Blessed by a Dying Man

He was a bear of a man, in two varieties. He was big, strong and burly, an imposing presence like a grizzly. He is also warm and kind, always ready with an encouraging word, like a teddy bear. He is one of those remarkable patients who always takes the time to ask me how I am doing and truly is interested in the answer. On more than one occasion he has asked me if he could pray for me before he left the office. It made me feel guilty at times. I was the one who was supposed to be making others feel better.

He is only one kind of bear now. The big bear aspect of his nature has faded. Cancer has removed almost 100 pounds from his frame and the tumor compressing the nerves to his left arm has resulted in incapacitating pain. He has been on hospice for over a year now, his disease incurable and his death imminent. It is hard for him to get out as much as he used to which makes the still present teddy bear side of his nature more difficult to share.

As encouraging others has been such a major part of who he is the isolation has been difficult for him. He has been wondering why he is still around, why God has yet to take him home, why he must live in so much pain when there is so little he can do for others.

He shared these thoughts with me when I stopped by his home on Friday for a hospice visit. There was not much for me to do from a medical perspective. For the last several months the only changes in his care have been increases in the dose of his pain medicine. He has been in agony, daily choosing to endure the pain rather than be comfortable yet sedated and less present for others. As bad as the physical pain is as we talked I could tell that the emotional pain was taking a greater toll. He felt he had little to give others and that was breaking his heart.

In almost the same breath as his sharing a sense of worthlessness he told me that I had been on his mind for the last several weeks and that he had been praying for me daily. He asked me how my family was, if everyone was okay. If there was anything or anyone who needed prayer it was clear he wanted to know. He told me that he loved me, not just as a doctor, but as his friend. We spoke for a few minutes more and I tried my best to encourage him.

As I turned to go he stopped me and told me to wait. He reached for his wallet and I could tell he wanted to give me a gift. “Please, no,” I said, “You do not need to give me anything! This is my job!” He shook his head insistently and told me that he wanted to give me something. He took money out of his wallet.

“Take the girls in your office to lunch on me,” he said. I hesitated, he would not take “no” for an answer. He wanted to do something, to make a difference in my life. I realized how important it was to him. He wanted to bless me, to bless my office, in any way he could. He needed to bless us, because that is who he is. He is a man who lives to bless others. I let him shove the money into my hand.

I left his home, once again moved at his kindness. As unsure as he is about why he is still around his purpose is clear to me. He is a testimony to others about what it means to be a Christian. He embodies Jesus’ teaching about putting others ahead of ourselves, of loving selflessly. He is a blessing to others, and a blessing to me. Like the Savior in His moment of suffering, my patient is choosing to consider the needs of others.

 Bart

Thanks for reading. Pray for my patient, Mr. R, that God will comfort him and encourage him. Consider sharing this post and asking others to pray for him as well.

Learning the Power of "No"

I wanted to be an actor. I had no reason to think I could succeed in the arts, but I loved the theater. I had no formal training, I couldn’t sing at all, and had never taken a single dance lesson. My stage experience was limited to a couple of very low quality high school productions but that didn’t stop me from enrolling in college as a theater arts major. I had a dream. I wanted to act.

The dream died my first day of college. I do not remember what prompted the moment of reflection but after my first, very boring day at Cal State Fullerton I sat and reflected on the reality of my goals. Given my complete lack of musical talent there was no hope for Broadway. Drama or comedy were a possibility, but I was not leading man material. I was not particularly good looking. I had a very slight build and was not particularly tall (somethings never change!). “Romantic lead” was not going to ever appear on my resume. If I was going to be an actor I would have to do it the hard way. I would have to have another job and scrounge for any role I could find, likely as a bit player or character actor.

While many similarly endowed have gone that route and eventually succeeded I realized there would be another barrier to success, my beliefs and values. As a committed Christian, there were limits to the roles I could accept. There were things I would not say, even in character, and things I could not do because of my faith. There would be times I would be forced to say, “No.”

As I pondered all of these facts in my head I realized I had no choice. The chances of me making it as an actor, making it to the level of being able to one day provide for a family without compromising my values, were nil. My dream had to die and it did. As I had no idea what I wanted to do with the rest of my life I dropped out of school to reconsider my life path.

