The Wisdom of Gramps

I have spent much of the last several days thinking about my grandfather. As is often the case when a loved one is lost, his words and stories have filled my mind. He was a man who loved to laugh and tell jokes but I do not think any of his jokes were new. I doubt if any of them originated after 1955. Here are some of his favorites-

Whenever anyone asked how he was his standard reply was, "I'm older than I've ever been."

When one of his grandsons would walk in he would often say, "You get any better looking and you'll look as good as me!"

If I asked him if he could afford anything his answer was always, "I've got money I haven't spent yet!"

A few days before he died, I suggested it would be easier to put all of his money into a single account. Gramps replied, "You want to put both dollars in the same place?"

He always introduced himself by saying, "I'm Les. With one "s"

He told me several times what he wanted on his gravestone- "Les is no more."

I still laugh at the silliness of his jokes, but it is a serious comment he made when I was 10 years old that has most been on my mind. One summer my cousin and I spent a few weeks with our grandparents. We spent most of our time trying to one up each other. One morning we were debating who was greater and telling stories about why and how we were better that each other. Gramps overheard our friendly argument and called out from the other room.

"If you really were great you wouldn't have to tell anybody. They would just know." That lesson about  greatness, that it is based on your actions and not your words, has never left me.

Thanks Gramps.

- Bart

A Love that Lasted.

I said good-bye to my Grandfather today. He was 97. His last words were to my Grandmother, the love of his life for 77 years, "I love you, Sweetie." My grandfather was not a perfect man, but if a man’s life is measured by the love he has for his wife, he was a good one.

It was just 12 days ago that Gramps was discharged from the hospital. As he was deemed too weak to return to his assisted living facility I scrambled to find a nursing home near me that would accept him and my grandmother. His long term prognosis was poor as the combination of age, a muscular disorder and perhaps some small stroke had rendered him unable to protect his airway when he swallowed. We all knew it was just a matter of time before aspiration pneumonia would take him.

He was admitted to the skilled nursing facility late on a Saturday. I took my grandmother to visit him the next afternoon. My brother and cousin were there with him when we arrived. Gramps had been dozing off and only marginally engaged in conversation. That all changed when I wheeled my grandma into the room. His face lit up when he saw her, he was fully awake and smiling broadly. I pulled her wheelchair up beside his bed. He quickly took her hand and said, “I love you more than ever!”

For the next 10 days they shared a room together, their beds side by side, TV’s turned on to Fox News, their favorite channel. During the days they went together to physical therapy sessions. She worked on regaining sufficient strength in her leg muscles, he worked to be able to sit up in bed. When she finished her exercises she remained for his session, acting as cheerleader to get him to work harder. The staff told me that he did better when she was there. He always did better when she was there.

She is still there, but he is gone. Now she will have to make do on her own, a daunting challenge after 77 years. It will be a struggle for her but I pray she will find comfort knowing that she was truly and completely loved. Even more, I pray she will rest in the knowledge that she will see him again. When God calls her home, I expect my grandfather’s face will again break into a smile. Heaven will be even more perfect, because she will be there.

Bart

Infertility and Punching Friends in the Face

“If any one says, ‘My husband just looks at me and I get pregnant’, walk up to them, punch them in the face and tell them your doctor told you to do it.”

I was talking to a new patient who was dealing with infertility. She and her husband had been trying to conceive for over a year and she was feeling the strain. It seemed her life consisted entirely of ovulation kits and menstrual cycles. The spontaneity of romantic intimacy had given way to planned intercourse on designated days, their sex life governed more by hormonal cycles than love.

As Lisa and I had also struggled with infertility I was able to empathize. I said, “What makes it really hard…” and she finished my sentence for me, “It seems like everyone around you is pregnant!”

I gave her a second face-punching instruction, telling her she could also smack anyone who said, “Just relax, it will happen.”

We talked about how no one who has not dealt with infertility can fully understand how hard it is, and how we tend to suffer in silent loneliness for fear of being a “downer” to our friends. We talked about the fear of never having children and the rollercoaster ride of emotions and the tense days each month as the day a period was due approached, the hope and fear that build up simultaneously.

