Finances

Here's a post that I originally wrote a few months back, and just never posted it.  Thanks for reading, and I hope you enjoy!

This last year has been an incredible year of growth in Christ for me.  I had my first wedding anniversary a couple of months ago, and have a salaried position as a resident in internal medicine with a full year of experience under my belt.  In this last year I have witnessed the growth and change of my local church, with a transition to a new pastor over this last summer.  All through this year, I have studied God's Word, sometimes not as often as I feel I should, read numerous books and watched many video-based curriculum for Christians.  One thing that never ceases to amaze me is the fact that culture and Christ seem to always be at odds with each other.  In fact, I remember reading early on that the bible will always contradict at least one aspect of every culture on earth; if it did not, that culture would be perfect, and nothing on earth is perfect. 

I have discovered over the last year that nothing we assume as reasonable, rational, or even morally correct can be taken at face value.  This discovery comes mostly from just reading the bible on a regular basis, along with the other Christian material I've read, watched or listened to.  I'd like to talk about some of the different discoveries I've made along the way, in a series of instalments, and perhaps challenge your thinking on some aspects of your own life, or at least the life of a 'regular member of society.'

Finances

Western society has a completely backward view of finances and how to manage money.  It wasn't until digging into what God has to say about financial matters that I realized that my own assumptions about money and fiscal responsibility were off the mark.  There is a portion of the New Testament, where Jesus talks about money, and this is what he has to say:

"No one can serve two masters. Either you will hate the one and love the other, or you will be devoted to the one and despise the other. You cannot serve both God and money."

- Luke 16:13 NIV

As Andy Stanley points out in one of his sermons, when Jesus identifies two masters, he does not talk about God and the devil!  He puts God and money in direct opposition to each other.  That doesn't mean that money is a bad thing, but anytime we take a good thing and make it an ultimate thing, we are slaves to that in which we put our hope.  In this case it's money, but this principle applies to anything that we are capable of idolizing, whether it is money, sex, success, beauty, acceptance, a nice car, love, a relationship, children, and the list goes on forever. 

So how do we become slaves to money?  The book of Proverbs has a great answer to that question.  Keep in mind, that the wisest man aside from Jesus, ever to walk the earth, wrote the book of Proverbs.  He said:

"The rich rule over the poor, and the borrower is slave to the lender."

-Proverbs 22:7 NIV

So the question is, who in our society is debt free?  Who has not borrowed money to be able to 'afford' that which their income at the present time could not provide for?  Andy Stanley points out in his sermon series titled "Balanced" that there was a time, not in the distant past, when borrowing money was something that only poor people did, because they actually couldn't afford to buy the item in question.  Somewhere along the way, though, being in debt became an indication of success; after all, a bank wouldn't loan you much money if you were poor, but the richer you are, the more you can borrow.  So we get caught up in a materialistic rat race, where a Honda Civic is beneath your status if you can "afford" a Mercedes, and taking public transit is unthinkable.  A two-bedroom home isn't good enough because the bank tells you that you can "afford" to buy a four-bedroom home, despite the fact that it would require 40% or 50% of your monthly income just to make the payments.  Oh, and that 52 inch flat screen television?  Don't worry if you don't have $1500, we'll let you take it and then take 2 years to pay it off.  But don't misunderstand me, for I don't want to come across as a hypocrite.  The average debt for a medical student when they've finished their 4 years of undergraduate training is $125,000, an amount that I somewhat surpassed.  My wife and I spend approximately 20% of our net income on debt repayment, and at least 2/3 of that is interest.  The bulk of the debt that I accumulated was primarily attributed to a sense of entitlement, stemming from the fact that I had been a student for so long, that now I “deserved” to have a few nice things.  One of the first things I ever bought once I was given access to what I lovingly refer as "fake money" was a $1200 television - a television that I currently struggle to use as little as possible.  I wish God had sat me down and talked to me about finances before now - or rather that I had not hardened my heart so that I would not listen.

The effect of all this is extraordinarily far reaching.  The United States economy went into a recession when the housing market collapsed, and the straw that broke the proverbial camel's back is said to be the "subprime loans" that were meant to allow poorer people to get a mortgage, but at a higher rate of interest.  Here in Canada, the industry that has always made my stomach turn is the payday cash advance industry, which allows a person to cash their cheque before payday.  The catch is that one must sacrifice a portion of their income to take advantage of this service.  It never made sense to me that someone would go to a business to get cash in advance of payday, in order to pay bills that they can't keep up with in the first place, and end up with even less money at the end of the month.  The whole system should be outlawed, for it is a system that exploits the weakness of their clientele. 

