When Every Day is Memorial Day

When I saw that she had “liked” a post on my office Facebook page I clicked on her name. I was taken to her Facebook page where I saw an amazing picture. It was of her, embracing the marker on her father’s grave. She had never mentioned him, perhaps because he had died when she was a little girl.

The grave marker read “Leonard G. Svitenko, Captain USAF”. Curious, I Googled his name. I learned that he died in the service of our country, the lone fatality in one of the most significant events of the Cold War. He was 27 years old.

In the early 1960’s the Cold War was at its peak. American leaders viewed the Soviet Union as a constant threat and the fear of nuclear attack was constant and real. The United States had an Air Force Base in Greenland that was tasked with monitoring radar for Soviet missle launches. In order to be able to rapidly respond to a nuclear attack, US bombers equipped with nuclear weapons were continually in flight over Greenland. Captain Svitenko was the copilot of such a flight in January 1968.

Prior to take off a member of the flight crew stored some seat cushions under a seat in the back of the plane, seemingly unaware that they were in close proximity to a heater vent. During the course of the flight the plane's heater was malfunctioned. Halfway through the scheduled flight Captain Svitenko was relieved to take his schedule rest break. As the temperature in the plane continued to drop, the officer in the co-pilot’s chair opened an engine valve to allow for heat to enter the cabin.

Another malfunction allowed the air flow from the engine to enter the cabin unfiltered and extremely hot. The stored seat cushions caught fire. By the time the fire was discovered it had progressed to the point where it could not be suppressed with the onboard fire extinguishers. As the cabin filled with smoke the decision was made to evacuate the aircraft.

The crewmen who were in seats ejected safely. Captain Svitenko, who had given up his seat, attempted to exit through a bottom hatch. He didn’t make it. He suffered fatal head injuries as he tried to leave the plane.

The plane crashed. Although the nuclear weapons did not detonate, their payload dispersed in the crash and contaminated the area, resulting in an international incident. The radioactivity and policy of continuous flight received a lot of attention in the following months but the incident ultimately faded out of the national consciousness.

The nation may not remember the death of Captain Svitenko, but his family does. His daughter grew up without her father. She is one of the millions of Americans throughout our history who have experienced first hand the high price of military service. Although Captain Svitenko was not a combatant in a war and did not die in direct engagement with an enemy, he nonetheless died in defense of our nation, doing his part to keep his country safe.

On Memorial Day, may we all take the time to honor the sacrifices of servicemen and women like Captain Svitenko, those who believed in service, in freedom, and in duty and who proved their commitment with their lives. My we also pray for their families, those who remember the sacrifices every day of their lives.

- Bart

Demented. Demanding. Depressed

She was worried. She had lost 20 pounds in a matter of months, her blood pressure was elevated and her blood sugars were out of control. Her worry had led her to walk into the office without an appointment. As abnormal blood sugar can be dangerous in the short term (especially if it is low) this was what I focused on first.

“What have your blood sugars been?” I asked.

“I don’t know, they have been all over the place,” she replied.

“Do you have the numbers with you? Did you write them down?” I asked, hoping for some data I could rely on.

“I don’t have them with me, I left them at home,” was the discouraging answer.

The remainder of the visit was even more discouraging, which did not surprise me. I knew her answers would be unreliable. I had diagnosed her with early dementia months earlier.  At that time I had my staff call her son and ask him to come for the next visit. That visit had occurred a month before the day she walked in without an appointment. At that time I shared with them that I did not feel it was safe for her to live alone any longer. I told her son the she had not remembered to get blood tests done ordered a month prior and that it seemed her forgetfulness was worsening. Since she was a on over 10 medications for nearly as many diagnosis, I was very concerned about her safety. She clearly needed help.

When she walked in worried about her blood sugars I had not heard anything from either her or her son for over three weeks. The blood tests had still not been done, so I was in the dark about her long term diabetic control, kidney function, thyroid levels and blood chemistry. All I had to go on was what she told me and that was completely unreliable. She was also still living alone. 

