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.

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 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

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!

Random Update #8: Neurology → Nephrology

Well, my blog has reached a low ebb in the last few weeks. For one reason or another I've lacked all inspiration to write. But there have been a few things happening...

1. I just spent a month working on the inpatient neurology service at the hospital, taking care of mostly stroke patients, seizure patients and a random assortment of other neurological disorders. Even with some very long hours at times it was an enjoyable month which makes me realize I'm finally settling into this doctor thing a little bit. I got to do another lumbar puncture which ended up going very well - I got a "champagne tap" which means there were no red blood cells in the cerebrospinal fluid (CSF) samples I collected. Frequently you will nick a small blood vessel as you insert the needle deep into the patient's back, thus contaminating your sample with a small amount of blood. I was able to avoid this complication and received the traditional gift of a bottle of white wine - CSF (without blood in it) is clear - from my attending. Technically the traditional gift is a bottle of champagne but the colonel reasoned that no one really drinks champagne. Unfortunately I'm not much of a wine drinker either.

2. Today I started working in the Nephrology clinic and that's where I'll be for the next month except for a week of leave I'm taking starting on the 18th.

3. I've occasionally been able to read a few pages of the Bede's Ecclesiastical History of the English Nation. It's an amazing work of history and of literature. Two men about whom I knew little were St. Augustine of Canterbury (d. AD 604) (not to be confused with "of Hippo") and Pope Gregory the Great (AD 540 - 604). Both of these men played a great role in the evangelization of my ancestors and the formation of the English Church. For that I am grateful to them and more so to God who chooses such sinners for tasks so great.

A snowy drive to work

4. I passed my final board exam (USMLE Step 3) to be a licensed physician. I took it in Puyallup, Washington just before most people in the Puget Sound area got socked-in by a huge snow and ice-storm or "snowpocalypse 2012" as us residents who had to drive to the hospital each morning at 4:30AM in spite of the weather referred to it (and yes I grew up on the West-side of the Cascade Mountains so I am a snow-wimp like the majority of Portlanders and Seattleites).



5. While I haven't been writing on my blog I have gotten myself involved in a facebook debate about baptism with a bunch of Lutherans (with whom I mostly agree) and Baptists (with whom I mostly disagree). And by Baptist I mean "Non-denominational," "Charismatic," "Pentecostal," and also all those with the honesty just to call themselves "Baptist." With that said I know a lot of great Christians who are Baptists (heck, just look at my favorite Christians blogs on the right-hand of your screen - 4 out of the 7 are Baptists). But the debate I've been in has made me examine my own thoughts on baptism, and to be honest it's something I've probably tried not to think too much about in order to avoid debates with a good percentage of my Christian friends. A friend challenged me on a statement I made denying the intrinsic efficacy of baptism as a means of grace. He confronted me not with some systematic theology and not with some sappy platitude but with a fairly clear and plain-sounding statement from God's word: "Baptism, which corresponds to this, now saves you, not as a removal of dirt from the body but as an appeal to God for a good conscience." Hmm... Doesn't really seem to fit with what I had written.

6. St. Augustine wrote: "For whatever unbaptized persons die confessing Christ, this confession is of the same efficacy for the remission of sins as if they were washed in the sacred font of baptism." (City of God, Book XIII, chapter 7.)

"Baptism of St. Augustine" (of Hippo) - Troyes 

7. John Calvin wrote: "We must at the same time beware of another evil, such as prevails among the Papists; for as they distinguish not as they ought between the thing and the sign, they stop at the outward element, and on that fix their hope of salvation. Therefore the sight of the water takes away their thoughts from the blood of Christ and the power of the Spirit. They do not regard Christ as the only author of all the blessings therein offered to us; they transfer the glory of his death to the water, they tie the secret power of the Spirit to the visible sign." (Commentary on 1st Peter 3:21)

8. On the subject of Baptists and scriptural fidelity, I recently visited a nearby "Non-denominational" (read Baptist) church because they had a Saturday night service and it was my only chance to go to church that week. It was a pretty hip place, lots of 20-somethings with cool-looking clothes and the very latest in praise music. But I was thoroughly unimpressed by the preaching, which was topical and during which a very few Bible verses were used (likely misused) in making the preacher's somewhat questionable points. And then I started thinking about how the Lutheran church I sometimes attend when I'm in the Portland area and the Anglican church I like to worship at in Olympia have sermons that are absolutely saturated with Scripture. I can also think of quite a few other Non-denominational churches I've been to where very little Scripture is read during the service. The thing that gets me is that it's often these same people who will accuse Lutherans and Anglicans of being too beholden to "tradition" while they supposedly simply follow the Word of God.

