Confident, Offended, and Dead Wrong

He was mad at me, convinced that I was attacking our church and its leadership. Although I did not once mention our church by name he was certain that the sermon illustrations I used were intended to  call attention to the challenges our church was facing at the time. There were many points in the message that closely paralleled issues our church was confronted so it was natural to assume that I had crafted the message with the intention of emphasizing those problems. 

His assumption was logical, reasonable, supported by his observations, and wrong.

I was part of a team of teachers who had been asked to each teach about one of the Kings of Israel or Judah. I requested one king, but was assigned a different one, so the lesson I taught was not one I had chosen.I had first outlined and taught on that king and the associated passage of scripture seven years earlier, at a different church, long before our current church’s problems had begun. Recognizing the potential that some might think I was attacking our church, I agonized and fretted and worked hard to stay true to the passage. I repeatedly edited and altered the message, taking out portions that I thought might be interpreted negatively.

In spite of my efforts, my friend reached the conclusion that I had selected the passage and crafted the sermon with our church in mind. It was several months before we talked face to face and I was able to correct his assumptions. When he heard the whole story his apology was genuine and sincere.

After we talked I reflected on how many times I had similarly and confidently reached a wrong conclusion about others, the occasions when I had misjudged others based on limited information.

I thought of patients I had written off as non-compliant, only to later learn that they had lost their jobs and their insurance. I remembered the many times I had wrongly thought my children were rude or disrespectful only to discover that I had misheard them. There is no shortage of examples of me confidently making quick yet erroneous assessments.

My friends, family and patients deserve better from me. It is my prayer that I will, over time, develop the habit of assuming the best in others, that I will be someone who gives others a chance to explain before I choose to condemn. I have a long way to go

- Bart

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When a Patient Wants to Die

What if he asked me to help end his life?

George was dying. I did  not expect him to last more than a few weeks. The esophageal cancer had spread to his liver and to his lymphatic system, mutated and spread beyond the reach of all known treatments. His esophagus was narrowed to the point where solid foods were impossible to swallow and he was starving. The impact of the cancer on his digestive system had resulted in intractable nausea. None of the four anti-nausea medications he was taking had made a difference. Every day was miserable. All pleasure was gone from his life and he was simply waiting to die.

He signed up for hospice care to ease his passing. He was too weak to come to the office so I went to his home to see him. He was a shell of the man he once was. He was once obese but was no longer. He had lost over 100 pounds, his clothes hung loose and his face was drawn.

During the hour I was in his home we discussed many things. He asked me many unanswerable questions-, wondering what caused the cancer, what would have happened if the specialist he had seen had made the diagnosis earlier when he first had trouble swallowing. He asked how long it would take for him to die. Having provided care to many hospice patients over the years I told him that only a foolish doctor would deign to predict a time of death. Death comes when it comes. Sometimes in comes in days, other times it comes in weeks. All I could promise was that I would be there for him, that he would not suffer.

Waiting can become the hardest part of dying. Once the inevitability of death has been accepted, when the goodbyes are said and the prayers have been made there is nothing else to do but wait, to watch each change in symptoms and wonder what it means, to wonder if the final countdown clock has started to tick or if it is just another meaningless change. 

For many patients and families the waiting is unbearable. As the suffering increases and the end approaches it is natural to ask, “Can we just do something to end it?”

Because physician assisted suicide has been illegal in California I have never had to directly answer the question. This could change at any moment, as the governor has signed a bill that would legalize the practice. When the law is implemented it will be legal for me to give patients like George a lethal dose of medication. The question of "When?" will become answerable and the agonizing days of waiting avoided. Family and friends could know the time and place and plan accordingly. Everyone would feel a sense of control.

And my role as a physician would change forever.

For patient's like George  it seems straightforward. He had at most a month or two to live, and his suffering was real. Why not provide definitive closure for such patients? What is the harm in providing a quick and easy passing?

George's case provides an answer to these questions. Under the law as written, George would have been a candidate for assisted suicide 4 months ago, when he was first diagnosed with the aggressive cancer. If he had not elected to attempt treatment his life expectancy would have been less than 6 months and he would have met the conditions of the law. Any doctor could have ended his life any time he wanted. He could have been given a large dose of morphine or other medications and the months of suffering avoided.

