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.

A prayer for my fellow residents

Psalm 25:10 All the paths of the Lord are steadfast love and faithfulness, for those who keep his covenant and his testimonies.

What a wonderful verse to choose for the resident CMDA blog. The powerful, life-giving word of God: that all the paths of the Lord are steadfast love and faithfulness. What a joy to know that this is the God we are saved unto for eternity. I think most residents at some point think to themselves, I don't even remember what path I am on! But God knows, and He designs it as good. It is filled with constant reminders of His love and faithfulness if I have eyes to see. My prayer for all my fellow residents as well as myself is for our residency to not be a journey devoid of any reminders of Him, but rather a season lived in the daily reality of Psalm 25:10.

A Parent's Care

Half way through my first month of residency, and I am greatly enjoying my inpatient my pediatrics rotation. It has been a wonderful time of taking care of a wide array of patients - the Mexican immigrant's child next to an Amish boy next to a Laotian newborn. The Amish are particularly interesting as they do not bring in their child until well past the appropriate time. The home remedies are usually first tried, and then only as a last resort do they seek out a physician's help. One child had a Lyme disease-related torticollis, otherwise known as wryneck, that had the little girl with a crooked neck for two weeks. Another suffering patient had a bad case of e.coli 0157:H7 causing bloody diarrhea. And yet another with ITP (idiopathic thrombocytopenic purpura) requiring on-going medical care.

With each of these diverse families exists a common feature to each: they all care deeply for their child. We are treating the parents as much as the patient. In each child, I see a glimpse of the great care that our heavenly Father feels and gives to us. Pains and trials, failures and defeats - His love is a great mountain that cannot be moved. The genuine care and concern that each of these pediatric patients receives, how much more can we know the safety that is in His good care. He is a good Father.

Lord, help me to know your fatherly care this week. Help me to see your great love and the safety of that care.

How we talk to each other

Let your conversation be always full of grace, seasoned with salt, so that you may know how to answer everyone. Colossians 4.6

Let no corrupting talk come out of your mouths, but only such as is good for building up, as fits the occasion, that it may give grace to those who hear. Ephesians 4.29

Thinking and praying these days about how to be engaged in conversation with people in the hospital in a way that is 'full of grace, seasoned with salt' rather than business-as-usual: sarcasm and off-colored humor. How do I bring humor and good conversation in a way that is neither heavy/unnecessarily serious nor vacuous?

God, grant me sincerity of speech this week.

First Call

I finished my first call on my second day of work as a resident. It was a Sunday, and coincidentally on my 29th birthday. It does seem that medical school took up most of my 20's but I am still young (still in my 20's at least). I arrived at 7am feeling the anticipation of the day ahead. The night float team hands over the pager and summarizes the list of patients: human lives summed down to one-liners and a few lab values. Throughout the day I received floor calls from nurses concerning patients whom I had never met before. Fortunately, this first call day proved to be manageable and ‘atraumatic’ to my psyche.

She was 56 year old, and had been an uncontrolled diabetic for years. Subsequent kidney failure and a bout of hemodialysis resulted in her life and mine crossing paths. The transfer order to hospice seemed simple enough. The day spent answering pages concerning Mr. So-and-So with new onset diarrhea nearly preoccupied me indefinitely, and pass over this precious soul.

She had decided to die. The dialysis had been too hard and too uncomfortable. But more than anything, dialysis had become too hard and too uncomfortable for what life was worth. There were few friends; family relations broken years before. As my shift ended, I sat to talk for a few minutes.

How are you doing? I am scared. What are you scared of? My friends are not here to be with me. Where is your sister? She was here a few minutes and then left.

She had but a week to live given her end stage renal disease. She would be comfortable and feel no physical pain. I prayed with her and left.

As I approached my locker something seemed unfinished. I returned to her room. I asked her when it all started, and where this self-hate came from that she would let diabetes destroy her life.

It started in childhood, she said.

A relative, a cousin, whomever he was had set her life on a course of self-destruction that would eventually end her life prematurely. She surely was not entirely without fault. But there seemed something so tragic about it all.

I asked her if she really wanted to go to hospice. She thought she did. Had she truly based her decision on medical facts, and with a competent, healthy mind? Or had she simply just woken up one morning to see nothing worth living for?

Surely counseling would help. A pastor could be called. Surely she could keep living and fighting? I asked her if she had any bitterness or unforgiveness towards someone else. She said no. I asked her if she wanted to pray. She said, yes. Her prayer was absolutely beautiful. She did not want to go to hell; she did not want God mad at her. She asked for her sister to come back and be with her. She wanted to know God was not mad.

No. You are wonderful, a very beautiful person. You are special. You are a good person.

