Codeword: Grace

I spent the last three weeks on a palliative care rotation working at an inpatient hospice facility. It's been an eye-opening experience. I've learned a lot about drugs that provide comfort at the end of life. Patients end up in hospice care when they've decided to pursue comfort measures only. Interventions done in hospice, whether pharmacologic or otherwise, are meant neither to artificially prolong life nor hasten death but only to provide comfort. I was very thankful to be working in a facility run by Roman Catholics where something like assisted suicide is completely off the table, especially in a state where it is unfortunately legal. More important than learning about pharmacology, I've seen the interactions between the providers, who are experts in this area of palliative care, and patients who have a terminal diagnosis and often have days to weeks to live.

At times I've questioned whether going into medicine was the correct choice. I've thought back longingly at times to the days of doing construction before I went to seminary back in the early 2000s. But the privilege of being with my patients and their families at their most difficult moments is something I'm very thankful for. The only other profession which probably has that same privilege is being a pastor or a priest.

Out of all of the patients I cared for in the past three weeks, one especially stands out to me. He was an elderly gentleman, close to the age of 90. Before he arrived I read through the hospital paperwork that had been faxed to our facility. I saw that while he had significant Alzheimer's dementia, he had still been walking up and down stairs and sitting at the dinner table and eating with his family until a week ago. A week ago he had fallen and after the fall his mental status never returned to its prior baseline. He was taken to the hospital where multiple problems were discovered including a broken pelvis, a heart attack and a blocked bile duct resulting in a severe and deadly infection called ascending cholangitis. The gastroenterologists, experts in the GI tract, were consulted but because of all of his severe medical problems were unwilling to risk an invasive procedure to try to unblock the bile duct. As the patient's clinical picture continued to worsen in spite of powerful antibiotics, IV fluids and other interventions, palliative care was consulted and the decision was made by the patient's wife and children to transition to comfort measures.

As I read through all the paperwork we had received I was interested to read that this man had been a Baptist pastor. I made a mental note of this, thinking that this might be a good opportunity to pray with the family, something I'm always on the look-out for. The patient arrived and was started on a morphine drip for his severe pain from his pelvic fracture and biliary obstruction. In my (very inexperienced) medical opinion the patient looked to be actively dying. I thought he probably had hours to live. After getting him situated I went to meet with his family along with one of the staff doctors at the hospice facility. We had a long discussion regarding the patient's prognosis, what to expect very near the end and the details of comfort care. One of the patient's seven children warned us that they were a "singing family" and that there would probably be some loud hymn-singing emanating from the patient's room. Now they really had my attention as I'm one of those strange folk whose favorite music genre are hymns, especially those written more than a century or two ago.  The meeting ended and I went back to my duties, caring for other patients.

The next morning I was surprised to see that my patient had made it through the night. When I entered the room it was crowded with his many children and a gaggle of grand-children. I examined the patient and answered many questions regarding his care. As I was about to leave I mentioned that I would have liked to have heard a hymn at some point. I didn't assume that this grieving family would invite a doctor, a stranger to them, into this fellowship and worship of the Lord. I was surprised when a hymn, "How Great Thou Art," was rapidly begun. So I belted out this hymn with the rest of the family, around their dying father's and grandfather's bed.

I should have known that my experience with this patient and his family would be a blessed one from the beginning though. During our first meeting, after his arrival, the family was asked to come up with a codeword so that if one of them called our facility asking for information the information could be supplied without breaking privacy rules - if the codeword were supplied. After a brief moment of silence one of the patient's sons said the word "grace." The patient's elderly wife who was hard of hearing and had said very little during the meeting asked for the codeword to be repeated. "Grace!" said her son. She smiled. "That's a good one! I'm saved by grace!" she replied.

I was greatly blessed by this patient and his family. They preached the gospel to me. It's good to be a doctor.

And when I think, that God, His Son not sparing;
Sent Him to die, I scarce can take it in;
That on the Cross, my burden gladly bearing,
He bled and died to take away my sin.

Amen.

