Missing the Most Important Diagnosis

I almost missed it. I had covered all of the essential medical details of the visit but I nearly overlooked the most important issue for the patient that morning. I caught as he walked out the door.

His appointment that day was for recurrent abdominal pain which was at times severe and debilitating. His problems began a year earlier when he had a case of diverticulitis that resulted in a visit to the emergency room and a week of antibiotics. That pain resolved but in the months that followed he had three more cases of severe pain in the left lower quadrant. He was seen by a doctor on each occasion but, unlike the first episode, diverticulitis was not the cause. All of the tests came back negative and the pains resolved. No one could tell him what was going on.

His most recent episode has been two weeks prior to the current visit to my office. It was bad enough for him to return to the emergency room. Again, no answer was found and the pain resolved. Although the pain had been gone for several days he came to my office to see what the next steps would be. He was full of questions.

“Could it be my gallbladder?” he asked. I explained that it could not be, as gallbladder pain occurred in the right upper quadrant, a completely different area from where his pain was located. His questions continued, and I patiently explained why we knew it was not diverticulitis (normal CT) or an ulcer. While I did a good job of explaining all of the things he didn't have I was not able to give him a definitive diagnosis. I decided to refer him to a specialist for help in determining what additional testing was needed. I completed the referral request online and wrapped up the visit, wishing him well.

As he left the room I walked alongside him, (not out of courtesy,I wanted a cup of coffee and needed to walk the same direction). As we walked I realized what I had missed. I had addressed his questions but I had not addressed his fear.

“It's frustrating not knowing what is going on isn’t it?” I said.

“It is,” he replied.

“It would almost be easier if it was diverticulitis,” I said, “because then we would at least know what we were dealing with.”

“Yeah,” he responded, “I am really worried about it.”

I stopped walking and looked him in the eye. “Don’t let yourself be too worried over this. In my mind there is nothing serious on the list of possibilities. Cancer is not even on my list. We are just being thorough. On a 1 to 10 scale of worry, this is about a 2. Nothing to lose sleep over!” I saw his shoulders relax a visible display of tension releasing.

“Thanks. That really helps.”

As he left I thought about the multiple times in the past that I had not had this conversation, about how many patients had walked out of the room with correct treatment but their major question unanswered. Uneducated in the mechanisms of disease, many patients don’t know which of their symptoms are serious and which are not. When confronted with any change in how they feel, especially a change they have never known about or heard about before, they often think of the worst. Fears of cancer, tumor, serious disease and mortality can often accompany mild illnesses. Doctors, whose medical knowledge allows them to dismiss such fears in an instant, can easily forget that these fears are intense in the minds of their patients. The result is patients who have correct care but still leave the office afraid.

As I reflected on this patient I was reminded of the words of the Apostle John, “Perfect love drives out fear.” As a man of faith, I am called to love the people God brings into my life. If I love, then the fear of others matters. Whenever possible, whenever it is in my power, I need to do my best to address these fears. While John’s words were addressing the truth that the perfect love of God means that His followers need not fear His judgment, I believe the application still applies. I need to reflect the love of God towards others. When I do, people's fears will be addressed and often eliminated.

This truth is not limited to doctors. Incomplete understanding can lead to fear in any circumstance. For me, my lack of expertise in things mechanical can lead me to worry about noises in my car, sounds in my attic, and smells in my garage. I am always grateful when my mechanics, plumbers and handymen are kind enough to explain what is going on and calm my fears.

My prayer for myself is that I will grow increasingly sensitive to the fears of others with each passing day, and that I will take the time to drive it away.

-          Bart

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Spiritual Outside, Empty Inside

It is not often the big sins that destroy us. Most of us are too proud, too cautious or too concerned with the opinions of others to allow ourselves to fall into the major traps. We would never kill or steal, never physically abuse a child or a spouse and even in our darkest moments would not consider being unfaithful to our spouse. We forget that little sins can be equally deadly. Like slow acting poisons or a chronic disease, they chip away at our spiritual health until our lives are in shambles.

Joe learned this lesson the hard way. He had been married for over 10 years and had what appeared to be a perfect life. He was financially secure, active at church and even gave significant time serving the poor. If there was a goodness list, he seemed to be systematically checking all of boxes. At each visit he about family, church and ministry to the point where I was impressed by his obvious spiritual commitment. It seemed that the right things mattered and that his life was in balance.

