Stained Hands

As I look at my fingernail beds today, they are dark and they have been that way since a couple of Saturdays ago.  Of course, my daughter Anna's fingers look worse than mine.

On Saturday, she and I peeled the hulls off of many black walnuts.  They still aren't cracked (that's a fun activity for another day), but they are ready to be.  Walnut juice stains really deeply.  Even after multiple scrubbings, the stain remains.

Last Monday, Anna's teacher even made her go wash her hands, because they looked so dirty.  I guess at least it's clean dirt...

I think of the verse from Psalms "Who shall ascend the hill of the LORD?  And who shall stand in His holy place?  He who has clean hands and a pure heart..."  This verse speaks of clean hands, but one can have filthy, walnut stained hands and still have clean hands before God.

The verse is clearly speaking of sin stains.  These are stains that go far deeper than even the subcutaneous layers.  These are stains that go to the heart.

There is a tendency to think that the remedy for sin is good deeds.  We just need to do more good than bad and that will clean the dirtied hands.  The only problem is that it doesn't work.  Sin stains are a lot more tenacious than even black walnut juice.

In the end, the only thing that will wash away these stains is the blood Jesus Christ.  For only the power in His blood can make my hands clean and heart pure before Him.

Catching Ebola

I read last week a survey of Americans that showed that they are moderately scared of getting Ebola, but that they have a lot of confidence that if they would contract the virus, they would be treated effectively.  In my opinion, that's a little backward -- I am not worried about catching Ebola, but would be pretty concerned if I actually contracted it.  But at least people aren't afraid of everything.

I suppose that's good, as it prevents panic in the streets (although not on Facebook).  Truthfully, for the tiny number of patients with Ebola Virus, who were treated in this country, the survival rate is pretty good -- far better than it is in the African nations dealing with the virus.

In the end, even in the United States, there is no "cure" for Ebola.  Infectious disease specialists have used HIV drugs, ZMAPP, and plasma infusions from Ebola survivors, but they cannot say for certain which of these things was, or will be effective.

I am afraid that modern medicine is too good at seeming like it has answers, even if it doesn't actually know very much.  The fact that we are doing "something," even if it is likely ineffective, gives people the illusion of control.

Much of life and health is actually beyond the control of humans -- even doctors who are specialists.  That is fine, because there are a lot bigger hands than ours in charge of this world.

I'm afraid that God has to bring us to the point where everything is spinning out of control, just so that we will give the control we never really had to Him.  For, when we are in God's hands, the wisest One in the Universe is in control of our destiny.  And even in the middle of an Ebola epidemic, that is a very safe place to be.

Making the Right Diagnosis

"The history is the most important thing!"

I still remember those words, spoken by one of my attending physicians in medical school.  An encounter with a patient is broken up into three parts.  The history, or what the patient tells the provider, the physical examination, and review of testing (labs/xrays).

Many believe that the physician should be like Sherlock Holmes, carefully inspecting the finger nail beds of their patients, looking at their tongues, and the soles of their feet.  Then, finally after a period of silence intone the fateful diagnosis:  "You, sir, have Tsutsugamushi Disease!"

It isn't that way.  I know about my patients from what they tell me and the key for me is listening.  Studies show that many doctors interrupt their patients within thirty seconds of them beginning to speak.  Doctors feel that they are "on the clock" and need to come to a conclusion quickly, so they can move on to the next patient. 

I feel these same time constraints.  Still, I have learned that if I let my patients tell the story in their own words, my patient tell me what I need to know in order to come to a conclusion and it really doesn't take that much time.

It isn't just about listening to patients either.  There are many people whose voices contribute to good care.  Nurses, techs, and medical assistants all tell me many things that I wouldn't know otherwise -- things that perhaps the patients wouldn't tell me, but share with them.  It may not even be symptoms, but other things, such as reasons why they aren't taking their medications or, family situations that are impacting their health.

I am just not smart enough to figure out every diagnosis without some help.  Even more, I can't always get a person the treatment that is best for them without understanding, not only their illness, but also, who they are.

It isn't easy to listen.  More often than not, when a person is speaking, doctors are figuring out what to say next or, the next question to ask.

In the end, listening isn't about me, it is about the person in the chair across from me, the nurse at the desk, or the patient in the bed.  As I listen, I will not only identify what my patient's illness is, I will learn who they are and understanding who someone is is sometimes one of the most important things to helping them find healing.

