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