It wasn’t. The illusion of success and harmony was shattered by his wife’s decision to leave him. He was committed to church, attended a weekly small group and served in ministry but he was failing in the one area where the Bible gives specific instruction. He wasn’t putting his wife first. The attention, love and devotion that should have been hers was consistently directed outside the home. She grew weary of being ignored and set aside, ultimately reaching the point where she decided she couldn’t take it anymore.

Her decision pulled back the curtain on his life and revealed him for the man he truly was. The external man visible to the world, active in church and talking about spiritual things, was just that, external. His motive for service was the way it made him feel and they way others viewed him. He made a show of grand acts of service but the simple essentials of being a good man at home were ignored. The smaller, unseen sins of selfishness and neglect of his wife went unaddressed and eventually brought him down.

His story reminds me that this is a common problem in our culture today. Our interactions with one another are brief and our conversations shallow. We define goodness and spirituality by readily observable actions and activities- Good people go to church, really good people attend a small group or a Bible study, and Godly people give a few hours a week to the poor. The reality is that these activities do not require goodness and do not require significant change in our hearts or attitudes.

Just as physical health is more dependent on daily habits than on a thrice weekly exercise program, spiritual health is more dependent on daily faithfulness than church attendance and small group meetings.

True Christian character is not defined in superficial terms or occasional activity. Godliness is best defined in the drudgery of daily life, in the daily interactions we have with our family, friends and co-workers, in the relationships in which we spend the majority of our time. It is by being faithful in even the smallest details of our lives that our light truly shines the brightest and best and is least likely to fade over time. 

My prayer is that I will be faithful first in those areas of my life that the outside world doesn’t see, in ways my church friends could overlook. May my life be characterized by love, kindness and forgiveness in my home, may I treat my patients and employees with grace and gentleness, may I overlook slights and mistreatment at the hands of others, and as I do, may the character forged in these daily endeavors serve as a foundation for greater service.

-          Bart

The idea of our daily lives and interactions being the way in which we shine the light of Christ to the world was a major them in Jesus’ teaching in the Sermon on the Mount and was the subject of a sermon I shared recently with a church group. You can watch the clip here.

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The Lesser of Two Evils is a False Choice

The king was backed into a corner. His small country, founded on religious principles, was no longer a major force. Unable to protect himself form the powerful nations that surrounded them he felt no choice but to align himself with one of them. The nation was Judah and the king was Jehoiakim. To his north was the Babylonian empire, to the south the Egyptians. Neither of these empires shared the culture or values of his people but his only hope seemed to be aligning with one of them.

Four years earlier it seemed as if the Egyptians were the major force. The Egyptian army had swept through Israel in its way north to challenge the mighty Babylonians in battle. Jehoiakim’s father died in a foolish attempt to halt the progress of the Egyptian army. A short while later the Egyptians joined the Assyrians in battle against Babylon and were defeated. Pharaoh and his army went home defeated. The King of Babylon followed south to Jerusalem and besieged the city, forcing the new king Jehoiakim to surrender.

Since that time Judah had been forced to pay tax and tribute to the pagan nation of Babylon. The burden was great on the people and the city of Jerusalem was divided in its opinions. Some felt Egypt was still its greatest hope, others were persuaded that subjection to Babylon was the only way forwar (perhaps because Babylon allowed them to continue with their own king and customs.) For four years the allegiance to Babylon held sway.

At that time a second battle between Egypt and Babylon led King Jehoiakim to question his loyalty to the Babylonian king Nebuchadnezzar. Nebuchadnezzar’s army had tried to expand its influence further south into Egyptand had been repelled by the Egyptians. Jehoiakim king of Judah again had a choice between two evils. With whom would he align? He chose Egypt, hoping the might of the Pharaoh could save him. It didn’t.

A short while later Nebuchadnezzar returned with his army and laid siege. King Jehoiakim died during the siege and before long the city fell. Nebuchadnezzar and his army took Jehoiakim’s son and thousands of the nation’s best and brightest away into captivity in Babylon. Leaving behind a puppet king to rule in Nebuchadnezzar’s name.

The new king, Zedekiah, did not learn from the mistakes of his predecessor. A new Pharaoh came to power in Egypt, and once again the King of Judah was tempted to change his alliances and allegiance. He too rebelled against Babylon.

Only 4 years after Jehoiakim fell, Nebuchadnezzar and his army arrived again outside the gates of Jerusalem. This time, his wrath was not contained. He laid waste to the city and destroyed the walls and its temple. He killed Zedekiah’s sons right in front of the king and then put out his eyes, making the death of the sons his final visible memory. Judah was no more.

