One Man's Nightmare, Another Man's dream

He was worried. He had been a well paid executive manager for years and had climbed the corporate ladder to a salary of $300,000 a year. His outlook had been positive and his future secure. Then the market crash came. Now he was out of a job and watching his savings rapidly disappear. He was stressed and worried and his blood pressure was way too high.

We talked about life, financial security and what the future might hold. He was in the midst of a job search but had no solid leads. He expressed concern that he might lose his home if he did not find a suitable job but then talked about his faith and how he was trusting God to help him through the difficult times.

“But what if He doesn’t?” I asked. He was surprised by my question. I explained that while I often hear people talk about trusting God for material blessing and support through difficult times I wasn’t sure that He had promised the level of support people hoped for. Here in America when we think about our "needs" we think of keeping our houses and having a good paying job. In poorer parts of the world people pray for the true necessities of life such as a meal and safety. I shared that what we would consider terrible would be anything but for most people on the planet.

“What is the worst thing that could happen to you?" I asked, "Losing your house and winding up living in a one bedroom apartment in Santa Ana flipping burgers for a living? There are people dodging Border Patrol agents and coyotes for an opportunity like that!” I shared that a one bedroom apartment in Santa Ana would be an answer to prayer for many people in the world.

He paused for a moment, “You’re right,” was his simple reply. As we talked I reminded him that none of the difficulties he currently faced threatened any of the things that mattered most in his life such as his faith or his relationships with his family.

I think about our conversation often, usually when I hear someone's prayer request. It causes me to reflect on what really matters in my life and reminds me not to cling too tightly to my “stuff.” I remember that Lisa and I aren’t really any happier now than we were when we were living in an apartment and barely making ends meet. Back then we found joy in trips to the laundry and cooking meals together. We lived paycheck to paycheck and scrounged up loose change for trips to McDonalds, but we were happy. Even now we realize that our best times are our best times because of who we are with and not because of what we have. True joy comes from our family and not our possessions.

I am also reminded of the danger of putting too much emphasis on what happens in this life. When all is said and done and I am called to give account for my life my financial achievements will not matter at all but the love I gave and the sacrifices I made for others will. Like all men I well be measure by the content of my heart and not the contents of my bank account.

-          Bart

Does Easter Still Matter?

Why care about Easter? What importance can there be in isolated event from over 2000 years ago? Billions of people have been born and died since then, thousands of important leaders have entered and exited the world stage, and we have seen the rise and fall of many global empires. Compared to these events, what does one event on one day matter?

Sometimes a single event on one day changes the course of history. Archduke Ferdinand was unknown to a majority of the world on the day he was assassinated in 1914 but his death triggered a chain of events that resulted in the deaths of 37 million people in World War 1. Alexander Fleming was a brilliant researcher with an untidy lab. One day in 1928 he returned from vacation to discover that a fungus has grown in one of his Staph cultures, inhibiting the growth of the bacteria. Penicillin was discovered and medicine changed forever, one event on one day.

Jesus of Nazareth was an itinerant preacher in the land of Israel. His public ministry lasted only three years. Dramatic miracles led to a following that was initially large numbers dropped significantly when His teaching became more challenging. He still commanded enough of a following to be considered a threat by the Jewish leaders who feared He might lead a revolt against Rome. Determined to end the threat they had Jesus arrested, tried, convicted and executed in less than 24 hours. When He was placed in a borrowed tomb late one Friday He was, to all appearances, just another failed rebel, a philosopher rabbi whose words would likely fade over time.

Then Easter Sunday came. The tomb was empty and He was seen alive by many who had followed Him.  A new religious movement arose based on the story of Jesus' resurrection. Reports of His resurrection could have been easily disproven if false,  simply producing His body would have put an end to such claims. But no body was forthcoming and not a one of His followers retracted their story. Many even died for it. All of the evidence pointed in the same direction. Jesus of Nazareth had come back to life.

His resurrection did not just bring back His body from the grave. It did far more. It brought credibility to his teaching and affirmed His remarkable claims of divinity. The Apostle Paul summed up the meaning of Easter, writing that Jesus. “through the Spirit of holiness was declared with power to be the Son of God by his resurrection from the dead: Jesus Christ our Lord.” Romans 1:4

One event on one day 2000 years ago changed the world. By His resurrection Jesus proved that He was not just a rebel, not just a prophet, not just a teacher and not just a man. He was, and is, much more. He is the Son of God and as such must be dealt with.