I believe in the prosperity gospel

I had a sickening epiphany today. I realized that I believe in the Prosperity Gospel. In spite of the fact that I think it’s one of the most widespread and destructive lies of Satan in the church today I realized that, to a degree, I’ve come to believe in that which I hate. Residency has been tough spiritually. The struggle with temptation and sin has often been a losing battle. Compared to the past year, my life in medical school and in seminary before that looked like “victorious living.” I’ve also become more cynical in the past year. This morning I realized why. It’s because I’ve developed a sense of entitlement that God should just take it all away. In spite of praying for decades that various sinful desires would leave me they are still here and as strong as ever. Sometimes, by God’s grace, I feel strong and those temptations seem to have little power over me. But other times I’m weak, like in the past year, and those temptations have much power over me. But the temptation to sin has never completely left me even at my best times.

And somehow I came to the place where subconsciously, at least until this morning, I felt that God was not holding up His end of the bargain. The belief that God will make our lives easy has a name. It’s called prosperity theology. Instead of Christ alone being our portion, instead of Christ alone being enough, we must add on financial prosperity, good health, success in business and victory over sin. If these “blessings” are not seen in the life of the Christian it is attributed to not praying the right magic words, or not having enough faith, or perhaps not “declaring” correctly, whatever that means. And while I find Word of Faith style Christianity to be ridiculous I realized this morning that because of my frequent prayers and Bible-reading and participation in the Sacrament I had somehow come to expect that God was going to make things easy.

I realize that there are Bible verses which seem to indicate that God sometimes blesses with financial prosperity or with healing and with other tangible material goods. But I’m perfectly willing to get into a proof-texting battle with anyone and remind them that we’re also promised the hatred of the world (John 15:8), tribulations (John 16:33), family strife (Matt. 10:34), suffering (1 Peter 3:17), persecution (Matt. 5:11), the painful-feeling discipline of God (Hebrews 12:11), thorns in the flesh which remain in spite of prayer (2 Cor. 12:7), and captivity to the law of sin which dwells in our flesh (Romans 7:23). Prosperity and good health may be blessings from God although in our sinful state, needful of constant humbling (2 Cor. 12:7), I think the Psalmist’s words “It is good for me that I was afflicted (Ps. 119:71)” are more likely to reflect what truly is a blessing.

Ultimately, true blessedness has nothing to do either with prosperity or affliction. True blessedness is that which can say, “I know how to be brought low, and I know how to abound. In any and every circumstance, I have learned the secret of facing plenty and hunger, abundance and need. I can do all things through him who strengthens me (Philippians 4:12-13).” True blessedness is that which is based on the objective reality of Christ and His work outside of ourselves, outside of our poverty or prosperity, outside of our sickness or health, outside of our victory or failure. The Psalmist speaks of the true blessedness when he writes, “Blessed is the man whose sin the Lord does not count against him (Psalm 32:2).” Christ Himself speaks of this blessedness when he corrects his own disciples who were mistaken about the locus of true blessedness. When the seventy-two returned to Christ they were rejoicing over the fact that the demons were subject to them. They were rejoicing in the miraculous, in that which is tangible in the here and now. But Christ offers them a word of correction – He commands them not to rejoice in these things but instead to rejoice that their names are written in heaven (Luke 10:17-20). Instead of being filled with sorrow because the false expectations of a damnable and false “gospel” are not fulfilled in me I should rejoice in the fact that my name is written in heaven and has been since I was baptized as a little baby in the name of the Father and of the Son and of the Holy Spirit. It is only this assurance, this looking to Christ, who sympathizes with us in our temptations, and Christ's perfect work on the cross, where He became sin who knew no sin, which will ever give me the strength to resist sin and to seek after God. Instead of believing that God is going to make things easy I must know that His grace is enough even in the midst of the worst strife. I pray that God will cleanse me from the delusion of “prosperity,” and that He will rid His holy Church of this evil leaven.

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."

The Heav'n rescued land

An artist's rendering of the bombardment of Ft. McHenry in 1814 which inspired Key's poem "Defense of Ft. McHenry," which became known as "The Star Spangled Banner." 

O thus be it ever, when freemen shall stand

Between their loved home and the war's desolation.

Blest with vict'ry and peace, may the Heav'n rescued land

Praise the Power that hath made and preserved us a nation!

Then conquer we must, when our cause it is just,

And this be our motto: "In God is our trust."

And the star-spangled banner in triumph shall wave

O'er the land of the free and the home of the brave!

