Like it or not, it's Easter

He was mad, seething mad. It showed on his face, disgust and anger intertwined, all directed at me. Because I had the audacity to speak the terrible truth about his condition.

A long-time smoker, several months earlier he had been diagnosed with advanced esophageal cancer, an unwanted answer to the question of unexplained weight loss. Surgery and chemotherapy had done what surgery and chemotherapy do in patients like him, lengthened his days without changing the end result. He had a terminal disease.

He had returned to work, convinced that he was winning, weeks earlier. A few weeks before this conversation he took a turn for the worse, shortness of breath was now a constant companion. A chest x-ray revealed a large build up of fluid around his lungs, laboratory analysis confirmed the fluid was cancerous. All treatments had failed, he had days to live. It was my job to deliver the bad news.

“I refuse to accept it,” had been his reply, “I am not ready to die.” His defiantly set jaw supported the passion of his declaration. He was certain that he could still beat the disease.

“Whether you choose to accept it or not, whether you are ready or not, doesn’t change the fact that you are dying.”

He repeated his refusal, his voice rising.

In an attempt to break through his denial I spoke even more bluntly than before. “You are dying, and there is not anything anyone can do about it!”

He stormed out of the office and drove to the hospital where he demanded treatment. The doctor there admitted him to the intensive care unit. It was there he died less than two weeks later, proving the point that reality does not change because you refuse to believe it. The truth of things exists independent and unchanged by our acceptance of it.

His story and attitude came to mind this morning as I pondered the Christian story of the resurrection of Jesus. For over two millennia, followers of the Christian faith have gathered to celebrate a remarkable, unbelievable story. On a Friday, a Jewish man named Jesus was executed by crucifixion, his battered and lifeless body placed into a cave-like tomb. The following Sunday, the “third day”, the tomb was empty, and hundreds of his followers claimed to have seen Him alive. He had risen.

His resurrection signified to them that Jesus was more than just a man, that he was God in the flesh. It affirmed his teachings and his life, which had proclaimed the way for men to have relationship with God.

The message of Easter, as with all messages, is either true or it isn’t. As is always the case with truth, the veracity of the story is not dependent on our willingness to believe it or desire to deny it. Jesus either rose from the dead, with all of the associated ramifications, or he didn’t, with those associated ramifications.

Either Christians are fools, victims of a cruel hoax or childish fantasy, or they are not. It behooves all men, those with and without faith, to explore the truth about Easter, to formulate answers and reach conclusions based on the facts of history and the available evidence. Neither blind faith nor blind rejection are appropriate responses.

Bart

Thanks for reading and sharing. If you have honest questions about the Easter Story, or any questions of faith, I can be reached through the contacts page on this website.

The Things I didn't see in Tennessee

Just one of the amazing wildflowers in the Smokies!

A little over an hour ago we arrived back home after 8 days at our cabin in Tennessee. It was a wonderful trip, our minds filled to overflowing with memories of wildflowers, wild animals, beautiful rivers, classic cars, dogwood blossoms, scenic back roads, and pancakes. There is so much to see and do there that it will take many trips before we even begin to feel we have seen it all.

But today, it is the realization of some things I didn’t see or hear that gives me cause to reflect. I didn’t see a single Mercedes Benz or BMW, nary a Tesla or a Prius. There were pickup trucks everywhere, and the truck-less typically drove basic sedans. It was as if cars were about function, not about status.

The women didn’t carry designer bags, and if they colored their hair, it seemed it was done at home and not in a fancy salon. I didn’t see designer clothes (it was mostly jeans and t-shirts). I didn’t see a single health club, a single liquor store, or overhear a single argument. I can’t recall hearing anyone use the F-word.

I heard a lot of people say thank you, a good number say “I appreciate it”, and was on the receiving end of a lot of smiles. It was as if instead of trying not to be angry people were instead going out of their way to be nice.

An old grist mill in the Smoky Mountains

I wonder if the reason for the cultural differences we experienced was something else we saw. We saw churches, lots of churches. Churches in Tennessee are like Chase banks in Southern California. You can’t drive a mile without seeing one. Faith is a big part of Tennessee life. Almost all of the stores and gift shops sell faith-based products, from bibles to inspirational signs to Christian hats and t-shirts. A furniture store we shopped at even hosts a gospel concert every Monday evening. (The recliner section of the store serves as the seating area!)

Tennessee does not have the material wealth of Southern California, but it seems they have some things money can’t buy. Maybe the hillbillies aren’t as backwards as we think.

Bart

What to Do, When There is Nothing to Do

It was nearly midnight when the call came. Spencer was in pain and the hospice nurse was over an hour away. Could I come and give him a dose of morphine? They knew the answer before the question was asked. Of course I would come. I had made that promise the moment Spencer enrolled in hospice with incurable brain cancer. I could not save him, but I knew I could keep him from suffering.