Lying to Your Doctor

A man diagnosed with Ebola Virus is under treatment in Dallas, Texas.  Two days before he was admitted to the hospital, he was seen in the Emergency Department with fever and abdominal pain.

Now, due to HIPPA, we are unlikely to know exactly what transpired during this visit, but it seems that the patient mentioned to the nursing staff that he was visiting from Liberia, but did not make further mention of it.  It is particularly clear that this Liberian gentleman did not emphasize to the physician that he was from Liberia or, that he had recently had close contact with a woman who died from Ebola.

I don't totally understand the rationale for not sharing this information.  I would have mentioned this several times just to be sure that the medical staff included it in the possible diagnoses, but maybe that's just me.

"Excuse me, Dr. Smith, but about a week ago I watched a lady die from Ebola.  I just thought I'd mention that."

I am always amazed by people who choose to lie to their doctor or, at the least, fudge the truth. 

I remember a woman with diabetes who brought in her sugar log books.  Carefully noted in the columns were various sugars, all between 90 and 140.  A couple of slightly elevated sugars -- 176 and 182 -- were noted with little notes:  "Ate at Golden Corral," or "Aunt Nellie's Birthday Cake."

"Looks good, Lynn," I said.

"Can I get you to cut down on my insulin dosage?"  She asked me quickly.

"Let's see what your A1C showed," I said.  I clicked on it and paused.  "Oh my, Lynn," I said.  "Your A1C test is 14.1."

"What does that mean?"  She asked.

"It means that your average sugar over the last three months has been a little over 360."

"Oh," she said and was quiet.

The whole log book was a complete fabrication.  There was no reason for Lynn to lie to me.  Even if I had no way of checking her average sugar, lying about it wouldn't change the fact that it was totally and completely out of control.  Lying about it wouldn't change the effects that the high sugar was having every day on her eyes, kidneys, and nerve endings.

Lying to your doctor doesn't hurt your doctor at all.  It just hurts you.

In the end, I am afraid that there far too many people who don't just lie to their doctors.  Many people deceive themselves and try to deceive their Maker too.  Of course, it never works, because no amount of lies can change the heart's condition.

In the end, honesty is not just the best policy, it is the only way to begin the path that leads to physical and spiritual healing.

A Three Year Old's Sense of Time

I was taking Elliot to the bathroom.  He apparently had other things on his busy schedule and didn't want any part of it.

"Just sit for a little while," I told him, encouragingly.

"I don't need to poop, Dad," he said emphatically.

"No?"

"No, Dad," he said.  "I pooped last year!"

Now, Elliot is correct in his statement, although whether or not he remembers the particular event is debatable.  Even more debatable is whether or not he has any concept of how long a year is or, when last year actually was.

As I look at his three year old sense of time, I think about how much different my sense of time is from his.  Yet, even though I know when next week is and when last week was, I am far removed from God's perception of time.

I think of this, in particular, concerning God fulfilling his promises.  "But do not overlook this one fact, beloved, that with the Lord one day is as a thousand years and a thousand years as one day.  The Lord is not slow to fulfill His promise as some count slowness, but is patient toward you, not wishing that any should perish, but that all should reach repentance."  (II Peter 3:8,9)

If God promises us something, He will fulfill it -- in His perfect time and way.  It is just that I usually don't perceive time the way He does.

There are time that I wish God would hurry up a little, but I never need to worry.  For, whether it is last year, this year, or next year, God will be right where He always is -- right on time.

Vaccines

"Oh, one thing more," the elderly lady sitting across from me said.

Now, I must confess that I have learned to dread the "one more thing" questions that seem to come at the end of office visits.  The questions may be short, but so often they are anything but easy to answer.

"What's that?"  I asked.

"Could I get a tetanus shot today?"  Mildred asked.

I relaxed a little.  "Sure," I said, wondering a little.  There aren't many 89 year old women who are particularly concerned about keeping their tetanus shot up to date.

Mildred, it seemed, could read my mind.  "You are wondering why I am concerned about getting my tetanus shot.  Well, young man, I will tell you.  My aunt died of tetanus.  It was long before they had the vaccine and there was nothing to do but watch her die.  It was terrible way to die."