-Francis Scott Key, from The Star-Spangled Banner

The Longest Year

This morning I walked into the hospital as an intern and this evening walked out a resident. I guess I didn't think I'd feel anything but the usual exhaustion after a long call day on the wards but I was surprised by the sense of a monumental task having been completed. This year has been perhaps the hardest year of my life. Feelings of frustration and anxiety about notes, assessments, procedures or presentations which could have gone better have frequently been my chief emotions. I remember calling one of my best friends in the first few months of this year and telling him I didn't think I could do it. Many things have been neglected, including this blog, in the past year. In spite of all this the one reality undimmed is the reality of Christ and His gospel.

God has provided for me abundantly this year. During some of the hardest times of internship it was only meditating on Christ and His Death and Resurrection which gave perseverance. I know that this meditation on Christ comes only by the grace of God and not from some innate good within myself. I've been reminded of this by seeing temptation and sin rear its ugly head to a disappointing degree this year. I could look at my life and become discouraged and despair but in the words of John Newton I remember two things, "That I am a great sinner, and that Christ is a great Savior." Seeing that God has given me the grace to know this, to believe the Gospel and to know the Person of Christ, is the only wellspring of joy which can be taken away by no disappointments or failures in life.

God has provided for me in His holy catholic Church. Two churches in particular have kept me fed with the Word of the Gospel preached and the sacrament of the Body and Blood of Christ broken. These are Hockinson Apostolic Lutheran Church and St. James Anglican Church. If most people, whether Christian or not, were to observe these two churches in their respective worship services they might see little in common. But one thing is held in common by the two, Jesus Christ, and Him crucified, is preached. I am directed toward the objective reality of Christ, and what was done by Him, outside of me, on the cross. All of heaven is mine because of Jesus and his shed blood in atonement for my sins and the sins of the whole world. This year has often brought me to my knees - literally, but one of the many things I am thankful for is that I've been reminded again and again that I have nothing to offer God. And yet amazingly, in spite of this, in spite of my sin and frequent failings, I am convinced by the Word of God that I should have an unshakable hope and joy in Christ and His shed blood, and nothing else.

Things aren't going to get any easier. Many say that the second year of residency is actually more challenging. But I do believe that God will continue to provide, encourage and discipline as He has thus far.

Still the small inward voice I hear,

That whispers all my sins forgiven;

Still the atoning blood is near,

That quenched the wrath of hostile Heaven.

I feel the life His wounds impart;

I feel the Savior in my heart.

-C. Wesley

Pentecost: And I believe in the Holy Ghost

The Holy Ghost, then, always existed, and exists, and always will exist. He neither had a beginning, nor will He have an end; but He was everlastingly ranged with and numbered with the Father and the Son. For it was not ever fitting that either the Son should be wanting to the Father, or the Spirit to the Son. For then Deity would be shorn of Its Glory in its greatest respect, for It would seem to have arrived at the consummation of perfection as if by an afterthought. Therefore He was ever being partaken, but not partaking; perfecting, not being perfected; sanctifying, not being sanctified; deifying, not being deified; Himself ever the same with Himself, and with Those with Whom He is ranged; invisible, eternal, incomprehensible, unchangeable, without quality, without quantity, without form, impalpable, self-moving, eternally moving, with free-will, self-powerful, All-powerful (even though all that is of the Spirit is referable to the First Cause, just as is all that is of the Only-begotten); Life and Lifegiver; Light and Lightgiver; absolute Good, and Spring of Goodness; the Right, the Princely Spirit; the Lord, the Sender, the Separator; Builder of His own Temple; leading, working as He wills; distributing His own Gifts; the Spirit of Adoption, of Truth, of Wisdom, of Understanding, of Knowledge, of Godliness, of Counsel, of Fear (which are ascribed to Him) by Whom the Father is known and the Son is glorified; and by Whom alone He is known; one class, one service, worship, power, perfection, sanctification. Why make a long discourse of it? All that the Father hath the Son hath also, except the being Unbegotten; and all that the Son hath the Spirit hath also, except the Generation. And these two matters do not divide the Substance, as I understand it, but rather are divisions within the Substance.
-Gregory of Nazianzus, On Pentecost (Oration XLI)

And I believe in one Catholic and Apostolic Church

For anyone who checks this blog still, you've probably noticed that there hasn't been much activity here. I've not felt much inspiration to write lately and, to be honest, have been struggling spiritually. And while I do struggle I trust in God's grace and power in Christ to keep me.