I rolled out of bed, threw on some clothes and headed out the door. My heart was heavy as I drove the few miles to Spencer’s house. It was a rainy night, which seemed strangely appropriate. I pulled into the driveway, exited my car and walked, slowly, to the door. I was somberly welcomed into the home, the wave of a hand directing me to where Spencer lay in bed.

I had not seem him in a while, and was shaken by his appearance. It had been a year since the day the neurosurgeon had called me with the diagnosis of inoperable brain cancer. They were going to do all they could to prolong his life, but another year was all they could hope for. “All they could do” included high dose steroids, which caused Spencer to gain considerable weight. His face was so puffy he was nearly unrecognizable. He was no longer able to speak and I could not tell from his eyes if he was even able to recognize me.

Quietly I reached for the vial of morphine on the table to his side. I drew up the dose into a syringe, rolled down the top of his pants to access his muscle, and gave him the injection. I set the empty syringe down on the table and sat, looking at him, wondering what to do or say. I fought back tears. I lost that battle and teary-eyed, took his hand. I asked if I could say a prayer. I asked God for comfort and peace, said, “amen”, then leaned over and kissed him on the forehead. “I love you Spencer,” I said, and quietly left. That was the last I saw him. He died a few days later.

He was 5 years old.

I thought of Spencer yesterday as I was driving away from the home of another hospice patient, a woman just 2 weeks older than my wife who was dying from uterine cancer. Although the original diagnosis was made years ago, until February of this year she had considered herself cured, attending to her life with no thought of the cancer growing within. It was then that she came into the office for two red lumps that had appeared on her abdomen. They had grown rapidly and were quite tender. She thought they were skin abscesses. They weren’t. A CT scan brought the worst possible news. They were metastases. The cancer was back, and it was every where. In addition to the lumps on her skin it filled 90% of the space where her liver should have been. The hope the initial oncologist gave, of perhaps another year of life, proved to be false and a second opinion from the City of Hope quickly took it away. There was nothing anyone could do. We enrolled her in hospice, committed to making sure her few remaining days would not be days of suffering. That was just a few weeks ago.

Her husband called me late Saturday morning to tell me she was emotionally done, too tired to fight any longer. She wanted to go to sleep and not wake up. He wondered if there was anything I could do. I was at my son’s house only 5 minutes away from her home when I got the call. Something in the tone of his voice told me I needed to be there. I left my son’s and went straight to her home.

Her husband met at the door, his gesture toward his wife similar to the one Spencer’s mom had given me so many years ago. She was in a hospital bed near the door. An empty chair was pulled close to her, near enough to hold her hand or caress her face. It was her husband’s chair. I sat down and looked at her.

She was clearly uncomfortable. Her speech was clear but slow, every few words followed by a long pause, as if she was gathering the strength to continue each sentence. Her eyes were tinged with yellow, a sign that her liver had succumbed to the cancer and begun to fail. I knew she did not have much time left, days at the most.

With her husband listening on I developed a plan. I put in a call to the hospice nurse instructing her to begin giving morphine around the clock, a dose every few hours. I added a sedative to help her rest. She was not going to suffer, not if I could help it. I finished my explanation, took her hand and asked if I could pray for her.

She and her husband responded in unison, “Please!” Unsure what to say, I prayed as I did with Spencer, asking God to give her comfort and peace. I asked God to welcome her into the home which He had prepared for her. There were six wet eyes as I said, “Amen.” I let myself out, wondering if I would ever see her again.

I won’t. The hospice agency called me just 5 hours later. She was gone.

Both patients remind me of a lesson I learned a long time ago. Even when there is “nothing” more I can do, there is often still something I can do. I can love, I can give comfort, and I can pray. I can shed some tears, hug my wife, and thank God for the gift of life with which I am still blessed. And I can press on, willing to accept the pain and sorrow, committed to sit at the next bedside, take the next hand, and say the next prayer, knowing that as a Family Doctor this is my calling.

Bart

In Assessing Patients, There’s No Place Like Home

“Why would he want to live like this?”

It was his first visit to the office, yet I was taken aback at the extent of his suffering. Wheelchair bound after a stroke, unable to speak or walk, it seemed to me his was miserable existence. Even worse he had a chronic bone infection that could not be cured, a continually seeping wound that caused persistent pain. And then there were the bedsores, I wondered why he hadn’t yet given up.

In spite of this his wife assured me that he had a good quality of life. She told me that he enjoyed his kids and grandkids and took great joy in his time with them. I wondered how this could be true. At that visit (and the several that followed) he seemed subdued, almost depressed. At each visit his interaction with me was minimal, only an occasional nod or mouthed word. I never saw a smile or heard a laugh. My heart broke for him.