The question the Roman Governor Pontius Pilate asked on the night Jesus was crucified is one that we all must ask ourselves, “What shall I do with Jesus?”

Easter demands an answer.

-          Bart

Who Killed Jesus?

Who is to blame for the death of Jesus? In some ways the case seems open and shut. The Jewish religious leaders of that time conspired with the Romans overseeing Jerusalem to have Jesus arrested and then tried in the Jewish religious courts and then in front of Pontius Pilate, the Roman governor. Who else could we blame?

This simple answer overlooks an important detail. Jesus knowingly and willfully walked into the trap. His death was not something that caught Him off guard, was not an interruption of His plans or a defeat of His strategy. His death was the plan, it was the strategy. Knowing in advance what lay ahead of Him  Jesus spoke these words to His disciples- “The reason my Father loves me is that I lay down my life — only to take it up again. No one takes it from me, but I lay it down of my own accord.” John 10:17-18

The gospel writer of Luke described Jesus heart and intentions as the end of His life approached- “and it came about, when the days were approaching for His ascension, that He resolutely set His face to go to Jerusalem” Luke 9:51-52

He resolutely set His face. With purpose and intent he turned toward the city where death awaited Him. Knowing this, He chose to go anyway. He chose to die. He chose to die not because He had a death wish for Himself but because He had a life wish for us. The writer of Hebrews described what His death accomplished for His people “He sacrificed for their sins once for all when he offered himself.” Hebrews 7:27

So who killed Jesus? He offered Himself. He offered Himself for the sins of all men. The Jews and Romans were the instruments by which His death was accomplished but the reason His death was necessary is because of what all men have done. We all are guilty.

- bart

A Jerk Like Me

The email seemed downright mean, albeit efficient. In just two paragraphs the patient managed to criticize my attitude, my responses, my office staff, my computer system, my scheduling system, my treatment of patients and my overall business acumen. Although I was taken aback at the meanness of the message it was the basis for the outburst that most caught me off guard. The email was written in response to a brief message I had sent. My message was, “You are overdue for a visit, please schedule a visit so we can process your refill request.”

I had typed my message quickly in response to an email query from the patient asking me to clarify a previous message. His message seemed straight forward and to need only a brief reply. I was obviously mistaken.

My initial response to the email was defensive. I had done nothing wrong to my knowledge and if there had been an error it was clearly unintentional. The patient had no reason or right to be demeaning. As I thought about what to reply a thought came to my mind. “If your motives are pure, why worry about defending yourself? Why not ask the patient what you can do for him?”

I called the number in the chart and followed up with a brief email saying any failure to communicate on my part was unintentional. To make sure he knew I was sincere I included my personal cell in each communication. We finally connected after a few email and phone tags and he shared with me why he was unhappy. He had struggled with our online system  and he wanted me to know how bad it was. There were a number of system failures and it took a while for him to share them all.

As we talked to things became clear. First, he had indeed struggled with our online system. It is glitchy at times and he had definitely been glitched. Secondly, he was someone who desired excellent service. Excellence was his goal in his business and he expects the same from others. What's wrong with that?

Sometimes excellence is not possible. His struggles were the type of understandable and inevitable communication difficulties associated with email and computers in general, the frustration that comes when we quickly type out questions and answers. Because the communication was about something personal, and because it took of too much of his time it was easy to see each mistake as a personal affront, as an insult to his time and person. In his frustration and impatience he reminded me of… me.

For years I demanded excellence from every vendor, service provider and business with whom I interacted. If I was paying for a service I expected the very best. It took me years to realize that perfection is impossible and that excellence is an elusive goal. I thought I was a professional pursuing excellence. Everybody else saw me as a jerk.

On the majority of occasions I complained about unmet expectations I did so ignorant of how hard the other party had worked to meet my needs. I did not take the time to understand what they were up against, what the standards were in the industry or how much time my demands required. I fear that on many occasions I reacted negatively when someone had done all he or she reasonably could have done to respond to my requests. It never dawned on me that I wasn't paying for perfection, that if I wanted perfect performance from the person handling my medical billing or processing a referral it would cost me a lot more than $20 an hour! How unreasonable I must have seemed to others.

