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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Are You Being Paid Enough?

What constitutes a fair wage? Fast food workers have been holding demonstrations demanding $15 an hour. A young CEO in Seattle recently decided that every one of his employees deserved a minimum of $70,000 a year as that was what he considered to be a living wage for that city. The news is filled with editorials and opinions about income inequality and a fair salary. How should a Christian businessman respond? How much should we pay?

It is one thing to philosophically discuss the principles behind wage structure in America, it is an entirely different thing to sign paychecks.  I am a small businessman with 5 employees who depend on me for their livelihoods. The realization that 5 families rely on me every day of their lives is a sobering one. If I desire to do well in this life, if I believe that I will one day answer to my Creator for my actions, how I treat and what I pay my employees is important.

While this is one of the most challenging aspects of my job the topic was completely unaddressed in my education. My training was extensive- five years of undergraduate study, 4 years of medical school and 3 years of Family Practice specialty training, yet not one hour was devoted to the topic. Nobody taught me how to be a manager of people or how to compensate them for their labors. I was forced to find the answer on my own. I ultimately turned to Scripture, following the principles in Jesus’ Sermon on the Mount, where He said, “In everything, do to others what you would have them do to you.”

The application of this truth has caused me to consistently pay my employees a fair and competitive wage and to treat them well and with respect. It has not caused me to dramatically overpay far above market rates, for that is not how I would truly want to be treated or what I would expect from an employer. If I was an employee being paid $70,000 for a job that required little training or experience and for which typical compensation was $25,000, my $70,000 salary would feel more like charity than earnings. While the extra money would be nice, in my heart it would feel wrong. To apply the Golden Rule in the other direction, I would want my employer to pay me what I had earned and to keep the profits he had earned, regardless of how high they were!

To ensure my employees are paid fairly I intermittently survey the salaries offered for similar positions in the community. As I have very high standards the individuals who work for me are typically high performers, so I consistently pay them at or slightly above the top rate for their positions. As a result they know they are paid well for the jobs they do. They also know that they have chosen their profession and the salary range it offers and do not expect to be paid the same as others whose jobs require a greater skill set or more extensive training.

A conversation I had with my current nurse shortly after she joined my office perfectly illustrates the concept of a fair wage. She is a remarkable employee who clearly possesses the ability to move beyond office nursing and become an RN working in a hospital, a job with a pay level nearly double her current income. When I praised her performance and asked her why she didn’t go further with her training she replied that additional training would mean less time with her children so she decided that this was what she wanted to do. She was exactly where she wanted to be and comfortable with the salary that came along with it. She is so comfortable that with her last two pay increases she told me, “You don’t need to do that. You pay me enough.”

My nurse has integrity and a strong work ethic. She works hard for me and does her best for me and the patients we serve. Her effort is not based on her salary. Her desire to do her job well is based on her character and not her compensation. She is not looking for charity or a handout or to be paid more than she has earned. In her attitude and her efforts she earns not only her pay but my respect. Because I pay her fairly and treat her well, I have earned her respect as well. 

While some could look at the difference between what I make and what she makes and proclaim, "Income inequality!" those who took the time to look closely would see two people who worked together as a team, valued one another highly and respected one another. Two people who understood the truth that we have equal value as people, which matters much more than our pay rates.

-          Bart

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Standing Where Heroes Stood

Places have power. I learned this again this week as I visited Massachusetts. There is something about standing where others have stood that makes history come alive, that makes old stories seem fresh, new and more powerful.

I visited Plimouth Plantation, where there is a reconstructed Pilgrim village. I stood in a one room church building and looked at the pulpit, a small elevated structure facing simple wooden benches. There were no decorations or stained glass. I was reminded of the simple intensity of the Pilgrim’s faith. Their belief in God’s call on the individual and of the importance of the local church had caused them to leave everything and everyone as they sailed 3000 miles to their new home. 

We toured the grounds of the village and went inside the small homes that illustrated the simplicity and difficulties of their daily lives. As I looked at the sparse furnishings and clay walls I was reminded that these were a people who were more concerned with eternal things than earthly goods and needs. I thought about how difficult it was simply to eke out a living, of the labor required to acquire food and shelter. These people were committed.

As I looked at the small village and later as I visited the Mayflower II in Plymouth Harbor I thought of the bonds they must have shared. Over 2 months at see on a small ship would force them to live in community, as would they work required to survive when they arrived. I thought of the shared grief as they lost half of their number within the first three months. Was there a day when a grave was not being dug, filled or prepared?

Later in the week we walked the Freedom Trail in Boston. We stood by the grave of John Hancock. I thought of the brashness of the man who boldly declared himself a traitor to the King of England by signing his name in massive letters on the Declaration of Independence. We saw the burial place and then the home of Paul Revere, a silversmith who became a legend. We walked by the churches and meeting houses where many began their transformations from Englishmen into Americans and wondered about the debates and the arguments that must have occurred.

I was moved by the truth that both the patriots and the pilgrims were motivated by deeply held beliefs. They shared the belief that each person was a child of God and as such had value. This belief was the basis of the Mayflower compact, the initial promise that all would work together in the new land, and of the Declaration of Independence which declared that “all mean are created equal.”

I was moved by the realization that everything I have and hold dear in life I have because others believed and others sacrificed. These forefathers and founding fathers did not merely pay lip service to their ideals. They risked their lives for them. Standing where they stood I found myself praying that I may be one day found as faithful.

-          Bart

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