I have never seen a case of tetanus, never had a patient die from lock jaw.  I have only read about it in pathology textbooks and so, for me, it isn't real.  For Mildred, it was.

These days, there is a lot of fear of vaccines.  Anecdotes abound of the terrible things that vaccines have caused.  Some of these things are real, some just happenstance, but I am afraid that the biggest issue is that vaccines are too successful.  People are no longer afraid of the diseases that the vaccines are designed to prevent.

When the polio vaccines were first created by Jonas Salk and Albert Sabin, people did not question their safety.  Everyone knew a child who walked with a limp or, a teenager who had died in an iron lung from it.  Polio was far scarier than the vaccine that prevented it.

Even now, if you set up a clinic in West Africa and offered to vaccinate people with a completely untested vaccine against Ebola Virus, you would have a line a mile long at your door.  It isn't because people want a shot, it is because they are desperately afraid of a deadly illness without a cure.

The internet is an awfully effective magnifier of fear and anxiety.  Yet, I am afraid that all too often it creates fear in the wrong things.

The diseases of yesterday can and will return, without the effective vaccines of today.

Small Miracles

There is a need within this world,

  Let it be said, for God, for His presence,
For His greatness and smallness, touching here
  And filling all things with His triune essence;
For a simple sense of something greater,
  Able to work mighty deeds of wonder
And reach down through the wind and rain
  To spark the lightning and peal the thunder.

Small Miracles.

Ordinary, every day, run-of-the-mill miracles
  Things we see in nature every day,
Created with an awe-inspiring beauty
  To fulfill a divine plan and way.
Yet, these little things are easily explained
  By equations of physics and mathematics
And in a burst of logic faith is lost,
  Thrown into the domain of mere fanatics.

The deepest needs remain unfilled.
  Science finds more questions for every answer
And for every treated acute bronchitis,
  It seems to find an uncured cancer.
Science's miracles have limits here --
  Limits set by the human mind,
Which cannot fathom the smallest things
  Which divine fingers once designed.

So, even in this world of science,
  There is still a desperate need
For someone to touch within hurt lives
  To heal the scars, to staunch each bleed…
A need for something more that cannot,
  Will not be fit into the small space
That science still allows for God –
  There is still a need for God, in this place.

Joel Osteen

Joel Osteen is really popular right now -- with just about everyone (except a few folks on facebook).  I suppose it isn't surprising.  He is relentlessly upbeat.  He doesn't talk about negative things a whole lot.  He is someone who does his best to offend no one and please the masses.  He is a politician as well as a pastor.

I'm not a theologian, but it seems that Joel Osteen is in favor of people living with abundance, being happy, and doing good.  He doesn't like to talk about sin, because he prefers to dwell on the positive things.

He believes that God wants us to be happy and who could be upset with someone who is in favor of general happiness?

The problem with the whole situation is that he has forgotten how to speak truth.  Pastors have a responsibility to speak truth, even when it is painful.

When I see my patients, I always attempt to identify good things in their lives.  If they have lost a couple of pounds, if their cholesterol is two points better, I commend them.

I think it is just as important for me to share their problem areas with them.  If all of my patients walk away happy and satisfied with themselves, believing they are paragons of health, they may like me, but I have been a failure.

In the same way, pastors have a responsibility to identify the moral decay in the world around us and in their congregations and expose it.

Somehow, in a world that desires happiness and abundance, they must bring a suffering Savior front and center.

The message of the cross is clear.  Christ came and died for sinners, of whom I am chief.  Jesus came to bring joy within the storm.  He came to give us the strength to suffer.  He came so that we could walk in pain and rise above it.

This world needs a real Savior who speaks to us in our sorrow, not a glib pastor who wall papers over it with feel-good statements of happiness.

There is power in the cross.  There is power in truth.  For those will choose them.

What's Your Motivation?

I put my laptop down and clicked on Edwin's name.  "Did she prick your finger already?"  I asked him.  He nodded in response.

"Well," I said.  "Let's see...  Awesome!  Your A1C test dropped three points since your last visit here.  That's great.  Wow!  Your weight is down twelve pounds, too."

Edwin nodded again.  "When you told me I had sugar last time, I remembered how my uncle Harry had to have his leg cut off because of it and I decided to get things under control."

