tend to focus on our present circumstances but it is our eternal destiny that matters and how our eternity is not dependent on our current condition. We talked about how God’s eternal plan for her has not been altered by any of her current sufferings. His promises are based on His goodness, not our condition. She told me that she clings to this truth everyday.

We closed the visit with a prayer and she went on her way. As she left I reflected on her faith and example. I was reminded of one of the purposes of Christian suffering as described in 1 Peter 1- “These trials will show that your faith is genuine.” Her steadfastness through tough times has shown her faith to be real. I pray that when illness and suffering come to my life I will be equally strong.

- Bart

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A Big Mistake in a Doctor's Office

My office was blowing it. I didn’t know it until just this week, but we had a serious customer service problem. Patients were having their phone messages and questions ignored. They called the office with a question, need or request, and the person taking the call was not consistently entering the message into the chart or writing it down. I missed the early warning signs (a few patients told me personally they had left a message that was not returned but I thought it was a voice mail issue) so by the time the problem was discovered it had been going on for a while. As it was only a few times a day and not all patients complained it took weeks before there were enough cases for me to recognize the issue. By that time we became aware of at least 15 patients who had been slighted or ignored, there may have been more. Something needed to be done.

Dealing with the employee in question was straightforward. When someone fails in one of their position's foundational tasks on a repeated basis (apparently after being counseled by other employees) a change is in order. After dealing with the disciplinary issue I faced a bigger challenge. How could I fix the problem? I worried that the cases I had discovered were just the tip of the iceberg. What if there were dozens of overlooked patients? Customer service is key to my reputation and I pondered what I could do to rebuild lost trust.

I decided to reach out to patients and address the problem. I sent a mass message to all of the patients on our email list, over 2500. I described the issue, told them that I had just been made aware of the problem and that if they had left a message and not received a response to let me know. I shared our policy that all calls should be returned same day and all emails within 24 hours, and I asked that they notify me if we fail to meet that standard in the future. Within a few hours the replies started pouring in. There were a few who were letting me know of a failure to receive a response but the vast majority said something unexpected. The majority of the messages said, “Thank You!”

It seemed that my openness and honesty about the problem and quick action to address it had made an impression on my patients. One patient who is a business consultant wrote, “Way to own it.” Another hotel manager praised our “great customer service.” All of them appreciated our efforts to make things right. To date I have not received a single negative response.

The gracious responses received remind me of the importance of honesty in everyday relationships. Nobody is perfect and everybody knows it, so mistakes are to be expected. It is how we respond to our mistakes that defines our character. There is a tendency to cover up and hide and explain things away but that path does not lead to success in the long term. The gracious responses of my patients remind me that honesty is truly the best policy.

-          Bart

"Too Christian" to be a Doctor

I have gathered a collection of insults over the course of my 25 years as a physician. I have been called stupid, old, racist, arrogant, ignorant, too young (okay, this was a long time ago), unkind and once I was even called "a threat to children." This week I became the recipient of a new label. I heard that a specialist colleague told a potential patient that I was “too Christian” to be his primary care doctor.

I was taken aback by the news, surprised that a colleague would view my faith as a negative for my practice. In response to his words I stopped and considered the ways in which my faith has entered into my interactions with patients. I wondered if there were times I had crossed that an invisible line and gone too far, if I had gone from encouragement to offense. I discussed the topic with my staff, not all of whom share my faith and perspective. I realized that there are many ways in which I allow my faith to influence patient care but that these ways have for the most part made me a better person and doctor.  I have described many of them previous posts but decided to take the opportunity to share some the things I do differently because I am a doctor who is a devout Christian.

1-      I pray for my patients, and when appropriate, I pray with my patients. When I do pray in the office, I intentionally avoid denominational or theological lingo. Unless I am certain that the person has a Christian faith, I do not use the name of Jesus (He knows who I am talking to anyway!) I try to carefully assess the patient’s openness and then always ask for permission. Since studies have shown that half of patients actually want this, it seems reasonable. My experience is that patients are grateful for the additional expression of concern.

2-      I try to be more forgiving. My staff says I do this too often, but because of my faith, I intentionally extend more grace when patients are late, non-complaint, or unhappy. The Golden Rule requires it of me. I find my patients are more forgiving of me as a result.

3-      I give more hugs. I continually pray that God will help me love my patients more and serve them better. Overtime this has led me to listen better and care more, which leads to hugs, which seem to be appreciated!

4-      I stand up for my patients more. Since my faith is more concerned with doing right than being accepted, I find myself defending my patients and standing up for their rights. This means going the extra mile in fighting to get medications or therapy approved.

5-      I am more available. My office hours have become more of a suggestion that a rigid rule. When it is truly needed I come in early, stay late or work through my lunch hour. Just this last Saturday I met a patient at the office to suture a hand laceration. I did it because I could.

