Sunday, May 31, 2015

Communion Meditation 5/31/15

In our church, people rotate giving a short meditation before communion each week. People typically do this for one month at a time and then rotate. It is my turn this month, and these are my thoughts I shared today in our communion meditation. 

I've started gardening here recently. Nothing too complicated. Just four pots with one each labeled tomato, zucchini, cucumber, and squash. You can ask anyone that knows me; this was pretty shocking. I'm not the most handy individual. In fact, I often have no idea what I'm doing when it comes to any kind of home project or yard work. Tim Herlihy can vouch for me back there. He drove by and saw my yard after winter and just shook his head. I could hear him saying,"What is that boy doing?"

Believe it or not, I have managed to get the beginnings of some vegetable plants in my back yard. You see, despite my lack of green thumb or ability, growing vegetables isn't complicated. The ingredient list is short. Seeds, soil, pots, water, fertilizer, sunshine. That's it. Make sure you plant around the right time of year and keep the water and fertilizer coming. You'll have a fighting chance if you do that.

Watching these plants grow every day has been refreshing for me. Unlike us, these plants do not seek answers for their future or what God's will for them might be. The cucumber plant is a cucumber plant. That's what it aims to be. It doesn't try to become a tomato or zucchini. With all of it's needs supplies, the future of these plants is secure. They will become what they're supposed to be. Questioning that would be ludicrous.

The truth is that our questions about Gods will for our lives often sound just as ridiculous as if my cucumber plant were asking them. What job should I work? Should I live in this neighborhood or that one? Its just like my plants asking should I put my roots on this side or that side? Should I catch that raindrop or this one? These are really trivial questions in the grand scheme, and all of them come from an innate need for security and answers despite the fact that God has already provided for our every need no matter what neighborhood we live in.

So lets stop making it complicated. Lets stop being cucumbers trying to figure out if we should be tomatoes. Lets just be God's children and let that be enough.

Wednesday, May 27, 2015


Those of you that have read my previous communion meditation have heard me talk about limits. The stark reality of critical illness causes these limits to be displayed most prominently. There is no denying your limits when the patient worsens in front of you and you have no answers. It is undeniable.

The idea that we don't have limits in all other aspects of medicine is pervasive, however, and ridiculous. People are like that, though. We will always deny what we can't do until it becomes immediately obvious that we can't do it. Happens in all other aspects of life. Politics, business, all the same. "Sure, I can get that order done by tomorrow." "Read my lips, no new taxes." We've all heard it. We've all fallen for it, and yet medicine still gets away with it.

There are very practical implications to refusing to acknowledge our shortcomings as a profession. Our stubborness translates into real dollars and cents, real resources wasted in the delusional pursuit of ends that we claim to be able to reach yet lack the tools to reach them. 

End of life is the most obvious case study of this. What do you do if someone is dying but you view death as failure and merely a manifestation of some other lesser physician's previous mistakes? You burn through resources, that's what. You throw the kitchen sink at the "problem." And then? The patient dies. Every time. Without exception. 

It's an oversimplification of course. Some folks are critically ill and will recover wonderfully. We can't perfectly predict who will recover and who won't, but we certainly have a good idea sometimes. More importantly, and more central to what I want to say today, we often know who wants to use those resources and who doesn't.

Informed consent was initiated in the noble pursuit of joint decision making and patient autonomy. Why don't we tell the patient all the possibilities and let them decide? Sounds nice. It's imperfect, though. How do I adequately explain the risks and benefits of a procedure that it took years of school and training to master and understand? Explain that in ten minutes? Forget about it. Its a farce.

No matter how many forms you get patients to sign saying they understand everything and have made the decision all by themselves, physicians will always play a central role in making patients' medical decisions. Sadly, this is where physicians' refusal to acknowledge our limits most hampers, and dare I say harms, our patients. What do you do if a patient is wavering on a procedure that could prolong their life if you believe that death is failure and only happens if you allow it to happen? You push. You cajole. You tell them how they really want the procedure, how it will help them.

Patients will relent usually. They trust their physicians. However, they won't be better for it. Unlike physicians and their God complex, most of the patients that I have cared for do not view death as failure. They view death for what it is. Inevitable. If we are really acting as a medical fiduciary for our patients, then how should this affect our decision making? Should we make decisions based on our personal views of death or our patients?

If we accept that our patients views of death and disease are more important than our own, then this begins to have every day implications. Do you use low value tests and procedures that often result in much lower quality of life with minute quantity of life gain? Probably not. Out the window goes "routine" blood tests every three months, a lot of heart caths and CT scans. Costs come down. Patients receive care more in line with what we know works the best.