She was truly concerned and worried about her blood sugars and I felt I needed to communicate that I wanted to help her but I needed more information. I told her I could not make any changes to her medical treatment because I could not be certain that she was taking all of the medications as prescribed. I did not know what changes to make because I did not know that her current status was.

I gave her instructions and wrote them down as simply as I could. I told her to get the blood work done in the morning and then to return to the office two days later. I asked her to bring her medication bottles and her blood sugar measurements when she came. I stressed the importance of each instruction as clearly as I could. She had an elderly friend with her and I stressed it with her as well. After she left I had the office call the son so I could share my concerns with him. They reached his voice mail but left a message asking him to call us back right away.

A week later she called the office. The blood work had still not been done and she had not come in for the follow up visit. Her son had not called us back either. This was disappointing but not surprising. What was surprising was the reason she gave to the receptionist for not coming back- “I know Dr. Barrett never wants to see me again.”

It seemed her memory was worse than I thought! Apparently my words that "I can't treat you without more information" had been remembered as "I can't treat you."

We tried again to reach her son. He did not return our calls, but his wife did. Unfortunately the patient had never given permission to discuss her care with anyone but her son, so I could not speak with her daughter-in-law. The staff told her to have her husband call as soon as possible. When 24 hours passed without a call I organized an impromptu office meeting to discuss what we could do to help her. I had one receptionist call the medical group to see if we could urgently send a social worker out to her home. My other receptionist, who had worked for years in a neurology office, suggested we call Adult Protective Services to see if they could help. “Do it!” Was my reply.

Within a few minutes I was on the phone with the APS case worker. I told her that my patient was a diabetic who lived alone, that I was worried about her taking her medications correctly, that she was demented and I was concerned for her safety. I told her that I had left a message for her son and had not heard back for a week. She said they would send someone out within a day. I hung up the phone thinking I had done all I could.

The following day I learned that that not everyone agreed with me.

Her son walked into the office the next morning, seething with anger. I was not in the office, so he proceeded to loudly tell the receptionist that I had abandoned his mother by telling her that I did not want to see her any longer. He said I had committed malpractice and that he was going to report me to the medical board. Not knowing what to do, the staff called me at home. I asked them to put him on the phone, hoping I could calm his anger. I attempted to explain the misunderstanding and my concern for his mother but his mind was made up. As far as he was concerned I was an arrogant and prideful doctor who had abandoned his mom. After over 10 minutes on the phone and multiple insults and accusations I gave up, finally telling him that his anger did not change the fact that I thought his mother was a wonderful lady and I was concerned about her. He made it clear that I would never see his mother again and hung up the phone.

Although they had dismissed me as their physician I made several phone calls over the next few days making sure that the social worker made it to the home and that her new doctor would see her as soon as possible. I made the calls with a great deal of sadness.

I wish I could say her son's words did not effect me but they did. On several occasions in the days that followed I found myself replaying events in my mind, wondering if there was anything I could have done differently or better. While I do not know what I could have done to better resolve this patient's situation I have gained a greater understanding of the importance of supportive and accepting families in the care of those with dementia, and of how denial can complicate matters. 

- Bart

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Good Goal, Terrible Teaching. The Table Fellowship Myth

It is a sad truth that churches are not always unified. At times the reasons for division appear trivial, but in most circumstances the disagreements are based on interpretations of Scripture. When the disagreement centers around the direction of the church or on the emphasis of its ministry resolution can be difficult. One of the major questions with which the church has struggled  is the question of how the church should relate to the secular world. Teaching on the subject has fluctuated over time with some churches encouraging clear separation and others embracing cultural change. Most churches I have attended have taught that Christians should love and serve others as much as they can without compromising their principles or in anyway implying acceptance of inappropriate behavior. This traditional response has recently come under attack as our society has become increasingly secular and embracing cultural change become more challenging.