The fall of Judah reminds us of the challenges of choosing unholy alliances. The kings of Judah repeatedly saw only two options available, Egypt or Babylon. Neither option was good, neither nation shared any of their cultural values. One can imagine the debates in the courts of Jerusalem as people argued for one position or the other, trying to point out minuscule areas of good or potential incremental preserving of freedoms as they agonized over which evil was lesser.

They repeatedly out their hopes in powerful Pharaohs, setting their beliefs and values aside in favor of an alliance that might give them the best hope of preserving the greatest portion of the society in which they lived. Egypt may well have been the lesser of two evils, but they were still a bad choice. Judah lost everything.

What makes the story even more tragic is that Judah should have known better. The premise of having to choose between two earthly evils had been proven false many times in their history. Over and over again, their small nation had been threatened with destruction at the hands of overpowering enemies and over and over again they had been delivered, not through allying with another army but by trusting in their God. They should have recognized the false dichotomy. Their choices were not limited to Egypt or Babylon. There was a third way. They could have chosen to turn to God, returned to their values, and stood alone, trusting only in Him.

Modern day American Christians have much to learn from the lessons of Judah. We should resist the foolish claims of those who tell us that we have to choose between two evils. When both choices require us to compromise our values and deny who we are and what we believe, we need to choose the third way. If we do not, we should not be surprised when we find ourselves in trouble.

- Bart

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Do We Really Trust in God?

What do we trust God for? When I hear people talk about trusting God it is usually when they are going through difficult times. People out of work trust that God will help them find a job, people who are ill trust God for healing, and people who are lonely trust God to bring love or friendship into their lives. While it is wonderful when suffering is relieved, God does not always help people in the way they hope he will. This begs the question, what should we trust God for?

The answer is simple to state yet difficult to comprehend. We should trust God to be God. We can be confident that God will act in a manner consistent with His character and plans and in ways that bring glory and honor to Himself. It follows that trusting God requires us to first understand His character and plans and then to make His glory our priority.

God is an infinite, eternal being who embodies perfect love, mercy and compassion, but who at the same time embodies perfect justice, righteousness and holiness. None of His attributes can be appreciated or understood apart from the others. As an eternal God He is more concerned with our eternal destiny than with our temporary happiness. He allows pain and struggle to come into our lives and then uses them to shape us into the people that He wants us to be. He allows times of need to increase our dependence on Him, and He allows us to endure the consequences of our rebellious choices so we can learn to follow Him.

This means that many of the circumstances we interpret as being indicative of God’s absence may actually be demonstrations of God working in our lives for our benefit. The worst job I ever had, with an unsupportive medical group in which I felt alone and oppressed, was a place where I was able to touch the life of a dying man and watch him come to faith. 15 years ago a virus attacked my spine, bringing with it the greatest physical pain I ever experienced.  Those few weeks of intense agony opened my eyes to the suffering of others in more than all of the previous 15 years of practice and training combined. Out of the ashes of suffering rose a heart of compassion that had not exited before.

My life testifies to the truth that suffering is a tool in the hand of God. In times of suffering I have learned to trust God more, not to meet every earthly need but to accomplish every one of His eternal plans. With each of these lessons I gain more understanding of the words of Job, “Though He slay me, I will hope in Him,” for my greatest Hope is not for blessing in this life, but the eternal life that He has promised those who truly trust in Him.

-          Bart

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Who Should Christians Vote For?

Political posts are dangerous. It seems any post that even contains the words Republican and Democrat, or worse, the names Clinton and Trump, is destined to be met with a deluge of anger and recriminations. As dangerous as political conversations can be they have seldom been more difficult to avoid. The two leading candidates for president carry so much baggage it is amazing they don’t need two planes to fly to each campaign stop. Siding with either candidate gives others the right to ask, “How can you can vote for them knowing they did all of that?”

It has been a particularly challenging election cycle for devout Christians, those who seek to allow the teachings of the Bible to inform their decisions. Many Christians have over the years based their voting primarily on social, moral and religious issues, as these issues are easy to argue and support from Biblical texts. One does not need to be a Biblical scholar to be able to find scriptural support for positions regarding abortion and marriage. This clarity made voting a comfortable and simple choice for many. This election has muddied the waters. Those looking for Biblical guidance can find reasons to reject each candidate more easily than to support them.