The issue of money really revolves around society's perception of what money is actually for.  Again, Andy Stanley gives us great insight into God's word when he points out a great definition of greed.  He states that greed is "The assumption that everything I have is for my consumption."  Even Christians have a tight-fisted approach to money, tithing 10% and telling God "you have your share, the rest is mine to do with as I please!"  The problem is that God does not tell us that everything we have is ours, and that he asks only for a percentage.  What he does tell us is this:

"To The Lord your God belong the heavens, even the highest heavens, the earth and everything in it." 

-Deuteronomy 10:14 NIV

So, for the Christian at least, 100% of what we have in our possession belongs to God.  Tithing is not a matter of giving 10% of what is "mine" and keeping the rest for my own consumption.  It is a matter of making it a habit of contributing an amount each month of every year, sometimes more, sometimes less, but always giving as much as God directs us.  And sometimes that means loving our neighbour, even when it hurts us, and we have to sacrifice our lifestyle so that we might bring life to others.  After all, we find in God's word that:

"If anyone has material possessions and sees his brother in need but has no pity on him, how can the love of God be in him?"

-1 John 3:17 NIV

Remember also that we all have a deceitful heart (Jeremiah 17:9), and know that pretending not to see, or simply not looking, does not exempt us from having to live as God expects.  We all know that we have brothers and sisters in need, and that we would be just fine with less material possessions in order to reflect to those people the love that God has shown us.

So, how do we manage to live right with God in a culture that is greedy by definition, that consistently as a society spends more than it makes in a month or year? We remember the words of Jesus:

"For where your treasure is, there your heart will be also."

-Matthew 6:21 NIV

If you want to know where your priorities really are, and if you're a Christian and you wonder if you're really a disciple, you look at where your money is going.  I found out over the last couple of months that my household was spending as much on food in a month as we were on debt repayment, and almost twice as much as our monthly rent.  Half of what we spent on food was for dining out or fast food.  Until we started keeping track of where all our money was going, we had absolutely no idea.  Even after I had spent a month keeping track of all our expenditures, when I told my wife how much we had spent on restaurants, she exclaimed "There's no way we spend that much!"  It wasn't until after I sat down and showed her the spreadsheet that her next remark was "Ok, now I'm a believer."  The thing is, we were far over budget on both restaurants and groceries, but chronically under budget for savings and charity. 

I have struggled with my weight and the consumption of food (especially junk food) for a long time.  At one point I weighed almost 200 lbs.  While I don't weigh near that anymore, I still struggle with food, and the most difficult is fighting the sense of entitlement that comes with being on call in the hospital.  It's easy to work for 24 hours straight and then stop for an ice cream on the way home because "I deserve it."  Willpower just wasn't cutting it.  More recently though, my resolve is strengthened by the fact that I know that if I buy that ice cream, or that amazing pumpkin spice latte, or spend $15 per week on coffee because I'm too lazy to make my own, I won't meet my goal for charity.  If I don't meet my goals for charity, then I haven't been a good steward with what God has given me, and God will know that since my treasure has gone to my stomach, my heart lies there and not with Him.  While I know we will all disappoint God sometimes, the desire not to be wilfully disobedient is a powerful motivator to be financially prudent.

Consider, then, the purpose of having money at all.  It isn’t to buy ourselves the necessities of life; after all, we are clearly told that God will provide us with everything we need.

“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? Can any one of you by worrying add a single hour to your life?”

“And why do you worry about clothes? See how the flowers of the field grow. They do not labor or spin. Yet I tell you that not even Solomon in all his splendor was dressed like one of these. If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, will he not much more clothe you—you of little faith? So do not worry, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For the pagans run after all these things, and your heavenly Father knows that you need them. But seek first his kingdom and his righteousness, and all these things will be given to you as well. Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.”

-Matthew 6:25-34 NIV

A bit of a long quote, I realize, but so beautifully emphasizes that God is our provider, and that no amount of our own striving will ensure that we always have the things we need.  So if the purpose of having money is not to provide us with necessities and sustain ourselves by our own works, what is the point?  One of my favorite quotes from the bible explains:

“Anyone who has been stealing must steal no longer, but must work, doing something useful with their own hands, that they may have something to share with those in need.”

-Ephesians 4:28 NIV

Luke also wrote in the book of Acts, we are also told something that most people partially recite around Christmas time:

“In everything I did, I showed you that by this kind of hard work we must help the weak, remembering the words the Lord Jesus himself said: 'It is more blessed to give than to receive.'”