"You've done well," I told him.  "A drop of three percent in your A1C is the same as dropping your average sugar by 90 points.  But I have to warn you:  right now you are motivated by fear.  In my experience, fear is a really bad long-term motivator.  You need something better to get you to watch your diet than thinking about your Uncle Harry's stump."

A year later, Edwin was back in the same chair, but this time it wasn't such a happy visit.  He had gained back his twelve lost pounds -- and five more and his A1C test was up two percent."

"What happened, Ed?" I asked him.

"You were right, Dr. John," he told me.

"About what?"  I asked, not remembering our conversation.

"About fear not motivating me.  I found out I could cheat a little bit here and there and it didn't seem to effect how I felt.  Gradually, I fell right back into my old ways of eating.  I'm just a lost cause," Edwin finished dejectedly.

"No, you're not," I told him.  "You are just going to have to start doing today what you should have done a year ago."

It is difficult to become self-motivated.  When we are childen, we get up, go to school, and do our homework in response to scolding and often, the threat of punishment.  Later on, we may develop other motivators, but they are often based on the same childhood themes -- fear and guilt.

I am convinced that fear and guilt motivate people to do the minimum they believe is necessary to get by.  This is true not just in health, but also, in all aspects of life -- even the way we follow in Jesus' footsteps.

Somehow we must get to the place where we are motivated by a desire to be healthy, rather than because of a fear of disease. 

Rather than acting like Christ because we are afraid of hell, we must be motivated by a love for God and for our fellow humans.

For, these are motivations that will not burn out with time.

Just Another Block

"I need a red, six-piece block," Vince said.  He turned his attention to a large mound of Lego pieces of different colors and sizes.

As he sifted through the various blocks, he often would find a piece that was close and the discard it.  Finally, he found the right one and snapped it into place.

I must confess that to me, a stack of Lego pieces is pretty much worthless.  I can't build anything with the -- at least not without instructions.  I can't tell what pieces are usable for different things.

My son, Vince, can tell quickly what pieces he needs to build a variety of vehicles or, buildings.  The pieces stand out to him because he is a builder.  He knows his blocks, as silly as that may sound.

In a world as big as ours is, it is easy for us to feel lost as a single lego piece in a mound of seven billion lego pieces.  There is nothing that makes us truly special -- no way in which we are original, or will change the world.

In a sense, each one of is just a tiny sparrow in a huge flock of sparrows -- all chatting away and all of little worth.

Jesus said "Are not two sparrows sold for a penny?  And not one of them will fall to the ground apart from your Father... Fear not, therefore; you are of more value than many sparrows."  And so we are.  Not because of who we are, but because of who God is.  Somehow He can use even the squarest pegs, the smallest of sparrows, and even the oddest shaped Lego block.

It is not that we are the biggest block in the stack or, the most finely shaped, it is that the builder has a plan for us.  What is important is not who we are, but whose we are.

Our Heavenly Father looks down  into a pile of oddly shaped Lego pieces and recognizes us and knows us.  And lifting us gently from the stack, He gently places us in the place that He had planned the whole time.

For, we are valuable to Him and He loves each one of us as individuals.  In a world of seven billion, that is an amazing thing and blessing enough to lift the heart on the darkest of days.

Dealing with Depression

"Dr. Waldron," the man sitting across from me said earnestly.  "What do you think I should do?"

I looked at Nelson.  "What do you think you should do?"  It is sort of a non-answer, but sometimes those are the best.

"I just don't know," he said.  He looked down at his callused, workman's hands.  "There is a man -- a couple of men -- in my church who tell me that depression is a spiritual problem.  If I just had faith, I could go off of my medication.  God would give me real joy -- not like these medicines give."

Nelson wasn't the first person I had heard say these things.  I knew he was struggling.  He had been on medication for depression for several years.  We had tried to take him off of it a couple of times and he just didn't do well.

I shook my head.  "It isn't a good idea for you to stop your medicine," I said.  "Do you think there's some spiritual problem that you aren't dealing with?"

"No, I don't think so."

"Do you think you have a better relationship with God when you take your medicine or, when you don't?"

"Oh, definitely when I take my medicine.  When I go off, the despair gets so blinding that I can't do anything."

"Then you should keep taking it."

