53 years, 85 pounds and a Deadly Disease.

The first thing I noticed was her weight, 85 pounds, which was dramatically decreased from the first time I saw her. She did not look well. My voice reflected my concern as I entered the room, “85 pounds? What’s going on?” Her reply caught me off guard, “I think I am dying.”

She said it in a matter of fact tone. It was not a statement of fear or anger, it was simply her opinion on her current state. She went on to explain why she thought as she did. “I feel like I am suffocating.”

3 years earlier she had been diagnosed with MAC (Mycobacterium Avium-intracellulare Complex) a cousin of TB that can cause severe chronic pneumonias, usually in patients with a depressed immune system. In her case the disease was particularly aggressive, eating away normal lung tissue and leaving infected cavities in its place. Multiple drug regimens had been attempted without success. The last combination had so suppressed her bone marrow that her white blood cells had almost disappeared from her body, rendering her defenseless against other forms of infection. The specialists had run out of options and had begun to consider experimental therapies and perhaps even a lung transplant. I asked her thoughts about the future.

We talked about some of the proposed therapies and she told me that she had made up her mind that she was not going to bankrupt her family pursuing treatment and that she was pretty sure she did not want a lung transplant. “I am not afraid of dying,” she shared, “I just don’t want to suffocate.” I ordered some breathing treatments to help open up her airways and returned later to check on her. Her breathing had improved some and I sat and talked with her some more, asking about her family and their feelings about her illness.

As we talked I was impressed by how reasonable and rational she is. She does not have a death wish nor is she giving up. She just understands the truth. She is a very sick lady with a very serious disease. Death is a very real possibility. We talked some more and she shared with me her faith, which helped me understand her reasoning. She is a devout Christian who believes that death is not the end, that she has an eternal hope. She is confident that death will not permanently separate her from her family and does not feel that she needs to grasp at straws or pursue futile treatment to prevent it.

Later in the conversation she surprised me with her insights from her recent hospitalization. “The doctors there seemed uncomfortable with me. I felt like I was a disease and not a person.” It seemed that as the doctors ran out of medical options they were uncomfortable talking to her. It made her feel as if no one cared, that she was being defined by her disease.

She then looked me in the eye and thanked me for the time I spent with her, saying that although we had not shared many visits that my office was the one place where she felt listened to, that she felt that she was a person. I was deeply touched.

Before she left I asked for permission to pray for her and to ask others to pray for her via my office Facebook page. “I will take all the prayer I can get,” she replied. “I know God can heal, I have seen Him do it before!” She concluded by saying that even if God did not heal her that she was okay with that as well.

The visit came to an end. I prayed for her and gave her a hug, and we both got a little misty eyed. She has been on my mind ever since, I think mostly because of the quiet strength that she portrayed. She and I are the same age and I wonder how my family and I would respond if I was struck with such a severe disease. It is my prayer that we would also be able to draw strength and confidence from our faith and that we would be able to cling as confidently to the hope of the Savior as she has.

As I reflect on her faith I am reminded of the words of Peter as he wrote to the Christians who were facing terrible persecution at the hands of the sadistic Emperor Nero-

“While you may have had to suffer grief in all kinds of trials. These have come so that your faith — of greater worth than gold, which perishes even though refined by fire — may be proved genuine…” 1 Peter 1:6-7

Difficult times test our faith. Genuine faith endures these trials, is priceless, and demonstrates the reality of our relationship with God. Hers is a genuine faith indeed.

-          Bart

The Importance of Fixing what's Broken... By Yourself!

I don’t fix things. I occasionally fix people but I rarely fix things. Broken things scare me. I see in them a multitude of potential injuries. Lacerated fingers, broken bones and lost vision are just one misstep away.

I learned this lesson the hard way shortly after I started practice. Our home needed a new roof and we did not have the money to have it replaced. My father-in-law (who I always called “Pops”) assured me that we could do it ourselves. We decided that I could pay someone to tear off the old roof and then do the remainder of the work on our own. The day before we were to start Pops cut off about a third of his thumb tip on a table saw. He showed up to work anyway. He clearly was in pain as the sound of every third or fourth hammer strike was punctuated with a loud “Ow.”

In the mornings I went to the office and in the afternoons and evenings I worked on the roof. With the old roof off I learned to walk carefully and put my feet where the slats joined the rafters so I would not fall. This worked wonderfully until Pops moved one of the slats. There was nothing but air where I put my foot. Down I went. My descent was halted by my groin striking a rafter, unfortunately not before our master bathroom had developed a foot shaped skylight.