9. Much of the best, most Scripture-saturated and Christ-centered preaching I've ever heard was at Cornerstone Bible Church (Baptistic in theology) in Riverside, California during medical school. It's a complicated world we live in.

Night-float

Last week I started on night-float which means I'm the doctor in the hospital on-call between 5 at night and 7 in the morning. So if anything goes wrong with one of the patients in the middle of the night, I get paged. Some people try to take cat-naps during the night and then stay up part of the day when they're not at work. I elected for complete day-night reversal so I've been staying up all night and then sleeping all day. And although I always kind of feel like I'm in a weird kind of fog these days with my circadian rhythm all screwed up, I've actually really enjoyed night float.

The hospital at night is so quiet and deserted and I like the feeling of being one who keeps watch until the morning. There's also a sense of team-work with the nurses who are on overnight which isn't quite there during the day.

My favorite thing though has been having enough free time to just have some good conversations with patients. At the beginning of the night I like to go check in on most of those I'll be responsible for over the next 14 hours. When I'm seeing patients during the day it's always very focused on getting a medical history and doing a physical exam and the time is always short. But at night I just round by myself and check in with people. Sometimes I'll do elements of a physical exam but usually it's just me saying hello, letting the patients know that I'm the doctor responsible for them overnight and asking if they have any questions.

Without the usual day-time expectations of doctoring I've been able to have some interesting conversations with some elderly patients. I listened to the life story of a 95 year old gentleman last night. He told me of his one-armed grandfather who was a doctor in Mississippi. He told me of fighting in the Philippines and New Guinea in WWII, of coming back after the war to Rhode Island, of how he met his wife when he saw her getting on the train and helped her with her heavy suitcase, of how she sent him a post-card with the Empire State Building on it, of how he stole her away from the rich man she was to marry, and of raising a family with her in Texas. Then he told me of his sadness when she died in '98 and how the first thing he does "if he makes it through the pearly gates will be to go to the complaint desk." This saddened me but I understood. He was still telling me his story when we were interrupted by the "beep beep beep" of my pager. As I rose to answer the page I could tell he was thankful that someone had listened and he asked me to come back again. If he's still in the hospital tomorrow night maybe I'll stop by to hear some more.

I also spent some time with a 91 year old man who told me of his time stationed in Morocco after the war and how he and his wife toured Europe in the early 1960s.

Thankfully there haven't been any emergencies over the past few nights I felt like I couldn't handle. But I know that they will come and I know that like every other thing I felt like I couldn't handle being an intern (and there have been a great many) that with God's strength and providence I'll get by.

On the first night I drove to the hospital, dreading the 14 hours ahead of me, feeling relatively alone and responsible for so much, a prayer came to mind which is one of my favorites from the Compline service in the Book of Common Prayer. I thought of myself and the nurses watching, of my patients suffering and perhaps dying and of their families weeping. So this is my nightly prayer this week...

Keep watch, dear Lord, with those who work, or watch, or weep this night, and give your angels charge over those who sleep.

Tend the sick, Lord Christ; give rest to the weary, bless the dying, soothe the suffering, pity the afflicted, shield the joyous; and all for your love's sake.

Amen.

The Lord Provides: ICU

It's amazing how quickly I can go from being completely overwhelmed by anxiety, thinking "what have I gotten myself into," with this whole medicine thing to thinking "I'm glad I'm a doctor." The beginning of this week were some of the most anxiety-filled days I've ever experienced. I could barely sleep. I was confounded by my own inadequacy.

But yesterday I felt confident for the first time in the ICU, a rotation I started a week ago. I got my first "procedure" as a new intern. As we rounded on our patients in the morning we decided to do a lumbar puncture on a man with altered mental status. The year-2 resident asked for one of us interns to volunteer to do the procedure. He was my patient so I figured it would be bad form for me not to volunteer. So I said I would do it, thinking to myself that I would really just try to do it but probably not succeed. When I told one of my fellow interns what I was going to try to do later he quoted Yoda to me saying, "Do or do not... there is no try." Going into the room, about to perform the lumbar puncture, I asked for God's mercy and I asked for success in getting this procedure.

The other resident and I gowned up under the watchful eye of the ICU attending. I first injected the morphine, just under the skin, then toward the patient's spine where the large lumbar puncture needle would travel. After he was all numbed-up I inserted the much larger needle, first hitting bone then redirecting once and then going much deeper. I felt the deep tissues "give" three times, each time hoping that I had reached the spinal canal with it's precious cerebrospinal fluid (CSF). Each time I felt a give I would withdraw the stylet from the barrel of the hollow needle hoping to see clear cerebrospinal fluid drip from my end of the needle. After withdrawing the stylet twice I thought to myself, "alright, as I expected the resident will have to take over but at least I tried." I replaced the stylet and went a half centimeter deeper with the needle. I felt the tissue give once more. I removed the stylet and there it came, a sight for sore eyes, perfectly clear fluid dripped from my end of the needle, CSF, the last give had been the dura surrounding the patient's spinal canal and now the tip of my needle was within the spinal canal, among the cauda equina of the spinal cord, draining a miniscule quantity of CSF which would help us to diagnose the cause of our patient's problem, potentially guiding us in the treatment of an encephalitis.

