Sunday, August 26, 2012

The letter killeth, but the Spirit giveth life

This morning I finished a two-week block that I'd been dreading ever since I got my schedule for my second year of residency a few months ago. I spent the last two weeks on MOD night-float. MOD is an acronym for "Medical Officer of the Day," a term which originated in military medicine but which is widely used in both civilian and military settings. Basically when you are the MOD you are the go-to person for all of the internal medicine patients in the hospital and also for all of the patients in the ER or in clinics who need to be admitted to the internal medicine service. So I spent the past two weeks working from 6:30PM to 8:00AM admitting patients to the hospital overnight. It's been two weeks of the most independence and responsibility I've ever had as a doctor. And it was quite stressful at times but by God's grace I made it through. On average I took about 4 patients per night, evaluating them in the ER, making a diagnosis or diagnoses and starting the work-up and course of treatment I thought was appropriate. Everyone survived and for the most part I think I was correct in my diagnoses and initial work up and treatment. On my busiest night I was paged on and evaluated 8 patients, admitting 7 to the medicine service. The majority of the complaints were pulmonary - COPD exacerbations and pneumonias. I admitted a few patients with heart failure exacerbations, a couple of syncopes and GI bleeds, and one each of ascending cholangitis, diverticulitis, cellulitis and pyelonephritis.  I also admitted a man whom the ER had just diagnosed with likely metastatic hepatocellular carcinoma. I think I must have admitted about 50 patients to the hospital over the past two weeks. It seems I should have some deep philosophical reflection on the automatic intimacy you have with people in their darkest and most frightening hours in the middle of the night but disappointingly I don't. The greatest hope and fear I had over the past few weeks was the hope that I had done the best for my patients and the fear I had missed something important. Unfortunately I didn't get to pray with anyone but I did get to encourage an elderly lady I admitted for a heart-failure exacerbation who had recently lost her husband. Somehow we got to talking about Scripture while I was admitting her and we ended up talking about our favorite Psalms.

As with all of residency the past two weeks have been a challenge spiritually. I've been praying through the 119th Psalm every evening before work and reading from 2 Corinthians every morning before passing out. I think the Psalms are prayers for God's people so I like to pray them out loud but sometimes I come across one that I feel like I can't pray. This happened to me a couple of times in the 119th. Verse 97 reads "Oh how I love your law!" and verse 121 reads "I have done what is just and right." But as I try to pray verses like these I have this constant nagging thought which goes something like, "For we know that the law is spiritual, but I am of the flesh, sold under sin. For I do not understand my own actions. For I do not do what I want, but I do the very thing I hate. . . For I know that nothing good dwells in me, that is, in my flesh. For I have the desire to do what is right, but not the ability to carry it out (Rom 7:14-15, 18)." I know the law of God is perfect but often times I don't love it and it is that very law which shows me that I have not done what is "just and right."

This morning after leaving the hospital I headed to St. James Anglican Church for the first time in a good number of weeks. I was exhausted but thankful to be in the fellowship of believers and the presence of God. As the liturgy, the Creed and the Lord's prayer were said I was thankful to be uttering things infinitely more true and important than anything I had said or written with so much angst in the hospital over the preceding two weeks. Our priest is an excellent preacher and a very wise man and he preached from 2 Corinthians chapter 3 focusing on the verses "Not that we are sufficient in ourselves to claim anything as coming from us, but our sufficiency is from God, who has made us competent to be ministers of a new covenant, not of the letter but of the Spirit. For the letter kills, but the Spirit gives life (2 Cor 3:5-6)." After praying through the 119th Psalm and also reading 2 Corinthians in the past couple of weeks I was thankful for a sermon which touched on many of the thoughts I've been struggling with. I don't have some great synthesis or epiphany to share but I was reminded that my hope, my sufficiency, is in the One who did keep the law perfectly and died because I haven't and never will in this life. My hope is in Christ who promised the Spirit who gives life after we've been slain by the law (John 14:15, Romans 7:10). Ultimately I am reminded of one of my favorite verses, also in 2 Corinthians, and a promise I will cling to forever, "My grace is sufficient for you, for my power is made perfect in weakness."