Depression and mental illness are hard things to deal with -- hard for those who experience them -- harder for those who have never experienced them to understand.  They are invisible, seem so less substantial than pneumonia, or diabetes, and seem so much more in someone's control than these physical maladies.  Many are certain that a person should be able to think his way out of such a mental state.

Christian people often take this a step further, saying that depression is proof of a severed relationship with God.  This is a dangerous attitude to take. 

An attitude like this discourages people in need from seeking help and encourages those who are receiving treatment to discontinue their medications.  The underlying message is "Your Depression isn't real, it is only in your head."

But depression is real.  Those who have not walked in the Valley of Severe Depression do not know how dark this vale is, but those who are there now, need light and they need hope.

I do not believe that all illness -- mental or physical -- comes because of some divine judgment. 

Why does it come?  So that we can become more like Christ and so that God can be glorified in our lives.

We must not set up barriers to prevent hurting people from receiving help.  The message of the gospel is clear.  For unwell people there is hope and there is healing, if they but come.

I believe that medication is part of that healing.

Against the Current!

One day at school, my son Vince was standing, somewhat dejected, trying to make his way down a hallway in which a large number of students were moving in the opposite direction.  He was just one, small for his age, five year old boy trying to make his way against a tide of bigger children and making no progress. 

He saw a teacher walking in the same direction he was.  He looked up at her and then, trustingly placed his small hand in hers and walked beside her down the hall.

I think about this now, as I think of Dr. Kent Brantly, who left the possibility of a comfortable life and well paying job as a physician in the United States to minister to the poor in Liberia.  I think of my mother, who left her medical practice to teach high school in Niger.  There are so many who others who step out in faith, leaving the obvious path, not moving with the flow of society.

Robert Frost tells in the poem "The Road Not Taken" about two roads which diverged in a yellow wood.  The paths are a metaphor for life and the decisions we face there and as Mr. Frost looks at the roads, he decides to take the road that has been traveled less.

So often, though, we are called not to take a road that is seldom traveled, but a road in which all of the travelers are moving in the other direction.  Walking down such a road brings fear and uncertainty.

It is in this situation, as we question our road, our motives and our destination that we realize that our heavenly Father is standing beside us -- that He was there all of the time.  In that moment, the only way to go on is to trustingly reach up and take His hand and walk with Him into the future.

All the uncertainty will be replaced with confidence, for He is there.  For, when we are not enough, God is faithful and will lead us through corridors of opposition to the place that He has prepared just for us.

If we will but take His hand and let Him lead.

Fear of Ebola

Dr. Kent Brantly has Ebola virus.  He is in Liberia and a decision has been made to fly him and another American to Atlanta, Georgia.  Obviously, the decision to fly was based on the fact that he currently is in an undermanned, underequipped hospital in West Africa and would be coming to a University facility where proper care can be given to give him the best chance of survival.

The odd thing is that upon receiving word that Kent was bringing this deadly virus to the United States, the internet became alive with commenters who were upset at the danger of such a flight and of his presence in their previously safe country.  They very strongly hold the opinion that it isn't safe or wise to allow him to bring this virus so close to home.

As far as I can tell, these comments are mainly motivated by fear.  People are afraid of this dangerous an epidemic sweeping across North America.

It is understandable too.  Every story I have read quotes the mortality figures for Ebola as having "up to ninety percent fatality," even though it has been quite a bit less than this with the current out break. 

Ebola isn't terribly contagious.  The biggest out breaks in the past, while deadly, have only killed a few hundred people, even though they take place in highly populated areas of Africa that have few facilities for dealing with such a virus.  There is reason for fear, but there is more reason for hope.

In addition, Dr. Brantly will be flying in a carefully controlled environment with numerous precautions in place to keep the virus from spreading.  He will be cared for, when he arrives at Emory University, in a facility well able to take care of him without transmission of the virus.

Most of all, I think about the reasons it is that we are flying him home for better care.  It is for compassion.  It is for healing.  It is for love.

Love and fear cannot coexist.  In the book of First John, it says "There is no fear in love, but perfect love casts out fear..."  Kent Brantly went into a dangerous situation because of love -- love that was greater than his fear.

I would pray that he would be healed.  More than that, I would pray that Americans (and others around the world) would lay down their fear and love as Christ loved.  For only in that perfect love can we live without fear.