The attacks have not come only from those outside of the church. Many pastors are teaching that the model of Jesus is to fully engage with people “right where they are at”, encouraging Christians to intentionally go into settings previously considered taboo. The argument is that this is what Jesus did. Christians who value purity and who are fearful of condoning inappropriate behavior are labeled as judgmental, out of touch, and unconcerned about the lost.

In support of this more tolerant attitude passages of Scripture are cited in which Jesus is described as dining with “sinners and tax-gatherers” and as a result drawing the ire of the religious leaders of the day. In the culture in which Jesus lived sharing a meal was a significant sign of acceptance. That Jesus would accept those who were deemed unclean by the religious authorities was a big deal. There is no question that when Jesus dined with these people he was setting an example for others. But what is the example Jesus set? I have heard several sermons in which people were urged to be like Jesus, to go and partake of the lives of those traditionally not a part of the church. The teaching was that we go with an attitude of acceptance, welcoming people just as they are, regardless of lifestyle or behavior. 

One new church in town as made this principle of “table fellowship” a major part of its mission. On its website it declares-

“One of the most controversial aspects of Jesus’ ministry was his willingness to share meals with outcasts, sinners, and the marginalized.  Sharing a meal with someone in Jesus’ day was considered a form of acceptance and social approval. This was called table fellowship, and used by Jesus to manifest the open and expansive nature of his movement.

The practice of table fellowship is, for us, the most important picture of how we relate to the world around us: practicing radical hospitality, committed to countercultural friendship, and embodying extravagant grace.”

This sounds wonderful, but this understanding of Jesus’ “table fellowship” is inaccurate. The implication that Jesus was going out of His way to dine with immoral people without conditions in order to extend grace and show His love to outsiders is dangerously wrong. This is not what Jesus was doing and this is not the example we are to follow.

There are only three episodes in the gospels in which Jesus is specifically described as participating in a group meal as a guest in an outsider’s home- in the home of Matthew, a tax-collector who left his work to follow Jesus, in the home of Zacchaeus, another tax collector, and in the home of a leper named Simon. A close look at each of these stories reveals details that counter the popular “table fellowship” narrative.

The meal at the home of Matthew is described in three of the gospel accounts. Luke tells us that Matthew “held a great banquet in Jesus’ honor” and that a “large crowd of tax collectors and sinners were eating with them.” Mark’s account is similar, but in his description of the event he adds a crucial detail, writing, “many tax collectors and sinners were eating with him and his disciples for there were many who followed him.”

Mark’s words are important, for they tell us the nature of those who were at the celebration. They were followers of Jesus! Jesus did not invite himself to the house of a stranger or simply join in a secular gathering. He went into a home where he was invited to dine with people who believed in who he was and what he was teaching. These people came from questionable backgrounds, but their faith was what mattered.

The famous story of Zacchaeus, the diminutive tax collector of Jericho, provides additional insight. Zacchaeus had apparently heard of Jesus and his teaching prior to Jesus’ coming to Jericho. The amazing stories Zacchaeus had heard about Jesus had aroused his interest. Zacchaeus wanted to know more about who Jesus was. Luke’s account says that Zacchaeus climbed a tree because he wanted to “see who Jesus was.” He did not want only to lay eyes on Jesus and see what he looked like. He was interested in who Jesus was, in gaining knowledge of him. Jesus, in response to Zacchaeus’ interest, called him down from the tree and invited himself to Zacchaeus’ house for dinner. While Zacchaeus had been an immoral tax gatherer, subsequent events confirm that his interest in Jesus was genuine.

Zacchaeus welcomed Jesus “gladly” into his home. When others criticized Jesus for going into the house of a sinner, Zacchaeus answered their criticism by proclaiming that he was a changed man. He promised to give half of his wealth to the poor and to make fourfold restitution to any he had cheated. In this story we see that the key was not who Zacchaeus had been, but who he was becoming. Again, it was his faith that mattered.