This lady, whom had not yet cried, began to shed tears. We embraced, and then left.
What could I do? I was only cross-covering the teaching service for a few hours on a weekend call. I wonder how many people go through life without self-worth and without God-given worth, only to travel down the dark road of self-destruction. Blood sugar for some; alcohol for another; bitterness for even more. God, use me to help others out of the lonely road. Sins have consequences; forgiveness and redemption brings freedom and life. Freedom and life. I would like to think that she could have know a sense of freedom and life even as a disabled, crippled person dependant on a dialysis machine three times a week. O God, use me to help others out of the lonely road. Keep us all out of the lonely road.

May God give her peace tonight.

Jesus answered them, ‘Truly, truly I say to you, everyone who commits sin is a slave to sin. The slave does not remain in the house forever; the son remains forever. So if the Son sets you free, you will be free indeed."

Reflections

For the past 4 years, I have lived in Philadelphia attending Jefferson Medical College. Prior to that, I spent my previous 24 years calling home the beautiful Pacific Northwest. My parent and extended family still reside on the west coast as I have spent the past 4 years on the east coast pursuing the call to be a physician.

I can still remember the phone call from the dean of Jefferson congratulating me on my acceptance into medical school, and the joyful hugs from my parents in our backyard. It seems like years ago. I remember it was a beautiful day.

I can still remember working the 10pm-6am shift as a nursing assistant in a nursing home while studying for the MCAT. There were feelings of both excitement and impossibility at the thought of becoming a doctor. I had graduated as a chemistry major from Whitworth College but had taken a unique journey towards medicine via 8 months in the nursing home preceded by one month of dishwashing in the facility kitchen. I thank the Lord for his provisions along the way; I thank him for turning trials into wisdom and mistakes into mercy-filled lessons learned. Sometimes I felt like Jacob – a life of struggle and striving. Other times I felt like Joseph, keeping a faith for an unseen day. Maybe we all at one point or another feel like each and every character in the biblical narrative. Mainly, I felt hope in what lie ahead.

I sat as young boy next to my mother in an unremembered hospital room. Her medical condition would slowly improve as I steadily grew interested in medicine, and its healing balm in a world of pain and hurt and yet with a potential for beauty and hope. Improbable: the son of a blue-collar family from Tacoma working as a family medicine resident in Lancaster, PA. I do not deserve His kindness and grace.

This morning I reflected on how much I disliked medical school. I struggled. It was the unexpected trials that made my Philadelphia experience so difficult. At times I feel frustrated at how things went; other times joy at the remembrance of the rich community of friends met along the way. But during those late moments at night as a first year medical student the doubts would come pouring in - What am I doing here? Why leave Seattle? Should I have ever gone to medical school? Was Philadelphia a mistake? Honestly, for the majority of my 4 years I was convinced that I had made a mistake. With my mother’s health in jeopardy; as an only child; as one who found continual struggle at my school – there was plenty to give reason for doubt.

A gentle voice whispering words of power and promise, surely goodness and mercy shall follow me all of the days of my life.

Goodness and mercy. I am thankful for this opportunity to be a doctor. Why I had to leave the west coast and experience intense personal I hope some day to see. But His goodness and mercy I will walk in today.

God has an amazing way of knowing just what we would need years in advance. During those frequent days of doubt would come remembrance of an experience nearly 9 years prior that would convert my cowardly, fearful heart into purpose and resolve.

I had been working in Montana during my college days. My premed major had changed to pre-seminary studies, and my intent for medical missions replaced by a genuine desire to be a pastor. After working with a Christian ministry in Glacier Park, and enjoying the opportunity to act as an amateur pastor, I seemed to have my life mapped out.

It only took one moment, just one word from the Lord, to change everything. In that moment, I felt the trajectory of my life change; a ripple effect that would change everything. What about medical missions, Erik? Within a week, my girlfriend and I ended; religion seminars changed to chemistry labs; and a deep burden for China grew. Within I year, I would be living in China fully in love with its people and language. Little did I know just how much I would need this definable turning point to look back towards in remembrance. He spoke this journey into being. In this I find great peace.

And so tomorrow I will start my life as a doctor. I commit my next 3 years to you.

Surely goodness and mercy shall follow me all the days of my life and I will dwell in the house of the Lord forever.

Commit your way to the Lord, trust in him and he will act. He will bring forth your righteousness as the light, and your justice as the noonday.

Do you not know that in a race all the runners compete, but only one receives the prize? So run that you may obtain it.

Greetings

Dear friends,

I greet you in the name of the Lord Jesus.

I am in the midst of my life journey towards fulfilling a lifelong dream to be a doctor. I pray to write in the honesty of who I am and the story unfolding in my life. I am not perfect; Jesus is my savior for a reason. But I love him more for his grace and mercy coming to me as each day unfolds. There will be brokenness and sin; but I hope for much beauty and joy in increasing measure as the weeks and months unfold. In all things, I thank God for this gift to live for him. It is my pleasure to share with you the journey along the way.

It is not what we do, but whom we are that counts. Might we know and love and reflect Him more.

Much love,
Erik