A year later I made a visit to his home. It was difficult for his wife to bring him to the office and I had offered to come to the home to check on a wound for which he was receiving treatment. It was the least I could do.

His wife met me at the door and escorted me down the hall to their bedroom. He was propped up in bed, leaning against several pillows. He looked up when I entered the room with a response that was shocking to me. To my great surprise, a huge smile spread across his face and he enthusiastically extended his hand in greeting. He was happy to see me! An involuntary smile came over my face as I took his and shook it. I told him it was good to see him, and it truly was.

As I shook his hand I took a moment to survey my surroundings. On the walls of his room I were many framed photographs of him in dune buggies and go karts. He was a car nut! Every vehicle pictured was one he had built himself. I had no idea of the man he had once been. It was clear that he had lived a very active life. I commented on the pictures and asked a question about his interest. My surprise increased when he replied. he gave a one word answer but the word he spoke was clear and appropriate. I cracked a joke, and his laugh was full and genuine, his smile infectious..

His wife told me the stories behind some of the photos, at times turning to him to verify she was getting each tale right.. With nods and occasional words, he agreed with most of her descriptions and made it clear when he didn’t. As she talked and he responded I realized something- he was truly happy. He was able to communicate with the woman he loved, and the family he adored. He participated in the conversation, and even made me laugh. His life was better than I could ever have imagined.

It was a humbling experience for me. My initial impressions and conclusions about his life and functional abilities had been totally wrong. The judgments I had made in the office, arrogantly made over the course of brief interactions, were completely inaccurate. I realized that if I had not visited his home I would never have known him or understood him.

I left his home a different doctor than was when I entered it. I entered certain of my ability to make assessments regarding the quality of a patient’s life. I left realizing my foolishness, newly aware of the importance of seeing a patient’s quality of life first hand before reaching conclusions. It was a visit I will never forget.

There really is no place like home.

• Bart

A Case of Mistaken Identity

I receive several letters and notes from specialists every day. Most are dry summaries of patient visits, many provide no helpful information, and some are illegible. Almost all of them are forgettable, but  letter I received a few months ago from a local gastrointestinal (GI) specialist is one to remember.

The note was an angry rant about a mutual patient. In great detail the specialist described the actions of my patient, behavior that so offended the GI doctor that he had thrown him out of his practice. It was clear from the letter the the doctor expected me to agree with him about the unreasonableness of our patient and that his dismissal was warranted.

Except it wasn’t warranted at all.

The patient had undergone a colonoscopy and a few weeks later called the GI doctor’s office asking for results. The physician had his staff tell the patient to come in to have his questions answered. The patient did not see the need to take time off of work and pay a co-pay to be given information that could be easily given over the phone or in a note. He repeated to the staff member his reasoning and his desire to be given his results. The doctor adamantly refused. The doctor’s logic, explained in the letter I received was, “It takes time to give results, and I deserve to be paid for my time!”

While I understand the desire for physicians to be paid for the work they do, this physician’s greed caught me off guard. He absolutely refused to tell the patient his test results! His solution to the impasse was even more amazing. He told the patient to call me so I could give the results to him. (Apparently he was not at all concerned about me gettin paid for my time!)

I opened the patient’s chart and searched for the colonoscopy results. They were perfectly normal. The patient’s question was answerable in only 8 words. “Your colonoscopy was normal. Repeat in 10 years.” Even if the specialist had spoken r-e-a-l-l-y s-l-o-w-l-y, the answer would have taken less than 10 seconds. I tested this theory by picking up the phone and calling the patient myself to tell him the results. It took less than 10 seconds. Unfortunately, listening to him complain about the rudeness and arrogance of the doctor took a lot longer. 

I hung up the phone and thought about the specialist. I wondered how he came to be so disrespectful of patients. I pondered how he could be so blind to his arrogance and how he came to be so selfish and uncaring. It seemed to me that his self-worth and self-esteem were completely wrapped up in being financially successful, so much so that patients had become nothing more than dollar signs. It seemed that being paid for the care he provided was more important than caring. His identity was so connected to money that he could not “give away” even a moment of his time.

The doctor is an extreme example of a problem in society today, the problem of misplaced identity. Too many people measure themselves according to their finances. When we define ourselves according to our finances, when we seek personal worth in material things, we will never have enough and we will never be satisfied. 

I feel sorry for the doctor. I awake each day to the very real possibility of making a difference in the life of someone who is hurting. When we recognize these opportunities to love and serve others and seize them we find a joy money cannot buy. When we find our identity in God and in loving his children, we find peace and contentment.

Bart