At the end of the visit I asked her if I could say a prayer for her. I put my arm around her shoulder and asked God for peace and hope, and asked Him to bless them with a child. I also asked that He help her trust Him regardless of the outcome.

When she left, nothing about her circumstances had changed, but it is my hope that she left encouraged with the knowledge that she was not alone, that someone understood, that someone cared. Sometimes that is the most important medicine.

-          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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Men can be Pigs. Women Need not be Pig Feeders

While there are many things that men can inadvertently give away to other women, there are things women can give away as well. Just as I should not look at any other woman with desire, women should not set themselves up as the object of any other man’s desire. In many ways, provocative dress is the female counterpart to a man’s lustful look. There is no one who hasn’t walked down a street and seen a woman displaying aspects of her person that should only have been shown to her husband! I am not advocating that women be fully covered as they are in expressions of Islam, but I am encouraging women to reflect on their appearance. Some aspects of a woman’s physical beauty do not need to be shown to other men.

As we look at our own thoughts and attitudes about marital intimacy and how they impact the way we see the world we realize just how important our thoughts are. All of the commandments thus far emphasize the importance of how we think. God cares about how we think about sexuality and marriage. God knows that evil actions always begin with evil thoughts and wrong attitudes. The beauty and oneness of marriage can be easily damaged if we do not consciously work to protect it. We live in a world filled with easily accessed pornography, and where casual sex is the order of the day. With the foundation of intimacy under such attack it is not surprising that infidelity, divorce, and single-parent families are so common.

Given the prevalence of sexual immorality in our culture, intentional effort is required if we are to protect our families. Christians need to be vigilant in what we allow into our homes and into our minds. We need to be especially careful in our consumption of media. So much of what’s on television and on the internet threatens our families.

I have taken practical steps to protect my family. With my children, we review together the content of movies before we go. If there is questionable content, we don’t go. When my children were younger, I decided where the lines were drawn and what they could see. As my children have matured, they have been able to apply biblical principles and make good decisions on their own. If a television show is inappropriate we turn it off. When my daughter was in middle school she watched the Disney Channel, a lot. When I noticed that a show aimed at “tween” girls was encouraging casual attitudes about dating, we decided it would no longer be watched in our home. My twelve-year-old daughter was in total agreement with the decision. She had been taught the importance of morality.

I have worked to teach my children morality in their personal lives as well. When it comes to my daughter, I am the “outfit police.” I help her understand that there are things a young woman does not need to reveal to others or draw attention to. So much of girls’ and women’s clothing is designed to be provocative that it can be easy (especially by adding peer pressure) to grow comfortable wearing inappropriate clothing. As a man I can identify provocative clothing better than my wife can, so I make it a point to help my daughter understand what her clothes say about her.

With all of the tangible lessons I try to teach my children about modesty, I have learned that the best way to instruct them about sexual morality is through my relationship with my wife. There is no more powerful example than the one they see every day. I make sure to express my love for my wife in front of my kids. They hear me praise her and tell her she is beautiful. (And they don’t hear me praise other women!) I make it clear to her and to them that she is absolutely everything to me, and that no other woman has any chance at all of gaining my affection. Through all of this I teach them what it means to be faithful.

As with all of God’s commandments, His imperative against adultery is not punitive. I have seen in my own life the incredible blessing of a healthy marriage. I have experienced the beauty of the intimacy that God desires. A love for God and an appreciation of His gift in marriage drives me to work hard at thinking and acting as faithfully as I can. When God had Moses proclaim, “You shall not commit adultery,” He was showing us how to save our families and experience His blessings. 

- Bart

This is the 8th and post on adultery excerpted from my book Life Medicine, available on Amazon  A recent message on the topic is available on my vimeo page, click here to view. Comments or questions on this, or any post, are always welcome. If you are interested in having me speak to your church or community group, contact me through this site. Those who wish to subscribe to the blog and have posts delivered to their inbox need only click on the subscribe link, and posts will magically appear!