This story from my past came to mind this week as I read more of the tales of abuse and harassment in Hollywood. The lurid accounts of shameful and disrespectful behavior validated the conclusion I reached almost 40 years ago. So many have given up so much in pursuit of acting careers, preyed upon by lecherous men like Harvey Weinstein. It seems it is almost impossible to make it as an actor or actress without compromising one’s values.

As disgusting and offensive as the actions of Harvey Weinstein were I cannot ignore the reality of why they continued for so long. Men like Weinstein do what they do because there are men and women who are desperate enough to allow them to. Morals are tested, challenged and frequently cast aside. One compromise leads to another, and the compromises of one person lead others to feel pressured to similarly give in.

Strings of compromise lead to entitled expectations from powerful people who make or break careers. Actors and models who are willing to take off their clothes and imitate lewd behavior on camera for money or the opportunity at fame should not be surprised when others think they may be willing to do the same in private. When you have established a price, people will try to buy you.

The solution to this problem isn’t only to punish the perverts (although the punishment should be severe). The solution requires values and boundaries. People need to be willing to accept the potential adverse consequences of saying, “No.” They may lose coveted roles or even their careers to the whim and spite of a power-hungry sleaze, but they will keep their dignity.

They may lose a Hollywood career, but they will not lose their chance for happiness. They will have the same opportunities for happiness as the rest of the world, the happiness that comes from being a good spouse, parent, friend or co-worker. They can have joy that surpasses fame, the joy of being a good person who is true to their values. They can live a fulfilling life that is not subject to the whims of another, fulfillment dependent on neither fame nor income level.

I do not know any celebrities but my distant observations are that few of them appear to be truly happy. Most of the people I know have lives of better quality. I know I do. I have been happily married to my best friend for over 35 years. I have close relationships with my adult children. I have no skeletons in my closet and no terrible secrets waiting to be discovered. I also have my values and my dignity.

-          Bart

"Want to see a Fat Man Naked?"

I have said a lot of stupid and offensive things in my life but none of them rise to the level of stupidity displayed by Hollywood mogul Harvey Weinstein. Weinstein, twice married with 5 children and the producer of blockbuster movies (5 of which have won Oscars for best picture) can now lay claim to the dumbest pick up line ever spoken. He is reported to have asked Ashley Judd, “Do you want to watch me take a shower?”

A quick Google image search of Mr. Weinstein answers the question for all women (at least all of those not stricken with a pudgy fetish). No one would want to watch Harvey Weinstein take a shower. Ever.

Given the obviously disgusting nature of the question and the blatant sexual harassment it represents one is left to wonder why he would even ask it. What sort of man thinks it is appropriate or acceptable to ask women who work for him if they want to see him naked? Why would he think he could get away with such behavior? The answer seems to be that there were women who took him up on his offer, and that he did get away this behavior for over twenty years.

He was able to get away with it because he lives his life in a world without moral values, a world where money, power and fame are all that matters. In Mr. Weinstein’s world morality is about attending women’s marches, distributing movies about the victimization of women on college campuses (2015’s “The Hunting Ground”) and donating to the right political candidates. For him, morality seems to have very little to do with how he treats the actresses who work for him. He was too important to concern himself with the feelings of others.

While Weinstein’s pig-ness is unassailable, the fact he got away with it is also concerning. While the actresses who were victimized and harassed are not to blame for his behavior it is nonetheless sad that so many remained silent for so long. The danger of their careers being harmed should they speak out drove many to silence. Ms. Judd referenced this fear herself.

While these women are not to blame for the harassment the reality that their silence allowed it to continue cannot be ignored. In situations of abuse if we calculate the cost of making a stand, if there is a price we will not pay for our principles, bad will be inevitably allowed to continue. Values are either invaluable or worthless. Compromise is not an option.

This truth applies to every area of our lives. Every time we compromise our values, every time we say something is “Not that bad” and do things “a little wrong but not terrible”, every time we make excuses for our bad actions, every time we allow wrong to continue for financial or personal gain we follow the example of Harvey Weinstein. We become people without a moral compass.