Christians need to be reminded that the Christian Bible has existed in its current form for almost two thousand years. It is intended to be a spiritual history of the people of God and a description of God’s eternal plan for redemption through the sacrifice of His son Jesus, not an election guide. The writers of the Bible, especially those inspired to pen the New Testament, showed remarkably little interest in the political issues of the day. These men were eternally focused and believed that a person’s eternal circumstances were far more important than their temporary ones. Eternal freedom from sin was more important than any earthly right or privilege.

This focus on the eternal continues to be relevant. I have heard many believers this election cycle talk about the importance of religious freedom. Many fear that a Christian’s ability to live and act consistent with his faith is under attack. There is no arguing the reality of this threat, but we need to remember that the danger associated with living out the Christian faith was far greater 2000 years ago in the Roman Empire that it is today. Emperor Nero covered Christians with tar and set them afire to light his garden parties yet the focus of the apostle’s teachings was on the blessings associated with following God in the face of persecution, not on eliminating the threat! In his first letter, the Apostle Peter told the persecuted church that their steadfastness under persecution was powerful evidence of the genuineness of their faith. True faith endures through difficult circumstances, therefore difficult circumstances were the test that proved faith valid to a questioning world.

In the writings of Peter and the other apostles we see other perspectives that differ from many modern American Christians. Christians in the early church did not live in a free and democratic society. Many were not Roman citizens and many others were slaves. Neither of these classes had the right to vote. Even those who were citizens and had the ability to vote had no way to influence the decisions of the emperor. The focus then was not in changing government but in accepting the sovereignty of God over government. The world was to be changed not one vote at a time, but one heart at a time. The agent for societal change was God, not the individual.

American Christians seem to have lost sight of this principle. We have grown up in a nation that emphasizes the right to vote and its importance. We have been taught since childhood that we could change the world. We are continuously bombarded with ads telling us that if we just vote for this person or this ballot measure that the “problem” whatever it is, will be solved. Government, not God, has become the agent of societal change, even in the minds of those who claim the faith. In almost every political post and article I read and in every political discussion in which I participate the emphasis is on what “we” must do, on how “we” need to change things. If only “we” could regain power and influence, if only “we” could get the right people on the Supreme Court, then all will be good again.

The evidence of the last few years has proven that the apostles were right. If we want the world to change for the better the battle needs to be won in the hearts of the people not in the voting booth. Our society is changing. Political and judicial decisions and actions are not the cause of the change, they are the reflection of it. The current debate over marriage is a perfect illustration of this truth. Christian conservatives who hold out hope that a 5th conservative Supreme Court justice will change things are deceiving themselves. A recent Pew survey revealed that an overwhelming majority of young people, 71%, favor same sex marriage, and that even 27% of adults who identify as Evangelical do as well. Same sex marriage, even if overturned by the Supreme Court of the land tomorrow, has become a value of our culture that will not be denied. Any who hope that this will be changed by an election are simply deceiving themselves.

In fact, one of the few blessings of this Presidential election is the manner in which it reveals the misplaced hope of Christian voters. It is time for us to remind ourselves that true, lasting, and meaningful societal change is dependent on our ability to influence the hearts of those with whom we come in contact, not with our ability to influence the leaders in government. The choices in this presidential election are so hopelessly flawed, dishonest and corrupt it is hard for anyone of conscience to stand with either candidate. The best arguments tend to be those made about standing against the other side. People of strong faith and conviction are faced with the choice of siding with someone who has defied a number of Christian values or not voting at all.

I have decided that my decision comes down to the value of my vote. I believe that my vote, like every action I take, is an extension of myself, an expression of my values and beliefs. If there are no candidates who reflect these values in any way, then there are no candidates to vote for. I will vote for neither of them.

This is not a usurpation of a societal obligation or an abdication of responsibility. It is an acknowledgement that the power to change society is dependent more on my character than it is on my vote. If I compromise my character I lose that power. I choose to live my life as a Christian more concerned with the eternal state of people’s souls than with the current state of American government. I will continue to vote for candidates who are worthy of my vote but I will put my hope in no man or woman.

To my Christian brothers and sisters who feel that the future of America rides on the results of this election I offer this reminder. Two thousand years ago the Church had no voice in the Roman government, yet the church endured and the Roman Empire did not. The church endured and the message it spread changed the world. God did not need politicians to accomplish His purposes then and He does not need them now. Let us focus on Him.

-          Bart

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