6-      I am more respectful of my patients time. My faith teaches me that I am no better than anyone else, that my medical degree does nothing to change my standing before God. I am a wretched sinner just like anyone else. This has led me to be more respectful of the time and needs of my patients, and is in large part why I give away Starbucks gift cards when I fall behind schedule!

7-      I often refer to Biblical passages when I talk. Some might call this risky but I have seen it have a powerful impact in my counseling with patients. Truth is truth and wisdom is wisdom and I see no reason to avoid either just because they originate from Scripture. The passages I refer to the most have common applications. I use Adam and Eve to illustrate the truth that people in trouble tend to hide their problems and run from help. I quote the wisdom of Romans 12 to people dealing with depression or addiction as a reminder that we are all broken in our thinking and that trusting in our own thoughts can lead to trouble. Passages such as these are often a source of encouragement to patients.

I am not boasting in this post. None of the behaviors I describe come naturally to me, and for the most part were not a part of my early practice. These things came about through a lot of prayer and a lot of work. I am not by nature a very nice or kind person. I am a Christian who asks God to change me every day, to allow me to be His hands to touch and heal others.

After thinking about it, I have decided that being “too Christian” is a criticism I can willingly accept. It is far better than someone saying I am not Christian enough!

-          Bart

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A Little Boy's Birthday, A Mother's Suicide

On their birthdays, nine year-old little boys should not come home from school and find their mother dead. John did.

I met John when he was in his early twenties. My church had decided to rent a large home in a local neighborhood and open it up to young men who were homeless and needed a fresh start. My best friend was put in charge of the ministry and he invited me to come along and help. I cooked and cleaned and supervised the house when he was gone. I was only 19 but I was committed and responsible. I was also ill equipped and unprepared for men like John.

John was down on his luck, jobless and out of money when someone from the church happened to meet him. The home had just opened and the church member thought we could help John get back on his feet so he brought him by. We sat down with John, told him the house rules and agreed to let him stay. It did not take long for me to learn John’s story and discover how difficult his past had been and how challenging the road ahead was going to be.

On John’s 9th birthday he had come home from school and found his mother in the garage, hanging by her neck from the rafters. She had committed suicide. Happy Birthday John. The remainder of John’s childhood involved temporary homes and terrible insecurity. He did not receive the counseling and love he needed and his young life was filled with more emotional pain than he could handle. When he became a teen he took solace in drugs and they ravaged his body. His gaunt, pale and pock-marked face declared to the world that he was someone who was unhealthy both inside and out. He lacked social skills, job skills and self-discipline.

John was a talker and we spent many late evenings together in conversation. Whenever we talked about the future, about what he would need to do to make a life for himself, he would turn the conversation to the tragedy of his past. It was as if he was saying that it was impossible for someone with his past to ever succeed in life, as if what his mother had done had sealed his destiny. It seemed he thought he was supposed to fail and that as a result any effort he made to succeed, any attempt at normalcy, every job interview and each day of sobriety, was to be praised and celebrated. He craved the unconditional love that he had been denied as a child.

Unfortunately for John, each small step forward was typically accompanied by a stumble or a fall. It was difficult to give him the praise he desired and desperately needed as it would have required us to ignore behaviors that were harmful. He needed so much more than we were able to give. Eventually he left, unable to keep a job our follow the rules. I do not know if he ever turned his life around.

Looking back, I think our church leadership was naïve in its approach to the ministry. It was as if they believed that all troubled young men needed was a place to live and Jesus. The thinking seemed to be that if they had a bed to sleep in, food to eat and a Bible to read that all would be okay. There was no talk of providing professional counseling or 12-step programs, no concept of the years it would take for someone like John to change and grow. We had good hearts and intentions but lacked the training and expertise.

In spite of our inadequacies it was not the church’s fault that John did not succeed. We did give him a chance he otherwise would not have had. He was given some good advice and an opportunity to change yet because of his troubled past he was unwilling or unable to listen to and receive the counsel of others. In spite of the reality that all of his choices had resulted in disastrous outcomes he continued to make his choices alone, refused to submit to the leadership of others. He could not fully trust others and trusting himself was futile. He needed so much more than we could give and needed to do so much more than he was willing.

I will never forget John and the lessons he taught me. I have encountered many “Johns” in my 20 years of practice, men and women with terrible pasts who face terrible futures. I still struggle to find a way to encourage them to get the help they need and still mourn when I see them make bad decisions. Whenever I counsel people like John I am reminded of how crucial love and direction are early in life, how children need to be taught to be healthy. Without a healthy foundation a healthy life is hard to build.

-          Bart

Comments, questions and feedback are always welcomed and appreciated. A reminder, my book on the Ten Commandments, Life Medicine, is available on Amazon. If your church or small group is interested in using the book contact me directly, as I have set aside books for donation. A small group study guide is accessible via this website. Finally, please share information about this blog with your friends!