From an individual physician standpoint, the trade off comes in time. It will take serious time to explain to patients why they don't need a test. Much more time than to simply order the tests. As in all situations, inaction must be explained more than action, even when inaction is the correct action. That means a lot more of our day sitting in exam rooms simply talking to patients, learning their views and preferences. We must know the whole person if we are to consider the whole person in our decision making.

That should be no problem, though. Most physicians indicate that they got into medicine for the purpose of knowing and helping people. So spending large amounts of time talking to patients and not ordering tests that can make you more money should be second nature, right? Let's hope so...

Friday, May 22, 2015


Watching a two year old figure out the world can be pretty entertaining sometimes. There are hard times, of course, but some of the situations are downright hilarious. Take my little man's relationship with ants, for instance. The weather wasn't heating up for very long before those familiar ant hills appeared in our back yard. Little buddy was fascinated.

I could see the toddlers wheels turning. "How did this pile of dirt get here? I didn't put that there. This must be a trick." The first time he saw an ant crawl out of there, he immediately backed up. "What is this mystical, miniature being? There is no way that one of those could have moved all this dirt." The first time he saw me kick an ant pile and all the ants scatter? Pure chaos. "There's a million of them! We're being invaded!" He took off for safety immediately, otherwise known as Mama.

You more senior parents out there already know what huge mistake that was. Little man immediately took to using whatever objects were available to destory every ant hill he encountered. This was especially difficult becaus we were trying to impart to him how ants would hurt him. You could see the indecision gripping him. He would run up to the ant pile with ball in hand, ready to do battle. He would stop about two feet away and look back at me as if asking,"Are we going to war today or running for our lives?" I felt for him. No toddler warrior can work in this kind of environment.

We have managed to strike a balance in our relationship with ants now. We have adopted the same relationship with them that we use for strangers. That is, you are nice but wary. Thus, walking across our back yard with him is punctuated by stopping multiple times so he can wave at each ant hill and yell at the top of his lungs,"Hey, ants!" He will then stoop down to inspect each pile before moving on to the next one. 

As icing on the cake, he has even figured out that each hill is the ants' home. Unfortunately, this has presented him with an entirely new set of problems. We are now at the stage where finding an ant outside of an ant hill is the equivalant of seeing a missing child when an amber alert is going on. He starts screaming,"Oh no! Ant, ant, ant!" I've even overheard him sternly telling a solitary ant marching across our driveway that it needed to go home immediately. Fortunately, I haven't witnessed any rescue attempts as of yet. We all know how well that would go. Toddler warrior would return and unleash Hiroshima on the ant population of greater Berkeley County. Our family just doesn't roll like that.

Sunday, May 17, 2015

Communion Meditation 5/15/15

I had written a meditation that I took to church with every intention of delivering. Holy Spirit changed that during Sunday School and the following is an approximation of what I said. The communion meditation that some of you may have seen posted earlier today will be reposted later this month when I use it.

This week's events in Berkeley County, notably the shooting of Lieutenant Rogers, have prompted me to change what I'm going to say today. I'll start today by reading 1 Peter 5:7:

Cast all your anxiety on him for he cares for you.

The ICU rooms at MUSC are all designed the same. Each room has a desk sitting outside the room with a computer. There is a window into the room that allows you a view of the patient. Having spent many hours in the ICU's of MUSC during residency, I am very familiar with those desks. Physicians typically sit there and enter orders while trying to oversee the, sometimes chaotic, scene unfolding in the room.

You find out a lot about yourself at those desks. I know I did. As an ICU physician, your job is to essentially wait for catastrophic things to happen and then you are expected to fix it. The truth is that you learn a lot about your limits while sitting at those desks. You are witness to great feats of teamwork and hard work sometimes, which are incredibly rewarding. You are also witness to situations that you are simply unable to change. Physicians don't like to talk about it much, but there are quite a few situations where we simply have no control or idea of what is going on.

On those nights sitting at those desks outside those rooms where Lieutenant Rogers is now being cared for, 1 Peter 5:7 got me through. I take great comfort today knowing that those walls have heard that verse repeated countless times. I have said it over and over again late at night when I was the lone physician sitting there trying to do my best to help patients, just like the ICU team is doing now for Lieutenant Rogers.

The reason that 1 Peter 5:7 can get you through situations like that is because of what Christ did on the Cross for us. Today, we commemorate what Christ did and how that gives us power now. We remember that 1 Peter 5:7 still applies, whether you are Lieutenant Rogers and his family or the physician trying your best to take care of him. We should remember that power every day in our daily lives.

