Merry Christmas!

In the innocence of these children, even while in the hospital during Christmas, and even in the bleakest of moments, there was a hopefulness and joy. I am reminded that we must have hearts and eyes of a child to approach God throughout life’s ups and downs. One of the big blessings of family medicine is the chance to work with children, and to be regularly reminded of the spiritual principle Jesus spoke about. I often times need that reminded.

That we might maintain a child’s heart during residency and never growing out of that child like trust and simple faith in God as a good Father.

And he said: "I tell you the truth, unless you change and become like little children, you will never enter the kingdom of heaven.” Matthew 18.3

Night Float

For the past 6 weeks I have spent time on the in-patient hospital ward team. Our program has a pretty rigorous in-patient experience as we cover both ICU and general medical patients simultaneously. This has allowed a diverse clinical experience with a wide range of medical acuity on any given night. The first 4 weeks consisted of 'day' work, followed by two weeks of night float. My 13 hour days have been painfully long and tedious, and yet I am learning more than I ever have before. It's great to have an 80 hour/week limit with 16 hours max for intern shifts. It is hard to imagine working beyond our current 80 hours, but maybe the coffee was just a bit stronger in the 'old days' of residency.

Two weeks ago, I was able to attend a faith and healing conference in my current city of Lancaster, PA. 8000+ people came to hear prominent Christian leaders on the forefront of supernatural healing. While I have had numerous experience in the past with charismatic groups, this conference did not define itself by any one denomination. It brought together many different backgrounds, with the goal of encouraging more openness to God's powerful kingdom confronting the forces of darkness. I saw many miraculous healings and the testimonies of recipients. I began to wonder, what is the role of the supernatural in my work as a doctor? It seems there is a false division between natural and supernatural healing, as both come from God as sustainer and creator of both the seen and unseen. I pray for grace to seek out more of God's power to heal within both realms.

With these thoughts in mind, I recently had a conversation with a patient who has been in the ICU an average of 2-3 times per month with diabetic ketoacidosis. Though in her mid 20s, she has already accrued well over a million dollars of medical bills due to both poor compliance with her insulin regimen as well as a progressively worsening physiology. In just 6 weeks I have admitted and discharged her at least 3 times (maybe even 4). In talking with her last night, it became clear that she is absolutely miserable: severe, chronic abdominal pain; depression; isolation; misery. From a modern medical standpoint, I have no answers nor solutions for her problem. The only thing I had to offer was to reach out my hand and pray for God to powerfully heal her. I remember Luke 5:17, And the power of the Lord was with Jesus to heal the sick. I have full faith she will be healed and would know God's shalom one day.

Work is the Ministry

This evening I feel the wear and tear of residency. This is my inpatient medicine month and I am definitely working 12 hour days with the responsibility of following both ICU and general medical patients. I suppose we residents can say at least we are learning! And I do feel that I am learning much each day. It is a blessing to learn medicine, and it comes through no other way than a few hard years up front to build up that confidence and knowledge base to serve later on with a more balanced life.

Something that I have felt impressed is that my work is my ministry; my ministry is my work. During medical school I found much of my worth and significance in serving in our local campus fellowship and in church ministries. I found more joy and significance in explicit and direct 'ministry' discussing spiritual things. As an intern in my residency program, I have little time to do any sort of ministry in the traditional sense. My life is mainly filled with work in the hospital. From writing orders, to communicating with RNs, to rounding with the team: much of what I do is not filled with direct and explicit conversation about God and the gospel and yet it is about God and the gospel if I have the faith to see it. At times I still feel the need to be involved with ministry in order to feel significance. But He shows me that my work is the ministry for today, and that my secular work has become significant in and of itself as something offered to God in worship. That I might worship God with my hours of work and rejoice in this great opportunity to worship Him.

Patience

Within my residency program is built a unique dual-site program experience: the first site is our downtown clinic at the main hospital serving an urban underserved population while the second is a rural clinic site. At this second site in rural Pennsylvania, we residents must learn how to care for the rural poor often times in the same day we work back in the afternoons at the downtown clinic. Very challenging!