I still struggle with adjusting my expectations. Balancing a desire for excellence and a commitment to grace requires constant effort. I have learned that the effort is absolutely worthwhile. As I grow more patient and understanding my stress levels drop and I still manage to meet the goals I set for my practice. I am also considered to be less of a jerk.

I pray that my patient will learn the lessons I have learned and continue to learn. It is much better to be considered kind and gracious than it is to be viewed as excellent and demanding!

-          Bart

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Funny, Smiling, and Dead in a Moment

She was funny. From the moment she arrived in the emergency room she kept the nurses and doctors entertained with quips and jokes. She was seriously ill but she was full of life. Within minutes she was gone.

She came into the emergency room complaining of fever, cough and fatigue. She had been feeling poorly for a few days, ill enough that she had gone to another emergency room a day before. They had not found anything so they sent her home. When she failed to improve she and her husband decided to try a different hospital. It was early evening when they came to hospital where I worked. I was the resident on call that night.

Her oxygen level was on the low side and she did not respond to the breathing treatments she received so even before he saw the x-ray the ER doctor decided she needed to stay the night in the hospital. He called me down to the ER to handle her admission. I spoke with the ER doctor briefly, reviewed her chart and went in to say “Hi.” She was smiling and upbeat as we talked. While we were talking I received word that the xray results were in. I left the room to review the films.

I was shocked at what I saw. Her entire left lung was filled with fluid. Instead of the dark open appearance of air the whole left side was entirely white. It was the worst case of pneumonia I had ever seen. We all realized that this delightful lady was much sicker than we had thought. She was deathly ill. I quickly arranged for a bed in the ICU. Within the hour she was in the unit and IV antibiotics and oxygen were flowing. She was still smiling.

Then her oxygen levels started to drop. Her breathing became rapid and for the first time her smile was replaced with a look of concern. We made the decision to intubate, to put a breathing tube down her throat and connect her to a ventilator to improve oxygen delivery. The attending asked me to perform the procedure. A sedative was administered and I moved to the head. I reassured her as I tilted her head back to allow for placement of the tube.

My face was 12 inches from hers. I held the laryngoscope in my left hand and the endotracheal tube in my right. Right at the moment when I moved to insert the laryngoscope into her mouth her eyes rolled back into her head. I heard the ominous tone of her heart monitor as it turned flatline. This wonderful 40 year-old woman had just died right in front of my eyes.

I continued on and inserted the tube as resuscitation efforts began. After a few hectic moments filled with the chest compressions, shocks and IV medications a pulse was restored. Her pulse came back, but she didn’t. The infection was overwhelming. It took a few days for cultures and tests to explain what had happened. She never had a chance.

She had been on prednisone, a powerful anti-inflammatory steroid, for quite some time to treat a form of arthritis. Unbeknownst to her the prednisone had weakened her resistance to stomach acid and an ulcer had formed, eroding deeply into the lining of her stomach. Eventually it eroded all the way through and acid and stomach contents had seeped into her chest cavity, carrying with it deadly bacteria. By the time she arrived at our hospital she was septic and bacterial toxins were taking over her body.

Within hours of the resuscitation in the ICU her organs began to shut down due to the septic shock. She was comatose. All of us on the medical team knew it was over. Her heart continued to beat and the machines continued to supply oxygen but there was no hope. She was gone.

The reality of her condition was impossible for her husband to accept. She had been so alive just days before and he could not comprehend how the woman he loved could be gone so fast. In his grief he was angry, demanding and defiant. He repeatedly insisted that something be done but there was nothing anyone could do. Many of us tried to talk to him but it took several for him to understand that she was gone, days spent alone at the bedside of a woman who was no longer there.

I have never forgotten either of them. They come to mind whenever I deal with the unexpected loss of a young patient. They remind me of the fragility of life and the inevitability of death. They remind me that every moment with the ones we love is precious, that every breath is sacred. They remind me to hug my wife, to tell her I love her every day, to thank God for her and to cherish her, for we all can be gone in a instant.

-          bart