Lisa ran into the bathroom to see what had caused the noise and discovered my foot hanging out of the ceiling. She laughed so hard she nearly did in her pants what people usually do in the master bathroom.

Pops patched the hole and we eventually finished the roof. I was left with the confidence that Pops could fix anything but that I was simply dangerous.

Pops died 9 years ago and I have been left on my own. I think of him every time something breaks. I find myself wondering, “What would Pops do?” I have started to do more and more on my own. Each small job usually involves several mistakes and a number of bumps bruises and scrapes. Each success brings the satisfaction of knowing that he would be proud of me, not only because I succeeded, but because I tried.

I have also learned that the scrapes, bumps, bruises, cut off thumb tips and foot shaped skylights have value as well. Each brings with it a lesson and a memory. Pops had a remarkable collection of nicks and scars and he was one of the wisest men I have ever met. I think he was on to something.

The Church isn't as dead as you think

A new patient reminded of something important this week. As we talked I learned that this vibrant 67 year old had a passion for his faith and used to be actively involved in the leadership of his church, the largest congregation in town. I was sad to learn that he had not chosen to step away from leadership but had instead been cast aside by a youth movement. The church had hired a new senior pastor in his thirties and over a period of three years he had replaced the senior leaders with younger leaders of his liking. It reminded me of an error of my youth and the tendency of that error to be repeated.

When I was in high school I was a part of a small but active youth group in a small church in Southern California. At that time there were two things about which my fellow youth groupers and I were certain. 1- We were “on fire” for the Lord, and 2- The older people in our church weren’t. Looking back I cannot put a finger on what the basis was for our certainty. We tended to focus on music preferences, worship styles (we raised our hands and closed our eyes when we sang and they didn't) and clothing. I think a more likely explanation was that we had a new young pastor who wanted to make changes and who felt the “old people” were in the way.

As with so many things, time revealed who was on fire and who was not. The pastor left within a few years and the youth pastor was soon gone as well. What happened to our “on fire” youth group? I do not know what became of all of them but I do not know of any who are still actively involved in an evangelistic church today. Maybe those old people were wiser than we thought.

There is a tendency in our culture for younger generations to dismiss and discount the wisdom and experience of previous generations. As with so many other cultural tendencies this attitude has infected the church. We keep seeking new and younger pastors and leaders with “fresh vision” and “new approaches.” Typically this is associated with criticism and a degree of disdain toward the more mature members of our fellowships. When someone older expresses a question or a concern they are often dismissed as hanging on to the past or as being resistant to God’s work.

I go to a church filled with people who have served God for decades. I think of a woman in her seventies who continues to do prison ministry and lead men to Christ, of salesmen in their fifties who consistently pray for and share their faith with their clients, of a woman in her eighties who still goes on mission trips, and of a woman in her sixties who on her own organized an outreach to the homeless in our community. The Church as a whole has sent (and continues to send) missionaries by the score around the world. We have trained leaders over the years that have gone on to impact the world in remarkable ways.

In spite of this rich history, in spite of the presence of so many who do so much for the Kingdom of God with passion and vigor, there are some who would consider a church like mine to be in desperate need of renewal, a renewal that requires fresh vision and new approaches. That many church leaders of today feel this way is borne out in the online description I found for an upcoming pastor's conference-

“This event is an honest conversation about the joys and pitfalls of restoring historic churches.  Many churches need to return to their missional and evangelistic roots of decades ago. Partner with pastors that are helping their churches make this much needed turn. The challenge is immense…”

For the people I listed above, it would come as quite a surprise to learn that they need to “return to their missional and evangelistic roots of decades ago.” 

It seems that some current church leaders seem to share another trait with my youth group of years ago. We criticized the elder members of our church, but we did not know them. There was no regular interaction, no sharing of time or experience. They may have wanted to give counsel and advice but we did not want to hear it.

Instead of steadfastly pursuing the new, I wonder if a better approach might be for some of these young leaders to seek the advice and counsel of those who have been living missional and evangelistic lives for decades. They may find that instead of new programs and approaches what the church needs is mature leaders who can train others to do what they have been doing for years, mature leaders who are just waiting to be asked.

- Bart

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Are You Ready to Die?

Death is inevitable, but few people are ready. Even patients with terminal disease often find it hard to deal with their mortality. When I think about preparing for the end my thoughts return to a patient I lost a few years ago. My attempt to help him deal with his illness failed miserably.