- Acts 20:35 NIV

Based on these verses of scripture, we are supposed to work in order to have something to share with those in need.  As an incentive, we are told it is more blessed to give than to receive.  We are also reminded that we are to first seek God’s kingdom and his righteousness, and the necessities of life will also be given to us. 

Western society has a proclivity to assume that everything we earn is for our consumption.  We spout niceties around Christmas time and tell our children that it is better to give than to receive, and then demonstrate throughout the rest of the year that we’d rather give to ourselves than other people.   In general, our culture tells us that more stuff will make us happier, and yet we know from observation and many of us from personal experience that money does not bring happiness.  In one of his sermons, Timothy Keller, using the Myth of Sisyphus as an example, puts it this way: “Hell is an activity from which nothing good ever comes except the need to do it again.”  Buying more and more material items brings nothing good, only the need to buy something else. 

The solution then to our money problems is twofold.  First, we must break from the imposed mould that what we have in our possession is for our own consumption.  Andy Stanley in a podcast entitled Enemies of the Heart states that the remedy to greed is to write a big cheque, bigger than we’ve ever written before, and give it away.  It takes a decision to do something that greed would encourage you not to do, a decision to use what you currently have to help someone else rather than waiting for “a little extra” to come along so that you can give it away.  Second, we need to be good stewards of what we have been given, and create budgets, spending plans and track our spending so that every purchase is a conscious decision.  Knowing where our money is going and how much money we have left in all of the little pots that add up to make our budget is paramount.  Only by knowing where our money is going and how much we spend on everything can we make adjustments in our spending and saving pattern to avoid going into debt.  Last, don’t buy what you don’t have the cash for.  The only things I can think of that might (I emphasize that word) fall outside this category would be a house and education, but even those things could be paid for in cash if we were serious enough about avoiding debt.  What it would mean is living with our parents for longer, getting part-time jobs while we’re in school, and not living as if we’re entitled to all the luxuries that life has to offer.  Of course, our culture would encourage us to do everything exactly the opposite. 

In my own life, I started out by buying a vehicle that I could afford the purchase price but not the regular upkeep.  I didn’t budget for my tuition, and so when that came up, I couldn’t afford to keep my vehicle going and then had to run to my parents for a loan.  I continued on with my poor spending habits without revisiting my financial plan (which was non-existent).  Next I got a job after my undergraduate degree that paid minimum wage, and used my line of credit to buy great outdoor clothing at amazing discounts because I worked at an outdoor outfitting store.  The following year I got into medical school and obtained the proverbial professional student line of credit.  This seemed like the holy grail at the time, and my first purchase was a $1200 flat screen television.  I also moved out of my parents’ house, and got a debit card that was directly connected to my line of credit.  So now, after 8 years of undergraduate education, with a year between each degree, I owe more than the average medical student debt of $124,000.  Le sigh.  I have never before been a good steward of the money I’ve been given, and have worked myself into debt primarily due to my sense of entitlement, which was only recently revealed to me as being such.  In retrospect, I could have stayed under my parents’ roof a while longer, I could have done without a vehicle, and I certainly didn’t need to buy a frivolous television. 

Now, I have a spending plan and a budget.  I know exactly how much of my savings is for which purpose, our bills are arranged so that we never overdraft, and we have a plan for meeting our charitable donations goal.  One of the startling things that we realized was that when we budgeted and planned for all our expenses, we would need about $500 per month more than we currently make.  So my wife and I have decided that we need to sell my vehicle in order to reduce our expenses, and put us into a positive balance.  Sometimes being financially responsible means taking the bus and walking to work, instead of paying a second vehicle payment.

So what are you doing with your money?  Do you give any of it away?  Do you spend it all on yourself, and the things you “need?”  Do you even know where it all goes?  Being wise with your money and simultaneously letting go of materialism are definitely first steps toward true peace and happiness.  Remember, no one can serve two masters; you cannot serve both God and Money.

The First One

Let me tell you about the first one. 

This one particular lady was brought in under my care for having a mild heart attack, and was waiting for a cardiac catheterization (otherwise known as a dye test).  However, she had several other issues that made it unsafe to have this test, and required some medical stabilization.  (I’m deliberately being vague, in the interest of patient confidentiality). 

A week later, this poor lady had another heart attack, but one that required an emergent trip to the cardiac catheterization lab, where the cardiologist opened up her coronary artery that was causing all the trouble, and her EKG seemed to go back to normal, and her chest pain was pretty much gone.   Awesome.  My only wish for her was that we could have gotten her other medical issues under control sooner, so that her second heart attack could have been avoided.  Still, things seemed to be going well for this special patient of mine.