He also would have avoided hundreds of conversations with friends and family, including the spiritual conversations he had with me and others. A professed atheist, he specifically asked for prayer and if I would advise him spiritually as he went through the process of dealing with his disease. That 4 month process changed him. He became a different man with a different perspective. I would not have wanted to take that from him, nor should anyone.

Many will say that it should be the patient’s choice. In a godless world where man is the ultimate arbiter of his fate this makes sense. If there are no enduring consequences, if there is no ultimate meaning in life, if there is nothing good that comes from suffering, these choice advocates are right.

But we do not live in a godless world and man is not god, as much as many may wish that we were. Death reminds us of that.

As a Christian physician I will not play the role of God, I will not help a patient end his life. What I will do is relieve his suffering. I will aggressively treat his pain without reservation, even if that requires middle of the night visits. I will come to his home to pray for him, sit with him and comfort him, and do all I can to facilitate a death that is filled with dignity and comfort, knowing that each moment, even the ones filled with pain, provides an opportunity for love, reflection and faith.

- Bart

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Pizza, Porn and Making a Stand

It was supposed to be a pizza party. It soon became a porn party. The members of the high school basketball team went to the local pizza parlor to hang out after a game. After a while the conversation took an unexpected turn. Several players took out their smart phones and brought up pornographic images. They laughed and joked and thought it was funny. For the one Christian member of the team it was anything but. It was awkward, and it was wrong. He called his parents and got an early ride home

When I heard this story I was heartbroken. I felt terrible for the young man who had been placed in such a difficult circumstance and I grieved over the lack of shame displayed by his team members. One thought repeated in my mind, “How did our society end up like this?”

There was a time when right and wrong were clearly defined. Not everyone chose to do the right thing but just about everybody knew what the right thing was. Wrong things included lying, cheating, foul language, underage drinking and alcohol use, and sex before marriage. Good things included respecting your elders, politeness, honesty and morality. Somewhere along the line these definitions were abandoned. Wrongness now only applies to such things as violent crime and political incorrectness and goodness is defined as whatever one wants as long as it does not directly hurt someone else.

How did this happen? It is the natural consequence of moral relativism. When right and wrong are no longer universal absolutes but are instead based on individual perceptions, moral decline is inevitable. Human nature leads people to think highly of themselves, so it is natural that people will define good as “what I do” and bad as “what someone else does” when given the opportunity. When good is determined solely by our personal desires there will be no need to rein our desires in.

When our nation embraced the moral relativism of humanism and  turned from its Judeo-Christian roots it also turned away from the well-defined moral code that guided our nation since its inception. Absent the boundaries of a clear moral code, immorality is boundless. Pizza parties become porn parties.

In such a world not only will immorality increase, morality will be attacked. Those who declare immoral behavior to be wrong will face accusations of intolerance, bigotry and of being judgmental. In such a context people of faith will endure difficult times.

When I deal with individuals who are caught up in an immorality I have learned that a simple question can bring clarity. My favorite question when I talk to someone caught in a moral failing is- "Is that the best you can do?" I challenge people to set goals of excellence for themselves, to strive to do their best, not to the minimum, in every area of their lives. I tell people that my goal in life is to be the best man, husband and father I can be, and that when confronted with a choice about a behavior I have trained myself to ask how the activity in question can help me be the best. 

I could go out and get drunk, but I want to do better than that, to have a clear mind and to remain in control.

I could look at pornography but I want to be better than that, to value my wife and allow her to be confident and secure in the knowledge that she is my ideal.

I could lie, I could cheat, but I want to be better, I want to be someone who is trustworthy, respected and believed.

The reason I want to give me best? Because God gave His Best for me.

-          Bart

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Why You Shouldn't Hate Your Job

Millions of Americans have become spectators in life, sitting on the sidelines and simply watching as others participate in one of life’s greatest endeavors. 1 in 5 American families misses out on the character-building, relationship-training activity that was ordained by God from the beginning of time. In 20 percent of homes, nobody works at all. Everyone in our society suffers as a result.

