Good-bye JG. I will miss you.

I said good-bye to JG today. I have been his doctor for over 15 years. In that time he has had prostate cancer, bladder cancer, multiple heart attacks, diabetes, acid reflux, joint pain and multiple episodes of heart failure. He never complained about his health, although we talked a lot about his wife's conditions. She died a little over a year ago from lung cancer. She was much younger than he, and it hit him hard.

I am not sure if doctors are supposed to have favorite patients, but he is one of mine.

He loves golf, and loves talking about it. Several years ago I went alone to a local course to play and ran into him. We ended up playing 18 holes together. I learned a lot about him, his values, and his “expansive” vocabulary. Ever since then he repeatedly talked about how far I could hit the ball, graciously overlooking the fact that he beat me handily!

He has old school values. Once he quietly told me about a time many years ago when the daughter of a close friend physically was mistreated by a man. He and a few other friends went and found the young man and proceeded to educate him about his behavior in a manner that would have landed them in jail today. It was how it was done back then, how friends looked out for each other. He was fiercely loyal like that.

I visited him at home today to talk about his health and living circumstances. Life has caught up with him to the point where he can no longer live alone. He will be moving in with family out of state. We spoke for several minutes and then I got up to leave. It takes significant effort for him to stand, but he did, and gave me a long hug and told me he loved me. As I left, he followed me outside to watch me go, leaning against his car as I drove away.

I will not forget him and believe that the image of him watching me leave will linger for some time. I am so grateful for the trust he placed in me, for the love, affection and friendship we shared over the years. I am again reminded of the truth that medicine is first and foremost about developing healing relationships and of how much I would be missing if my job became about medications, conditions and diseases instead of people.

Good-bye JG. Here's praying we will see one another again.

A Patient gets what She Deserved... she had it Coming to Her!

Being a doctor can be hard, and giving patients what they deserve can be even harder. Patients can be needy, demanding, hard to deal with and harder to please. We have many more patients than we do patience. How we respond under stress says a lot about us.

Long hours, job pressures and difficulty communicating can stretch doctors to the breaking point, especially doctors in training. Work hours for doctors in their years of specialty training are pretty intense. When I was a resident physician, it was common to spend over 100 hours a week at the hospital. We were “on call” every 4th night, and call days typically ran from 7 am until at least 5 PM the following day. On that day after a call night, most residents passionately worked toward a single goal- getting done with their work and going home to bed.

This explains the intern's response when, as a senior resident, I paged him to discuss the care of a woman who he had admitted the night before. As the senior resident it was my job to oversee all of the patients cared for by the hospital team. It was 4 Pm, and I had just finished reviewing the admission notes for the elderly woman who he had admitted to a bed on the medical floor. In the intern's notes he had listed hyponatremia (low sodium in the blood) as one of the patient's diagnoses. Typically this notation would have been followed the cause if known, or if unknown possible causes and the tests ordered to identify the cause. Instead his explanation of the low sodium was simply- “cause unknown.” Nothing more was written.

While he may not have known the cause at the moment he wrote the note, a list of possible causes was available in any reference book, and it includes a number of potentially serious conditions.

Perturbed at the lack of thoroughness on his part I got him on the phone. I remember the conversation vividly.

“Hey Scott, what's with this “cause unknown' garbage in your note?” I asked with my trademark tact.

“I didn't know what the cause was!” was his reply.

“So look it up!” I said

"Okay, I'll do it tomorrow."

"No, you will do it now."

"But, I am post call!'

"Not my problem. This woman is in our hospital and deserves the very best medical care. If that means you stay until 10 o'clock, then you stay until 10 o'clock. We don't cut corners!"

"Fine!" he bellowed as he hung up. Boy was he mad.

At the end of the year at the graduation ceremony he sought me out. He shook my hand and said with a smile, "Thank you for making me good." I still get a warm feeling inside remembering the moment. I am still a demanding teacher, harder on students and even harder on myself. People deserve our best effort.

Doing our best and giving our all is a value that seems to be vanishing from society, even from the medical profession. I pray it will always remain a part of my practice.

Peace on Earth- The Enduring Promise of Christmas

The words "Peace on Earth" are repeated every Christmas. We say it, but we don't see it around us. At this very moment explosions and the sounds of gunfire are heard all around the world. In Afghanistan, Iraq, Syria, Somalia, the Sudan and many more countries peace is so far from present reality that it is little more than a quaint fairy tale hope.

If the birth of Christ was intended to bring peace, where is it? Was the promise true? Was it a promise of things in the future or was it a declaration that was true then and now?

To answer these questions requires us to not only understand the meaning of the message of peace proclaimed that first Christmas night, but also the messengers of peace were who proclaimed it-

"Suddenly a great company of the heavenly host appeared with the angel, praising God and saying, "Glory to God in the highest heaven, and on earth peace to those on whom his favor rests." Luke 2:13-14

The message- Glory to God in the highest heaven, and on earth peace

The messengers- a great company of the heavenly host

What is a host? It is not a choir. The word in the Greek for "host" is a word for an army, an ordered mass of soldiers. God has an army! He is a God of justice and truth who will ultimately forcefully reclaim this world as His own. (See Revelation 19:11-15).