Admittedly a lumbar puncture is a pretty simple procedure. But I have seen it unsuccessfully attempted by residents in the past so my success in completing it was definitely not a given. I had only tried it once before my third year of med school and had been unsuccessful then. I left the hospital Friday night happier than I've been in a long time.

And while I am very thankful to God for my success and my current happiness, it does bother me that it takes something like this to make me happy these days. For I know the King of the universe, and I know about His cross, His shed blood in my place, for my sins and the sins of the whole world. I know about His glorious resurrection on the third day when He erased all doubt about His victory over sin, death and the devil. Knowing all of this I should be continually rejoicing and I should be able to obey the words of my Lord, "Therefore do not be anxious (Matt 6:31)." But I fail miserably and I fail daily. And knowing my failure to "trust and obey" I am redirected again to the glorious gospel of God's grace, that my standing with God is not based upon my success or obedience but solely upon Christ's righteousness. And while I often foolishly fail in trusting God to bring me through the every-day trials and struggles of life, I do trust God with complete certainty in one area. And I know that this trust, this faith, has not been manufactured or achieved by me but has been given as a free gift of His grace. And this faith is that Christ died to save sinners, even a sinner like me.

This is my Father's world;

why should my heart be sad?

The Lord is King; let the heavens ring!

God reigns; let the earth be glad!

2 truths

From the scarcity of blog posts lately perhaps you can guess that the last few months have been challenging for me. This is true. I can say with certainty that I've never in my life worked as hard as I worked when I was on my CCU rotation in August. I truly felt burned out by the end of that month. September has been a bit of a much-needed breather but even my current rotation is very hard work compared to medical school or anything else I did before that.

It has been a mentally exhausting few months and what makes it more difficult is that it's very hard to see much light at the end of the tunnel. I know I am slowly adjusting to the realities of being a resident physician but this adjustment has not been pleasant nor fun.

Two spiritual truths have given me much comfort at times over the past month or so. Thinking about both of these truths has pretty much been birthed at Hockinson Apostolic Lutheran Church where I've been attending whenever I have a 2-day weekend and thus can make the 2 hour drive home to Battle Ground. I was reminded of one truth through hymn-singing and the other through hearing it preached.

The first truth I was reminded of is "He Leadeth Me." We sang this hymn, penned by Joseph Gilmore in 1862 as he meditated on the 23rd Psalm, one Sunday last month and I couldn't get it out of my head. This is one of the rare times when I'm very thankful for a song I can't get out of my head. The refrain goes:

He leadeth me, He leadeth me,
By His own hand He leadeth me;
His faithful follower I would be,
For by His hand He leadeth me.

Some of the verses are:

He leadeth me, O blessèd thought!
O words with heav’nly comfort fraught!
Whate’er I do, where’er I be
Still ’tis God’s hand that leadeth me.

Sometimes mid scenes of deepest gloom,
Sometimes where Eden’s bowers bloom,
By waters still, over troubled sea,
Still ’tis His hand that leadeth me.

And when my task on earth is done,
When by Thy grace the vict’ry’s won,
E’en death’s cold wave I will not flee,
Since God through Jordan leadeth me.

That Sunday night, not looking forward to the long and difficult week ahead, I sought the Lord and worshipped Him, singing this song. I was overwhelmed by the joy it brought me to think that no matter what I face I can be confident that "He leadeth me." A friend recently text-messaged me a verse from Isaiah which confirms this promise of God to lead us, the text reads, "For I, the Lord your God, hold your right hand; it is I who say to you, 'fear not, I am the one who helps you (Isaiah 41:13)." When I think of the most difficult days of being an intern, when I want to run from the hospital, truly this truth is "with heav’nly comfort fraught."

The second truth I was reminded of is a truth all Christians should look forward to, that is, Christ's return at the end of the age. I heard two men mention the imminency of Christ's return while preaching, first at the Amboy Grange and then at the Hockinson church by Pastor Holmgren. I realize that the return of Christ is something that Christians have expected in their own lifetime throughout the history of the church. But hearing it preached by men whom I respect filled me with much excitement and also provided great relief. Thinking that "He will come again" and that He could come at any moment made me realize how little and transitory are the worries that tend to completely overwhelm my thoughts lately when thinking of all of my responsibilities as an intern. When we see Christ coming on the clouds all these things which seem so overwhelmingly important will fall down as nothing as every knee shall bow and every tongue confess that Jesus Christ is Lord.