A few hours later, I got called to the Coronary Care Unit, with a sense of urgency in the nurse’s voice as she said “we need you in bed 3, right away.”   A first for me, I’d never been called to assess a patient urgently, they’ve always been stable, and I can just mosey my way to the patient without worrying too much.

I arrived in the CCU, to see my patient from earlier that morning, writhing in the bed, agitated and moaning with pain.  She looked very grey, not the normal pink vibrant colour that healthy patients always have, and wasn’t responding all that appropriately to verbal commands and to speech.  It was quite easy to figure out that something was very wrong with this woman, but the difficult part was figuring out what the issue was.

So, with the help of some other residents who were on call that night, we did several investigations, the first of which showed that my patient’s blood had become very, very acidic compared to what is normally acceptable.  So, based on that fact, she was electively intubated (a tube put into her airway, so she could be hooked up to a machine that would breath for her).  We brought her over to the xray department, wheeling her stretcher through the narrow hallways, and into the CT scanner, and back to the CCU again to await the results.

The Code

That’s when it really started.  While the other residents were attempting to get IVs and ART lines (special IVs that go into an artery and measure blood pressure in real time), I noticed her EKG starting to change.  When I became convinced (which was very quickly) that her heart tracing looked an awful lot like VT (one of the rhythms that we’re taught in first aid that an Automated External Defibrillator will shock), I mentioned it to the other residents, and checked her carotid pulse at the same time.  Nothing. 

I have taught, as a first aid instructor, and one of the changes that was made in recent years was the elimination of the pulse check.  Initially I thought that was ridiculous, but now I understand; the uncertainty attached to not finding a pulse is excruciating.  Nonetheless, for the first time in my career, I called “a code.”

The nurses rushed into the room, and put a hard, clear plastic board underneath my patient’s back.  I climbed up onto the bed, placed my hands on her sternum, and proceeded to administer chest compressions.  The first compression is always the worst, because it’s the one that breaks all their ribs.  I heard that awful cracking sound, and felt the vibrations right through to my shoulders, a sensation that haunts me even now, and brings tears to my eyes when I think of it.

But there was no time for tears then.  I counted, cycles of thirty, for 2 minutes.  No need to count, really, because she was intubated, and so ventilation and chest compressions happen independent of each other.  Still, it’s ingrained, and I counted until I felt my compressions were deteriorating, and I asked another resident to switch with me.  Once I had gotten down from the stretcher, it then became my responsibility to “run the code.” 

Keep track of the time.  Monitor chest compressions for effectiveness.  Give 1 milligram of epinephrine every 3-5 minutes.  Rotate people through compressions.  Check for a pulse every 2 minutes.  Rinse and repeat.  4 milligrams of epinephrine, 10 units of insulin, 3 ampules of sodium bicarbonate, 1 ampule of calcium chloride, a sodium bicarbonate infusion and 2 Our Fathers (which I said quietly when I wasn’t telling other people what to do) later, we checked the pulse, and she had a perfusing rhythm (meaning that her heart was effectively pumping blood around her body).

Right, so back to what we were doing: trying to figure out why this poor woman was suddenly trying to die.  By this time, the results of the CT scan were back, and our patient was bleeding into her belly, and had lost a significant amount of blood.  The collection of blood was putting pressure on her other organs, causing her bowels to become starved for oxygen, putting her into a medical condition called ischemic gut. 

So we consulted the surgeons, all of who said that this patient was not a surgical candidate, because she would die on the table.  “For medical management.”   So we tried to establish better IV sites for large bore needles that would allow fast infusions of various fluids.  A new ART line was needed, but we couldn’t seem to establish one in her radial arteries, which had been put into spasm by the number of times they’d been poked with needles. 

So we started giving her units of packed red cells (which is what we mean when we say a blood transfusion), fluids and medications to keep her pressure above 90 mmHg systolic.  Then we sat back and waited to see if all our interventions would help her to improve. 

A relatively short time later, 2 nurses burst out of her room, and called the second code blue on this patient in a single night.  So I ran the code again.  By the grace of God, this code was mercifully shorter than the first, and we established another perfusing rhythm in our patient.  Nothing short of a miracle the first time, much less the second time.

I hardly slept at all that night.  Terrified to leave the CCU for fear that I would just get to sleep, and my code pager would alarm, and I wouldn’t wake up, I took a chair and propped myself up across from this patient’s room, and dozed for 5-10 minutes at a time over the course of an hour.  When I finally left that morning, my patient was still alive, and I was full of hope that we had kept her alive with the possibility of a full recovery. 