Apparently the unique challenge at the rural site is the way patients abuse narcotics. Because the selling and abuse of narcotics is so high in this area, patients must sign a contract agreeing that they will only accept prescription drugs from one clinic site; must have urine tests during scheduled office visits; and promise to not sell any narcotics. A 3rd year resident and fellow brother in the Lord tells me of how frequent his patients break this trust agreement as they go from physician to physician abusing the use of narcotics. My friend had a of pain in his voice as he seems to takes this abuse of trust personally.

“But the way that I think if it”, he says, “Is that this it a way to enter in to the way that God loves us. In the same way that we fail God and abuse our trust with him, so our patients abuse our trust and yet we cannot give up on them. God is redeeming us through his patience and never turns us away; so we must help to bring redemption to our patients lives and never give up on them.”

The way we view God greatly affects our care for patients.

Transitions

There is a challenge for most of us residents in transitory nature of our lives. We can feel a sense of impermanence as we make the journey from college to medical school to residency. Yet there is a blessing in the new experiences and unknown travels that catalyze an Abrahamic-like faith as we 'go' into the unknown and move to new cities and states for our various training programs. But as we make our way from out of our college years and into our late 20s, and early 30s, where is the permanence that we long for? I wonder if other residents feel a tension on how to maintain past friendships, and the challenge of maintaining each layer of relationships added to the complex social fabric we have become.

As I have matched into a new geographical location for residency - another layer added to my social fabric - I now try to remake myself in a new community while at the same time try to keep in touch with my previous community.

Join with me as we can rejoice in the new opportunities ahead of us as residents. Let us not look back but with trust and confidence look forward to new opportunities ahead. God is good and is always providing! God makes no mistakes and we are right where we belong!

Dear Lord, help us in this season to join anew a new community of your Body as we transition out of medical school and into residency. That we could be joined to your Body with each transition and change in life.

We Lose Nothing

“If we let Christ into our lives we lose nothing, nothing, absolutely nothing that makes life free, beautiful, or great. Only in friendship with Christ is the great potential of human existence truly revealed … He takes away nothing, and He gives you everything”.

I heard this quote two weeks ago from a recent graduate of our family medicine program and instantly felt a draw towards its truth.

In many ways medicine can train in the art of self-promotion and self-preservation. It is no easy thing to remain selfless in our profession. Jesus shows us a better way: life is in giving and not taking. What we loose for him we always gain in the most wonderful ways.

Do my fellow residents feel frustrated, and even dismayed, and the sense of loss in choosing medicine? Lost opportunities with family, friends, life experiences, and maybe even just life itself, in exchange for a long course of medical training. The truth of Christ is that we never lose anything with Him. As the old poem of old says, Having Him, I must have naught beside.

In the midst of my busy month in obstetrics that I would seek to let Christ into the details of life - into my sign-outs; into my interaction with nurses; into my interactions with peers at happy hour. That Christ would dwell these details of life that seem so insignificant.

For days on end I get to work early and leave late at night. But during those times of spiritual fatigue, His joy is there to fill my soul. May we receive Him today. We are not alone in this journey. Even in residency.

Champagne Tap

End of my 3rd week of pediatrics with one more to go. My fellow intern and I have a friendly competition going on. Several of our peds patients present with symptoms suggestive of an infectious disease process involving the CSF. Being a resident in the lovely state of Pennsylvania - thick with woods and replete with ticks - allows me frequent acquaintance with the clinical manifestation of Lyme disease. This tick-borne illness is common in the summer time when kids go out camping in the great outdoors. With a fever, headache and rash, a lumbar puncture becomes indicated to rule out infections such as Lyme meningitis.

Last week, my fellow intern performed a most excellent lumbar puncture on a patient. The lab receives the 2-3 ml of (usually) clear fluid and in a few hours reports the findings: RBCs, WBCs, proteins, etc. The fewer RBCs, the more 'clean' the tap and the more accurate the CSF lab results. 'Champagne' tap means RBCs of 0. His results were excellent: RBCs, 2. After a long week of work, and at 6pm on a Friday, a patient presented to the ED with the classic symptoms, and soon I began preparing for my first pediatric LP. With some supervision and a very brave little girl, the tap was soon done and the results came in: RBCs, 0. It was a most rewarding way to end the week.