The story of Simon the leper contains little information, but there is still something we can infer. As it was unlawful for a leper to live in a town and to be in direct contact with others, and as there were others present in the home, it is likely that Simon had been cleansed of his leprosy, most likely by Jesus. This account would then follow the pattern of the other stories in that those who were outcasts were outcast no longer because of Jesus. Jesus was not going into a place where he was unknown or where his teaching was not embraced. He was a welcome guest, welcome for who he was and as who he was. There was no trust to be gained, argument to be won or persuasion to be achieved. He was welcome.

An honest assessment of these passages leads to a different application of the meaning of table fellowship. It is not about going to places where sin is rampant and people are opposed to Christianity with a message of acceptance. It is about recognizing that it is faith in Christ, and not our earthly station, that is the basis of our fellowship. Table fellowship, as practiced by Jesus, is not about how we relate to unbelievers and those outside the faith. It is about how we relate to fellow believers without regard to their background or earthly station. That this is correct is confirmed by the Apostle Paul's teaching that their is "neither Jew nor Greek, there is neither slave nor free, there is no male and female, for you are all one in Christ." (Galatians 3:28 ESV)

This leaves the question of how Christians should interact with those outside the faith. Jesus is the perfect example. Everywhere he went he went with a singular purpose- to proclaim the truth of who God was and of God’s plan for saving people from their sins. He was not afraid to address the sins of others, for the first recorded words of his public ministry were “Repent, for the kingdom of heaven is at hand.” He loved and served others, but His primary objective was not meeting the physical needs of others. His goal was to bring people into right relationship with God. It was what he lived and died for.

The question remains as to why an incorrect application of the concept of table fellowship has taken hold in so many places. I believe it is a reflection of the negative attitude toward the church that is prevalent in our society. As traditional Christian teachings and practices become viewed with an increasingly critical eye there is a natural tendency for some to want to place the blame on something the church is doing wrong. With the desire to "win people over" comes a desire to identify areas where Christians are in the wrong. Teachers search the Scriptures looking for something that Jesus did that we don't, believing that if we could be more like him that the world would see our love and goodness and respond. In spite of their good intentions, when people approach Scripture with presuppositions error is often the end result. 

True followers of Christ need to remember that being liked by the world has never been a characteristic of godliness. The opposite is true. No one was more like Jesus than Jesus and the world crucified him. The reward of living for Christ is not found in this life or in the responses of those who are outside the faith. The reward is in the next life and in the response of our Heavenly Father. 

The final question is more difficult. How does the church avoid conflict and division? The question is over 2000 years old. As long as churches are led by and filled with people the challenge will remain. The church will do better when it is careful in choosing its leaders, cautious in accepting new teaching and consistent in its commitment to Scripture as ultimate authority. It is when we are known primarily by the love we have for one another and not by our love for the world that unity can blossom.

- Bart

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You will Never be Cool. Deal with it.

“You are my son. You will never be cool. Deal with it.”

I said these words to my son when he was 9 years old. He was showing me the new school clothes he had just bought with his mom. Included in the new wardrobe was a pair of extremely baggy jeans, the kind intended to be worn well below the waistline. His mother had told him she did not think they were appropriate and would likely be rejected in the court of dad but he was determined to make an appeal to the judge. The pants were “cool” and he wanted them. Unfortunately for the future lawyer, in the court of dad any objection based on coolness was always overruled.

He was disappointed and not too happy about my verdict. What was the harm in wearing baggy pants? I explained to him that like it or not people judge other people based on appearance, that what we wear sends a message about us. Being cool was not important, but being godly and excellent was. While there may not be any harm in wearing edgy clothes, there is a higher objective.

I also considered a secondary long term goal in rendering my decision. The desire to be accepted, to fit it and be loved, is incredibly powerful and often increases over time. I knew that if I was going to raise a child who was driven by values that I would need to encourage values-driven thought at an early age. One of the most important values is that right and wrong, appropriate and inappropriate, are not determined by culture but by God. Following God inevitably leads to conflict with the culture. I could not expect him to stand up for his values in the future if I did not train him to do so in the present. Standing against the crowd is almost never cool or popular.