On that first Christmas night, on that hillside outside outside of Bethlehem, God chose His conquering army to be His messengers of peace. Those who would one day return with Messiah to forcefully reclaim the earth, the greatest, most powerful army in all eternity, on this night appeared to humble shepherds. Appearing to these representatives of rebellious mankind, people deserving of judgment living in opposition to Almighty God, this powerful army laid down their weapons and on this night proclaimed, "Peace."

The peace proclaimed was not a declaration that conflict between men was to suddenly end, with love and hugs all around. The peace proclaimed was Peace  with God, restoration of relationship with the God mankind had rejected. For on that night, in the City of David, there was born to us a Savior, who was Christ the Lord.

The promise made that night was true, reaching its ultimate fulfillment when Jesus offered Himself as the perfect sacrifice for the sins of all. Because of this sacrifice, all can experience true and lasting peace with God.

This Christmas, let us all join with the angels and proclaim the truth of the Good News that is for all. The Prince of Peace has come.

For more on the story of the Shepherds, you can watch a my message on the Shepherds on Vimeo Merry Christmas!

The C-section that Wasn't- An Amazing Childbirth Story

Labor is like life. Sometimes it goes smoothly and as hoped for, and other times it is touch and go with the ultimate outcome in doubt until the very end. Her labor was anything but smooth. She was past her due date, the fetal monitor repeatedly indicated the baby was under stress, and progress was excruciatingly slow, making for a long and difficult afternoon for both patient and doctor, as the outcome was anything but certain.

I had made arrangements for her to arrive in the hospital that morning. She was 41 weeks pregnant with her first child, a week overdue. Within an hour of her being admitted, the nurse started an IV drip of oxytocin, the hormone that causes uterine contractions.

Inducing labor typically follows a pattern- The medication is gradually increased with the goal of contractions every 3-5 minutes. Once that happens, it is a matter of waiting for the cervix to shorten and open and the baby's head to come down. Progress is usually slow early on, but once the cervix reaches 4-5 cm the bag of waters can be broken and labor accelerates. From that point delivery is usually 5-8 hours a way. Usually. This baby did not get the memo and had other plans.

It took four hours for the contractions to fall into a reasonable pattern and then, after just a few minutes of strong contractions, the baby voiced its displeasure. Almost every contraction was associated with an ominous slowing of the fetal heart rate, a sign that oxygen supply to the baby might not be enough to withstand the stress of labor. Worried, the nurse decreased the dose of the oxytocin to slow the rate of contractions. The heart rate tracing quickly returned to normal but was unfortunately coupled with an arrest of progress. After about an hour the nurse again increased the medication and the contractions increased. After 30 minutes there was minimal progress but also a return of the worrisome heart slowing. The nurse again decreased the oxytocin and called me.

"I do not feel comfortable continuing the oxytocin as the baby is not tolerating it. If you want it continued you will have to come in," was her report.

I canceled the rest of my patients for that day and hurried to the hospital. I examined the mother and inserted a pressure monitor to allow for better monitoring of the contractions. The nurse increased the medication again. Within 30 minutes the heart rate dropped again. I rechecked the mom and discovered that she had made slight progress but had a long way to go.

I debated what to do. I did not want to give up and do a c-section, but I was not sure the baby cold withstand several hours of labor. I called an obstetrician friend whose office was next to the hospital, asking him to be ready to come at a moments notice should things take a turn for the worse. I them settled in for a long afternoon.

I spent much of my time in the room with mom and dad, and we talked about the baby and their plans. They shared their daughter's name and told me how they had painted her room pink. She was their first and they were truly excited. I assured them that we were going to monitor the baby closely to make sure that she was okay. We hoped for a vaginal delivery but were ready to do a c-section if necessary.

The pattern from the morning continued and my concern increased. Around four in the afternoon the mom's temperature started to rise, yet another worrisome sign. I called the obstetrician again and we made arrangements for the c-section to be done around 5:30. I performed the necessary physical exam and dictated the pre-operative note into the hospital system.

At 5 pm, 5 hours after I had arrived back at the hospital, I went back into the room to perform one final exam before taking her back to the operating room. To my surprise, she was completely dilated! To my disdain, her temperature had climbed further. Since it was now apparent that a vaginal delivery was possible, I put the surgery on hold. Over the next nerve racking hour I remained in the room as we instructed the mom how to push and continued to monitor the baby's disconcerting heart tracing. I called the neonatologist (specialist in small and sick newborns) and asked if he could be present in the delivery room. I was worried that the baby might not be totally healthy immediately after birth.