So in the midst of much struggle the Lord is providing for this wretched sinner who deserves none of His goodness and who has yet been showered in His goodness since the day I was born. O to grace how great a debtor daily I'm constrained to be!

Maranatha! Come Lord Jesus!

How to make a (Christian) physician's day

Today I got to pray with a patient in clinic. It's the first time I've gotten to pray with a patient since I got my MD and left Loma linda. She had mentioned during the visit that she went to church so at the end of our encounter I asked her if she'd like to pray with me. She was very happy to. It made my day.

"Divine Appointment"

Some patient interactions make a strong impression on me. Sometimes it is because of an unusual diagnosis. But usually it's because I connect with a patient who is a Christian and is going through a very difficult time. Such an incident happened this week that I won't forget anytime soon.

I was just a few days into my internal medicine rotation, seeing patients in a clinic with an attending physician. Internal medicine is the field I'm interested in going into so I'm hoping I will like this rotation. The second or third patient of the day was called and entered the room. My first impression of the patient was that he was an elderly man who looked to be in a good physical state. He had no problem getting around and smiled widely as he shook my hand and the hand of the attending physician. As the doctor asked him why he had come to clinic that day it became obvious that this man had a very serious diagnosis, one with the potential to cause a lot of suffering and which had already caused a good deal of suffering in the days prior to his presentation to our clinic.

It turned out that this patient had gone to the ER with severe pain in one of his bones a few days earlier. In the ER they had ordered an X-ray and then a bone scan which revealed cancer that had metastasized to many different areas of this man's skeleton. Only in the last week had one of these metastases began to cause severe pain. The patient had been diagnosed with and treated for prostate cancer years earlier but the treatment had obviously been unsuccessful and now, barring a miracle, this man would most likely die from this cancer.

It struck me during the interview that this patient had a more severe diagnosis than any I had seen recently and he was also currently in a great deal of pain. But unlike many patients I see every week with less severe diagnoses he had a peace about him. He was friendly and smiled as he interacted with us.

At some point during the interview he mentioned, for some reason, that he had been a pastor. This piqued my curiosity but I thought that in the presence of my attending physician I would not get to explore this further. The fact that this man's diagnosis seemed so severe also made it difficult for me to consider talking about things not relating to that diagnosis. As the interview progressed the patient commented on how the hospital seemed very busy and it reminded him of when he had been a hospital chaplain in Kentucky. I mentioned that I had lived in Kentucky for a couple of years and the patient said, "I also went to seminary in Kentucky." Now he really had my attention and I said, "so did I, outside of Lexington." The patient still didn't expect that we shared any deeper connection and he said, "oh, I went to a small seminary called Asbury." I smiled and told him that I also went to Asbury. At this point I wasn't sure what the attending was thinking as I had just began working with her. But I was happy when she said she needed to step out for a moment and encouraged us to both keep reminiscing. And that we did.

We found that God had touched both of us at a wonderful place called Asbury Theological Seminary. We were far enough apart in age that we had shared none of the same professors but we had enough in common to enjoy talking of our memories of Asbury and Kentucky. When I asked what denomination he had pastored in he said "United Methodist," but quickly added that he had been one of the few conservative evangelicals in California. I could sympathize with him when he told me that it got so bad in the California-Pacific Annual Conference that he and the handful of other Bible-believing United Methodist pastors just quit going to annual conference. He told me that his family had finally left the United Methodist Church for a conservative, Bible-believing church. We were both encouraged by our conversation and with a big smile this elderly gentleman proclaimed that this was a "divine appointment." I agreed. I asked him if I could pray for him and just after I had started praying the attending walked into the room. We both straightened up but I hoped that I would be able to finish my prayer for him at some point.

The attending physician asked a few more questions, did a focused physical exam, and then formulated her plan to our patient. It looked like it would all be over soon when I was surprised to hear her ask, "is it alright if I pray for you?" The patient explained that I had already started praying earlier and said he would be happy if we all prayed together. So the three of us held hands and my attending prayed a wonderful Christ-focused prayer.

It was a great experience. And even though I grieve for what this man and his family might go through in the coming months, I'm thankful that he and his family know the Lord and have a hope of eternal life beholding, worshipping and knowing Him more and more. Seeing a patient with so much peace and even the ability to encourage those around him in the midst of pain and a potentially frightening diagnosis also made me think that this was evidence of God's grace in his life. I've seen many other patients with far less severe diagnoses who were angry, bitter and left the clinicians they met tired and cynical. But this man was a blessing to those he came in contact with. May God have mercy on him and his family.