This is a crucial matter for people of faith. Christian beliefs are often at odds with the values of the society in which we live. Simply stating one's beliefs can lead to significant cultural backlash, to accusations of bigotry and hate. People who have not been taught from a young age how to stand up for and defend their faith, people who do not value faith over cultural acceptance, are unlikely to be able withstand the pressure. They may cave.

A few months ago my son interviewed for a position with an attorney’s office in Southern California. During the interview he was asked about his upbringing and values. He told them that as a child his father taught him to do the right thing no matter what. He told them that he learned that doing right was more important than being popular or cool. He shared what he had been told as a little boy, that he was my son and therefore would never be “cool”. The interviewers laughed at the story but were also impressed. They realized that before them was a young man of character.

My son learned the lesson. He also got the job.

- bart

Love and an Irrational Fear of Alcohol

I have never had a drink. I have taken a few sips to see how something tasted but I have never downed a complete beverage. Alcohol wreaked havoc on my family so I have lived my life as if I was an alcoholic. I will not drink. I have a strong aversion to it and avoid it completely to the point of irrationality.

My wife learned about my irrationality early in our marriage. We had been married only a few months when she went to the wedding of a friend. I worked Saturdays at a market and was unable to attend so she went alone. When I came home late that evening she told me about the ceremony and reception. As a part of the story she mentioned having a glass of champagne for the toast. This bothered me terribly and I did not hide the fact well (I would never make it as a poker player, my face tells all).

She asked me what the problem was, it had only been a single glass of champagne. I told her that while there was nothing wrong with anyone drinking a glass of champagne, that the image of the woman I loved with a drink in her hand was terribly upsetting to me. I knew it was silly, but it really bothered me.

Lisa hasn’t had a drink since. Not because it is wrong for her to drink and definitely not because my argument was powerful and persuasive. She decided to never have a drink because she loves me. My revulsion to alcohol is irrational and extreme, but it is real and based on real hurt from my childhood. Alcohol is nothing more than a beverage to her and she gladly set it aside to ease my pain.

I thought of this story recently in counseling a patient. He is in the process of working a 12-step program after 30 years of an alcoholic life. He has fully embraced his recovery, going to counseling and hosting meetings for those he met in rehab. While he has been doing well with sobriety his relationship with his wife has struggled. One of the areas of conflict has been the coed nature of the meetings he hosts. His wife is not comfortable with him having friendships with women, even though he does not meet with them one on one.

“So don’t have friendships with women,” I interrupted. He defended the practice and explained that he was never alone with the women and that it was all centered around recovery. He told me he had invited his wife to the meetings so she could chaperone and see that there was nothing untoward going on, but she did not want to go. He could not understand why his wife was as bothered as she was. No explanation or protestation of innocence could sway her. He felt trapped, as he felt the meetings were important but wanted to respect his wife as well.

“Don’t have women at the meetings,” I said, “Make them men only.” I told him that his wife’s fears and concerns did not have to be rational to be respected. His wife had endured decades of his alcoholism and was no doubt deeply wounded. She did not owe him an explanation and did not need to defend her position. Instead of arguing with her, he should choose an act of love by telling her, “I understand,” and changing his meetings to men only.

I shared with him the story of my wife and the wedding champagne. I explained that while my request that she not drink was irrational and absurd, my wife honored it because she could. She loved me that much. My wife did not need to be persuaded by logic or convinced by argument. She needed only to understand my heart and my fears. After a little more conversation with the patient he decided that he would honor his wife’s request. He had been selfish in his drinking for years, he could now do this one thing for her.

As he left I thought of the incredible example of love my wife has been for the last 34 years. She has accommodated so much. Raised toilet seats, cupboards and drawers NEVER closed, as well as my fears, anger and anxieties. I thought of the hundreds of failed marriages I have seen over the years and how many times a marriage might have been saved if someone had let go of “being right” and simply given in out of love.

I went home that night and told my wife that she is wonderful and amazing. Because she is.

- Bart

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