He had been my patient for 15 years. He had a combination of high blood pressure and high cholesterol and he came in at least twice a year. Routine follow up appointments and the occasional illness visit led to a total of over 50 meetings over the years, so I knew him rather well. He worked in hotel security for a large hotel in Irvine. He did not earn much, only about $11 an hour. In spite of the relatively low pay he took great pride in his work. He often shared work stories, most of them concerned his efforts to protect the guests and provide a safe environment in a hotel with a limited security budget.

I developed profound respect for his character. He seemed to me to be a valuable employee, someone who always did his best. sadly it was one thing he never did that proved to be his downfall. He never quit smoking. He was diagnosed with esophageal cancer, a deadly form for which there was no cure. He fought hard but the disease eventually got the best of him.

I saw him frequently in the last few years of his life,  on one occasion even driving him home when he needed a ride. I was on vacation in Florida when the phone call came that told me the end was near. He had been experiencing shortness of breath and X-rays revealed a fluid build up around his lungs. The fluid was drained and sent for testing which was positive for cancer cells, which meant that the cancer had dramatically advanced. So severe was the spread that the fluid needed to be drained every few days. There was no longer any chance that he would live much longer.

I called him on the phone and told him that the news was not good and that he was a very sick man. I asked him to come and see me as soon as I returned from vacation to discuss what this meant long term. He made an appointment for my first day back in the office and I told him the bad news. “This is bad,” I said, “there is nothing more we can do.”

He replied, “I am not ready to die.”

“I understand. But you will need to prepare for it because it is coming.”

“I refuse to accept it.”

“There is nothing more anyone can do. There is no treatment left. It is hard to accept, but you will have to.”

He got angry. More than angry. He was furious with me that I would dare to take away his hope. Convinced that I was uncaring and insensitive he left my office and went to the emergency room. He was admitted to the hospital. He died there less than two weeks later.

It was hard not to take his anger personally as I thought my genuine fondness, respect and concern were well established. Saddened that I had failed to connect as I had hoped, I took comfort in knowing that I had done my best.

As I reflect back on our final conversation I am reminded of how difficult it is to discuss death. I am also reminded of how important these discussions are. 

Years ago I heard the President of the American Academy of Family Physicians speak on death. His observation that, “In spite of all of the advances in modern medicine the death rate has remained constant. It is still one per person,” speaks to the reality that we will all need to be ready someday.

For people of faith it seems that being ready is less difficult, perhaps because of the assurance that there is more life to come. Something to think about!

-Bart

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The Secret to Success

Why do some people make it and others not? How is it that sometimes gifted and talented people fail miserably?

These thoughts were in my mind when I recently traveled down one of those link by link internet rabbit trails. I do not even remember where I started but I know I ended up reading a list of past Major League Baseball Rookie of the Year winners. My eye was not drawn to the recent successes such as the Angel’s Mike Trout (who has a very good chance of being considered one of the greatest players ever), but to the names on the list that have been nearly forgotten.

There are many players who, after initial success, saw their careers quickly flame out. They were stars one moment and forgotten has-beens the next. I read about the careers of players like Bob Hamelin, who won the award for Kansas City in 1994 and was out of baseball within 5 years and Mark Fidrych, who won the award and 19 games as a starting pitcher for the Detroit tigers in 1976. Fidrych won only 10 more games in his entire career.

I reflected on the elusiveness of long term success. It is one thing to do something well for a while, it is an entirely different thing to do something well for a lifetime. I thought of my major roles in life, my roles as husband, father and physician (in that order), and how being really good for one or two years would be nearly meaningless.

I then asked myself- how do you maintain excellence over the long haul? The best answer I can come up with is, “You work at it every day, and you never, ever stop trying to do better.”

When I look at the people who were the all-time greats it seems they all shared this characteristic. They were never satisfied by past success. They were always working to get better, to strengthen their areas of weakness, to eliminate flaws and fortify their strengths. They accepted criticism and instruction and made themselves a little better every day.

I will never be paid millions of dollars to ply my trade in front of thousands of people but I have been given a job to do. When my life is over it is my prayer to find myself standing before Almighty God and hear Him say, “You did well.” I am pretty sure that hearing that will make my heart grateful for all eternity and make all of the hard work seem worth it. I am absolutely sure that I will not hear those words if I do not continue to work every day to be the best I can be in whatever situation God places me.

- Bart