I do not want to be like Harvey Weinstein. I cannot change the culture of Hollywood or influence what happens in the halls of power but I am not powerless. In my own circle of influence I can choose to treat people well, to make difficult and costly choices and to do the right thing, every time. I cannot change the world, but I can change my world.

-          Bart

A Police Shooting, A Facebook Debate

Last week a Huntington Beach police offer shot and killed a man outside of a convenience store. The deadly exchange was captured on cell phone video by two different bystanders, one of whom posted the video to Twitter within minutes of the encounter. It took only a few minutes more for arguments to begin on social media.

The video was only 17 seconds long and captured only a portion of the interaction but that was enough for hundreds of people on Facebook to make confident judgments about the rightness or wrongness of the officer's actions. The opinions were diverse, with the officer being described as everything from a hero to a murderer.

The assessments were diverse but shared a common confidence. Multiple "analysts" expressed their opinions without wavering, seemingly oblivious or uncaring of the thoughts of others. People chose their sides and held their ground eager to judge not only the officer and the man who was shot but also the assessments of fellow commenters. Scorn, praise, disdain and encouragement were freely given to complete strangers based on brief comments on Facebook. The relative of anonymity of social media led to name calling and personal attacks, peppered with dismissive insults of others such as “Embarassment”, “Fool”,  “Wackadoo” and “Asshat.”

Those against the officer's actions demanded he be punished, confidently stating he could have and should have acted differently. Some declared that the officer could have shot his attacker in the kneecaps instead of the torso, (which leads me to wonder if they have ever fired a handgun, as such marksmanship under pressure would be truly incredible). Others asserted that the officer, after an intense wrestling and fighting match with the man, should have somehow been able to subdue the man with his hands alone. Some were confident that had the officer only had better training in mental health issues he would have been able to “deescalate” the situation and avoided violence. They described the 27 Year-old man who attacked the officer in sympathetic terms, as a victim of society, the mental health system and overly aggressive policing.

Others decided not only to support the officer but to devalue the humanity of the man who attacked him. His name, once revealed, was seldom used as people chose to instead call him pejoratives such as "scum", "garbage" and "loser". Many said that not only that the officer justified in his actions but that the man "deserved to die."

Almost all of the comments revealed major flaws in American society, the seemingly universal inability to listen to and entertain alternative points of view, as well as the inability to questions one’s own positions and arguments. Battle lines take priority over lines of communication. Personal feelings of moral superiority trump the personal feelings of others. We are quick to judge, quick to speak and completely unwilling to listen to one another.

Many of the responses I read displayed a type of selfishness, an apparent desire to elevate one's self over others and to gain a sense of moral superiority. Opinions mattered more than people. Lacking in most of the dialogue was a sensitivity to those involved in the actual event, as if they were characters in a drama instead of real people. I do not know the officer but I suspect he has no need for others to question his actions.  He will undoubtedly undergone countless hours of self doubt and questioning in addition to the inevitable formal investigation. For the rest of his days he will have to deal with the reality of taking the life of another human being. The family of the man killed have had his mental illness and irrational behavior put on display for all of the world to see, with their family dynamics called into question. Those who disparage his upbringing and support network do so with no knowledge of the pain and agony experienced by the loved ones of those with serious psychiatric disorders. Families of the mentally ill often question themselves, wondering where they went wrong and what they could have done differently. This family has the added emotional stress of processing the graphic video images of someone they loved die from gunshots. With so many opportunities to question themselves and their past actions, they do not need the questioning of strangers.

It is time for all to take a step back. We need to be less confident in our opinions, more questioning of ourselves, and less questioning and judging of others. We are all flawed and broken people, we all fail, and we all struggle. None of us wants our imperfections publicly displayed and debated or to have our actions examined under a public microscope. We need grace more than we need judgment.

For me, I am going to make it a personal goal to change my initial responses to the actions of others shared in the media. Instead of jumping to conclusions and passing judgment I aim to fall to my knees and pray, for this may actually accomplish something.