When the time for delivery came, I focused on getting the baby out and handed over to the neonatologist as quickly as possible. As soon as the cord was cut I turned and gave the baby to the specialist, who began to examine and stabilize the child. After about 30 seconds he turned to the father who still was standing at his wife's side.

"Dad, you can come over here and see your baby if you like," he said.

The father came order to the baby warmer and looked down at his newborn child. In a perplexed tone he said, "Um... Honey?"

The mom started laughing, "Are you going to tease me and tell me it's not a girl?"

The neonatologist looked up, "You didn't know you were having a boy?"

I started laughing, "I sure hope he likes pink!"

In that moment all of our worries and concerns faded away into laughing, as we celebrated their healthy little BOY!

They had planned and prepared for parenthood, attended classes, and painted a room. Yet, in spite of their best plans, they were not prepared for the surprise the future held. Isn't that how life works?

It was no different with the birth of Jesus. The knew a baby boy was coming but there was no way that Mary and Joseph were fully prepared for what was in store. They knew Mary was having a boy, but how could they comprehend the truth of incarnation? Recipients of angelic visits, I doubt they were prepared for the shepherds' tale or the testimony of the wise men. They assuredly expected people to question their morality, but were they prepared for that stigma to follow them so intensely for the rest of their lives

Their experience foreshadows what we all experience in our journeys of faith. God reveals a small amount of what he Has in store for us, just enough for us to be confident in His promises and calling, but our walk of faith will certainly contain surprises.

This is the 6th and final Amazing Childbirth story, leading up to the Greatest Childbirth Story, the birth of Jesus Christ. (for the other stories click here, here, here, here or here)Please consider sharing these stories with your friends as a way to bring a new perspective on the Savior's birth. Merry Christmas!

5 lessons from Phil Robertson's GQ Interview

I do not know much about Duck Dynasty, having only seen one episode. My initial impression was that guys that wealthy should be able to afford a haircut and a straight razor. Other than that they seemed to be good guys from a traditional family who shared a common love for God, fun and killing ducks.

I paid more attention to the Robertson family this week after reading about the “controversy” over remarks made by Phil Robertson, the patriarch of the family. I am either to smart or too ignorant to wade into the specifics of the remarks and the response, but believe I have learned a few lessons (5 to be exact) from the story that are valuable to those of faith-

1- Be careful who you talk to. Phil gave an interview to a reporter from GQ, a secular magazine with a decidedly secular world view. Reading the interview it is clear that the author is neither a person of faith nor a person with deeply held traditional values (the article is peppered with profanity.) The writer spent hours with the Robertsons and included only a handful of significant quotes. Giving that much time to a reporter antagonistic to your views is almost certain to result in your quotes being cherry-picked in support of the writer's agenda.

2- Be careful what you say. Think before you speak, and choose words carefully. When it comes to controversial subjects, have a prepared response that has been prayed about, reviewed by others you trust and committed to memory. If you do not have a prepared response, don't give one. There is no shame in saying, "While I have feelings on the issue, I want to be careful in my response. Let's come back to that later." Phil's responses were more inarticulate than incorrect. Caution may have prevented some of the backlash.

3- Address your remarks to the audience. GQ is not a magazine that targets men of faith. It's readers are mostly secular in their worldview. Many aspects of the Christian faith that are commonly understood by believers are completely foreign to those with an unchurched background. Many of those reading Phil's words do not even believe in God at all, and many that do may still consider the Bible to no more than a fable or a fairy tale. Words such as sin, salvation, and repentance may as well be in a foreign language. We need to address the audience at their level of understanding. A perfect example of this is the Apostle Paul's address to Greek Philosophers in Acts 17. Read the passage and you will note that this great evangelist never uses the name of Jesus and does not quote a single passage of scripture! He does however make reference to Greek gods, poets and philosophers.

4- Stay focused on the message. As Paul declared in his Acts 17 sermon, our root problem is that we reject God's ways and choose to live according to our own rules instead. There are consequences to that rebellion, which is why Jesus came. People love to start arguments over hot button issues such as abortion and gay marriage. Resist the temptation to debate moral issues apart from agreement on God's established moral law. When asked what we think about a specific issue or behavior a good response is, "We are all broken and we all have chosen our way over God's in one way or the other. Every one manifests their brokenness differently, but we all share the same root problem." Every sinful behavior is a manifestation of an attitude that declares that our thoughts, feelings and desires are more important than what God has set forth.

5- Remember- you don't have to declare the whole gospel to every person every time. Say as little as needed and as much as can be received. We don't convince or convert anybody. That is God's job. If you go back to Acts 17 you will see the outcome of Paul's remarkable message- "a few believed".

We live in a world that is increasingly hostile to the Christian faith.We need to proceed with caution, heeding the exhortation of Paul in Colossians 4 - "Be wise in the way you act toward outsiders; make the most of every opportunity. Let your conversation be always full of grace, seasoned with salt, so that you may know how to answer everyone."