I recently had a few encouraging experiences in the past week though so figured I'd blog about them.

The first happened on an extremely stressful and busy day when I was admitting patients from the ER to the hospital. I went down to evaluate a guy with new-onset atrial flutter, an abnormal heart rhythm. When I got to the bedside I noticed that his elderly Korean wife seemed excited to see me. She called me by my name and talked to me as if I should recognize her. I didn't recognize her at first but she successfully jogged my memory by saying "you prayed for me in clinic." I then remembered that I had prayed for her during a clinic visit about 6 months earlier. She told me she had prayed for me every day since that visit! I was amazed. I love Kingdom economics. Before the visit was over she took me aside and told me she was awaiting the return of Jesus Christ. Just hearing His name was so encouraging in the midst of a day when everything seemed out of control and I didn't feel I had the strength to make it through.

A few days later I headed home to Battle Ground to have dinner at my girlfriend's house with some of her family and with a Christian doctor from India who is also a pastor and missionary there. Over dinner we discussed the persecution that Christians face there. He told of how fellow pastors have been poisoned to death by Hindu extremists because of their faith. This man of God faced the same persecution but you could see his joy in Christ. It was encouraging to see how all that he did in terms of the medicine he practices in India is motivated by a desire to spread the gospel.

Lastly, I was paged to talk with the family of a patient I'm taking care of who has terminal metastatic colon cancer. The nurse told me that this man's pastor was in the room and wished to speak with the doctor. I went to the room and the patient gave me permission to talk about his case with his pastor. This patient is a Japanese man with a Korean wife and their pastor is an African American. We went to another room and I had a somewhat difficult conversation with the pastor and the patient's wife. At the end of the conversation I asked if we could pray for the patient. Both of their eyes lit up and they clasped my hands. We prayed for my patient. It was pretty powerful.

So in the midst of much struggle the Lord has encouraged me and reminded my of His goodness and faithfulness in spite of all my sin. Thanks be to God!

Dawn of the New Creation

On the third day the friends of Christ coming at daybreak to the place found the grave empty and the stone rolled away. In varying ways they realised the new wonder; but even they hardly realised that the world had died in the night. What they were looking at was the first day of the new creation, with a new heaven and a new earth; and in the semblance of the gardener God walked again in the garden, in the cool not of the evening but the dawn. 

-G.K. Chesterton, The Everlasting Man

Good Friday: What we have merited

St. Bernard was so terror-stricken by Christ’s sufferings that he said: I imagined I was secure and I knew nothing of the eternal judgment passed upon me in heaven, until I saw the eternal Son of God took mercy upon me, stepped forward and offered himself on my behalf in the same judgment. Ah, it does not become me still to play and remain secure when such earnestness is behind those sufferings. Hence he commanded the women: “Weep not for me, but weep for yourselves, and for your children.” Lk 23:28; and gives in the 31st verse the reason: “For if they do these things in the green tree, what shall be done in the dry?” As if to say: Learn from my martyrdom what you have merited and how you should be rewarded. For here it is true that a little dog was slain in order to terrorize a big one. Likewise the prophet also said: “All generations shall lament and bewail themselves more than him”; it is not said they shall lament him, but themselves rather than him. Likewise were also the apostles terror-stricken in Acts 2:37, as mentioned before, so that they said to the apostles: “O, brethren, what shall we do?” So the church also sings: I will diligently meditate thereon, and thus my soul in me will exhaust itself.

–Martin Luther 

Calvin: Christ's design on Palm Sunday

In the first place, we ought to remember Christ’s design, which was, that he came to Jerusalem of his own accord, to offer himself to die; for it was necessary that his death should be voluntary, because the wrath of God could be appeased only by a sacrifice of obedience. And, indeed, he well knew what would be the result; but before he is dragged to the cross, he wishes to be solemnly acknowledged by the people as their King; nay, he openly declares that he commences his reign by advancing to death, but though his approach was celebrated by a vast crowd of people, still he remained unknown to his enemies until, by the fulfillment of prophecies, which we shall afterwards see in their own place, he proved that he was the true Messiah; for he wished to omit nothing that would contribute to the full confirmation of our faith.

-John Calvin, Commentaries - John 12:12