- Bart

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"It's Cancer"

“It’s cancer.” I have said those words to patients hundreds of times. Sometimes the news was particularly bad, news that a cancer was not only present but had spread. Other times the news was more encouraging, of a minor cancer that was easily treated. Patient responses have been as varied as the diagnoses. On hearing the news some patients were shocked and some were tearful while others were stoic or silent. All were changed by the diagnosis as all saw themselves and their futures differently for having heard those two words.

I spent most of my morning today waiting to hear those words myself. I was certain they would come. 10 days ago I had my Physician’s Assistant biopsy a new mole on my forehead. I first noticed the mole a few weeks ago. Although no one else was worried about it,  its newness combined with my family history of melanoma made me concerned. My PA dutifully and skillfully performed the biopsy and sent the tissue to the lab for analysis.

Skin biopsy results almost always arrive within 5-7 days of submission. When day 7 arrived without results I started to wonder. This morning was the morning of day 10 and when results were still not in my inbox my wonder evolved into worry. I could not see any way that a benign diagnosis would take this long, especially when I had already gotten results back on patient biopsies submitted after mine. In my concern I had my nurse call the lab and ask for the results. The lab secretary told her that results were not yet available because the tissue had been “sent out for additional tests.”

That settled it for me. I was certain the diagnosis was melanoma. No one does “additional tests” on benign moles. The only question left was the seriousness of the diagnosis. Did I catch it early enough, or had it already progressed to a dangerous stage? I had the staff leave a message for the pathologist to call me back as soon as he arrived, wanting the final diagnosis as soon as possible. Waiting has never been easy for me, waiting for this call was agonizing. As melanomas can be deadly I found myself wondering what the impact on my family would be if the prognosis was poor. I began to mentally prepare and brace myself for the potential bad news.

My office staff was stressed as well. We are a close knit group and their concern was obvious. I made lame jokes that were not well appreciated and served to amplify rather than calm their fears. Sensing this I leaned over to my receptionist and quietly spoke words that were meant to encourage both of us saying, “Nothing about the diagnosis will have any impact on God’s eternal plan for me.” The truth of these words brought me comfort.

As there was nothing else I could do in that moment I went back to seeing patients, less distracted than I expected but distracted nonetheless. My eyes frequently drifted down to the clock in the corner of my computer screen. How long was the pathologist going to wait before returning my call?

When 11:30 came I decided I was done waiting. I called the lab myself. After a few minutes on hold the pathologist came on the line. “It is a lentigo maligna, a melanoma in situ,” he said. I felt a weight lift off of my shoulders. It was melanoma (the worst kind of skin cancer with the potential to lethally spread throughout the body) but it was “in situ”,  meaning that it was still confined to the surface of the skin and had showed no signs of penetrating deeper. I had cancer, but it was completely curable with minor skin surgery. I would not need chemotherapy, I would not need body scans or additional testing. I had caught it in time.

I spent the rest of the day emotionally drained. I felt like someone who had been involved in a near miss plane crash or car accident, relieved but shaken by the reality of the disaster that could have been. I found myself on the verge of tears as I drove home from work tonight. I realized that something about me had permanently changed. I am now, in a way, a cancer patient.

I have cancer, cancer that could kill me if I don’t get the rest of it removed. I will get it treated and I will be cured but for the rest of my life “melanoma” will be a part of my personal medical history. It will always be in the back of my mind. Every time I look at my moles and every time I look in the mirror I will wonder if there is something there. I will need to remain ever vigilant. The fear that I may not be as fortunate the next time will likely never fade away.

The events of today have also caused me to reflect on my patients who have experienced similar near misses, as well as those who were not so lucky. I currently have patients in my practice who have been treated for lung cancers, breast cancers, and melanomas. Some are battling widespread disease and face long odds. Others have no current signs of disease but continue to vigilantly follow up with their doctors, doing everything they can to detect any possible recurrence as soon as possible. I am just beginning to understand the truth of how cancer may have changed them.

I am grateful that my cancer is treatable, grateful of the time I have been given and the future that remains. More importantly, I am grateful for the opportunity to learn and grow. I pray that this episode will help me better understand the fears, pains and concerns of the cancer patients God brings across my path.

This seems to be a part of his eternal plan for me. 

Bart