Sunday, May 10, 2015

Mother's Day Communion Meditation

In our church, people rotate giving a short meditation before communion each week. People typically do this for one month at a time and then rotate. It is my turn this month, and these are my thoughts I shared today in our communion meditation.

As many of you know, today is Mother's Day. For those of you that have forgotten, its quite honestly too late for me to help you. Might as well enjoy the service now because you once walk out of those ain't gonna be pretty my friend.

Mother's Day is a special holiday for me. Sure, I always celebrated it with my mom growing up, and we would do nice things for her. But my perspective has changed over the past two and a half years as my wife has become a mother.

There's a whole new level appreciation for the fact that her work really never ends. You can hear it in my son's reply to almost any question around the house. Want to eat now, son? Momma? Want to take your bath now, son. Momma? Scared in the middle of the night and need someone to sleep on a half deflated air mattress next to your bed. Momma?

It's the only job that never ends, has no rules, and pays nothing, and God knew what he was doing when he put my wife and all of your wives and moms in that role. I know my job this morning is to get you ready for our time of communion, but the whole purpose of this day should already be doing that.

Today we celebrate the people in our lives that give all of themselves every day to make sure we are taken care of. They ignore their own personal wants and needs and think about their families before themselves. As we have been learning about in Sunday School the past few weeks, "Jesus spoke of that." Jesus gave His all so that we could be sons and daughters of God. Today, we think all mothers for being living, breathing examples of that kind of sacrifice every day in our lives.

Sunday, May 3, 2015

Communion Meditation 5/3/15

In our church, people rotate giving a short meditation before communion each week. People typically do this for one month at a time and then rotate. It is my turn this month, and these are my thoughts I shared today in our communion meditation. 

There's several different degrees to the word different. That may not be quite so obvious at first, but let me give you an example. My wife says that I'm "different" sometimes. All the wives know what I'm talking about here. That meaning is usually somewhat funny and in jest. Husbands , quite honestly, tend to think the same thing about their wives. Youth, some of you might call people at your school "different." They don't blend in. Don't look like you. Maybe you don't quite understand them. Likely, everyone pressures them to not be different. This kind of different can have a little more of an edge to it, especially when you're a teenager and simply worried about fitting in.

Then, there's Jesus' brand of different. That's the whole "I'm going to allow myself to be hung a Cross to save you even though I'm blameless" different. That's a whole 'nother level of different. Yet, that is what we're called to. In an American culture and even church culture that is placing more and more emphasize on blending in and not being different, Jesus says no. Jesus asks us to be different, demands it from us even.

We see this in 1 John 2:15-17:

Do not love the world or the things in the world. If anyone loves the world, the love of the Father is not in him. For all that is in the world-the desires of the flesh and the desires of the eyes and pride in possessions-is not from the Father but is from the world. And the world is passing away along with its desires, but whoever does the will of God abides forever.

What Christ did on the cross, what we commemorate now around this table, was different. Whoever puts their hope in worldly things, in being just like everyone else, will perish, but for those of us that come around this table this morning, being different is the key to life. Let us remember that our lives should reflect that.

Saturday, May 2, 2015

Toddler Nap Dibs

Naps on the weekend are a sacred time in any household with kids. There is a very limited time during daylight hours where a child is sleeping, and the parents are free to do whatever they want. Our weekend nap time routine has a fairly predictable pattern. We usually spend about thirty minutes to an hour frantically getting tasks done that would be impossible if little man was awake. We then spend whatever time remains relaxing.

The interesting part of this routine is when the toddler awakens. As those familiar sounds begin to emerge from his room, an almost primal situation occurs. His mother and I look at each other like two opponents ready to do battle. As I said, there are only a precious few minutes of relaxation available. For the person who must go get the awakening toddler, this time is cut short and also usually punctuated by a wet diaper, cries for juice, and a generally very cranky toddler.

We have developed a system similar to the childhood tradition of calling dibs. The basics go something like this. The parent that is able to yell first that the other parent is coming gets to remain seated. For example, if my wife is able to get out,"Your father is coming" first, then I have to go. You might think that you could just say this before the toddler awakens, but we have ground rules to prevent this. If you yell prematurely and awaken the toddler, then you're up sweetheart.

It makes for some pretty interesting routines during nap time. You never want to be too far from the stairs because if you are, then you can't hear him stirring in time. We also have a baby monitor still in his room, so I've adopted the strategy of turning the volume way down so only I can hear it. That drew some complaints early on.

As you can imagine, I lose these battles a lot, so I've adopted a plan to salvage the situation and gain some parenting status points. Every time I go up the stairs I say,"Daddy's here. Momma left." You can imagine how that goes.