My first job was as a janitor. Monday through Friday for an hour and a half I went into a small office building and cleaned toilets, emptied trash cans. dumped ash trays and swept floors. I hated it. With no one else around it was lonely, quiet and even a little spooky at times. It wasn’t fun but it wasn’t supposed to be. It was a job. I learned responsibility, commitment and that being a janitor was hard.

As with many teenagers in the 1970’s and 80’s I had several other jobs during high school and college and each taught me important lessons. I scooped ice cream at Baskin Robbins, where I learned inventory management, customer service and how to negotiate a raise. I sold shoes at Thom McAn, where I learned sales techniques, how to close a deal, how to read a customer and that working retail means working evenings, weekends and holidays. I worked on a loading dock for Montgomery Ward, where I learned how to balance a refrigerator on a dolly and unload a truck. I worked for Vons grocery stores, learning more customer service, how to pick quality produce and the benefits and disadvantages of union membership.

In each job I learned what it meant to work, to set aside pleasure and leisure to do what needed to be done. I learned what it meant to be a part of a team and how to work with people who were different from me. I had good bosses and bad bosses, both of which helped me become a better manager and employer. I learned the value of a dollar and how long I had to work to earn something I wanted. I gained self-respect and learned what it meant to do my best even when no one else was watching, or worse, to work hard even when the people who watched did not appreciate my efforts. Every job, every task and every shift was a growth experience.

Today in America, in 1 out of every 5 families, there is no one who is benefiting from the blessings of work. The innumerable lessons are unlearned and are not passed on. There is no one modeling the self-discipline of getting up on time in the morning and making oneself look presentable for the day. No one learning to submit to and interact with a superior, no one learning to negotiate a better deal. No one pays income tax and contributes to society economically, no one participates in making something or providing a service to a customer. 1 in 5 families receives all of its financial support from society, is totally dependent on others for survival..

It is impossible to overstate the long-term negative impact on our society of such dependence. Beyond the obvious fact that no economy can thrive in the long term when 20% of its families do not participate in the production of goods and services is the reality that no culture can thrive if large segments of the population do not receive the education and personal growth that only work can bring. 

Something needs to change. We need to quit referring to work as a curse and a chore to be avoided  and view it for what it truly is, a blessing and an opportunity to be embraced, whatever or wherever the job may be.

-          Bart

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Where have all the true Friends Gone?

I speak without fully listening. I interrupt frequently. I dominate conversations. People are intimidated by me. I am hypercritical. How do I know these things? My friends and family told me.

While none of the above messages was pleasant to hear, they have all been essential to my personal growth. They helped me identify my faults, understand the responses of others and grow as a person. If my friends had not cared enough to speak up, if they had simply “loved me for who I was” I would not be the person I am today.

It seems to me that although friends such as these are invaluable they are a vanishing breed. Most people seek out friends who validate and affirm, not friends who challenge and exhort, and our society is suffering as a result.

Not every feeling we have is healthy and not every desire should be fulfilled. It is our friends and family who can lovingly correct is when we wander, who can remind us that “being true to ourselves” is nowhere near as important as being true to our God.

Part of the reason such exhortations are increasingly rare is due to an incorrect understanding of judgment. If there is one scripture even atheists can quote it is “Judge not, lest you also be judged.” Jesus’ was teaching that we should not condemn others and reminding us that we would all be judged one day. What is overlooked in applying His words is that he also taught his followers to follow God’s law and that sin should be addressed. Avoiding condemnation is good, ignoring and accepting sin is not.

Distaste for judgment has become dominant and moral relativism has become the norm. As a result increasingly strange behaviors are becoming common place. Infidelity and sexual deviancy are so common as to be expected and embraced. No one speaks out anymore, no one stands for goodness. If anyone dares make a stand they are labeled as a hateful bigot.

The truth is that all human beings are broken and dysfunctional in one way or another and all of us have feelings and desires that are selfish and harmful. If we do not have people in our lives who love us enough to point out where we need to change and grow, we will do neither.

Let us pray that God will bless us with friends who care enough to correct us and that we will be true friends to those we love.

Bart

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