First the patient, then the doctor

My patient was the first to go into shock, but of the physical kind.  When I left the hospital, and decided I was going to forgo sleep for another while and go straight to church, the stress of the entire night washed over me at once.  I fought back tears, reminding myself that the patient was still alive, and I had done everything I could.  I made it to the church, where I met my wife who was already there, got a cup of coffee, and we started to walk to our seats in the congregation.  I got a half dozen steps inside the sanctuary, and I suppose I had let my guard down enough by then that I was able to slide into emotional shock.  That’s when I broke down.  I walked out the back door of the sanctuary, wife in tow, sat down and sobbed. 

Until that day, I had never been prayed over.  I had prayed over others, and other people had prayed for me, but never over me.  Our good friend Ron, who had previously prayed for my salvation many years before I’d ever met him, saw my distress and came to talk to me.  He prayed over me that day, and I don’t even remember much of the prayer, but I do remember knowing that God was with me in that moment.  Then Ron said something that I carried with me for the days to follow: “God knew you could handle it.  He’ll never give you more than you can handle.”  I didn’t think I was qualified to handle what God brought my way that day, but God knew otherwise. 

I went home and read the sermon on the mount in the Gospel of Matthew later that day.  What spoke to me most on that eventful day was this:

“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more important than food, and the body more important than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? Who of you by worrying can add a single hour to his life?

And why do you worry about clothes? See how the lilies of the field grow. They do not labor or spin. Yet I tell you that not even Solomon in all his splendor was dressed like one of these. If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, will he not much more clothe you, O you of little faith? So do not worry, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For the pagans run after all these things, and your heavenly Father knows that you need them. But seek first his kingdom and his righteousness, and all these things will be given to you as well. Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.”  (Matthew 6:25-34) 

I found a peace after reading this, feeling like I could face whatever the outcome was to be for myself and for my patient that was hanging on to life by a thread.  I prayed to God for her, knowing full well that she may not be alive when I came back to the CCU for my next shift.

Still Alive?

Return to the CCU I did, repeating to myself as I walked through it’s heavy double doors “Do not be anxious” and “God never gives you more than you can handle.”  I looked into the room where my patient had been, to find her still lying on her stretcher, with the sound of the mechanical ventilator essentially the only sound in the room.  I read through her progress notes from the night before, and found that she hadn’t required any CPR since I had left, but that she did need to be cardioverted (shocked with defibrillator pads) for a rapid heart rate that caused her to lose all her blood pressure. 

I spoke with the nurse who had worked with her through the night, and found that she had a list of problems that were new since I had seen my patient last.  She hadn’t made any urine in 48 hours, which meant that her kidneys had shut down, and her electrolytes had now begun to shift in a way that would require dialysis.  There was blood in her stools, which meant that her bowels had begun to break down from the previous lack of blood pressure and oxygen.  She was on multiple drugs to keep her heart going and her blood pressure at an acceptable level.  Her liver enzymes were at a level I didn’t even know were possible, indicating a condition called “shock liver,” which is another sequela of having no blood pressure for a period of time.  Worst of all, she had stopped responding appropriately, and even though she was no longer sedated, the only thing she could do was withdraw from pain.

So I consulted the surgeons again, but got the same answer as before – not a surgical candidate, would not survive the operation.  I consulted the kidney specialists wondering about dialysis, and received an equally dismal response – would not survive the drop in blood pressure associated with dialysis.

All that, combined with a CCU nurse’s proclamation that what we had done to this patient wasn’t in the patient’s best interests any longer, I knew then what God had in store for me that day.  I summoned up my courage, and asked the nurses to call the patient’s family.  So I had my first family meeting, just myself, one of the CCU nurses, and the patient’s close loved ones.  I explained that it would not be in her best interests for us to provide CPR if her heart stopped working again.  I emphasized the gravity of the situation, and I told them in very frank, honest words, that the only one who could save this patient now was God, because there was nothing we could do to cure her current condition.  To add to this, we all agreed that the patient that we had all talked with, laughed with, smiled at so few precious days ago, was no longer really with us.  So it was that between myself and the patient’s family, we decided that my patient would have her treatment withdrawn, and her life placed firmly in God’s hands, where it had been all along.    

I returned to the CCU, and informed the nurses there of the new developments.  I went into the room with my patient, while the family waited outside, unable to bear to watch what was about to happen.  One of the nurses took the patient’s hand, and I followed suit and held her other hand, which also had a set of rosary beads tenderly wrapped around her fingers.  A respiratory therapist disconnected her from the ventilator, and another nurse pressed the power buttons on all the IV poles that were running the drugs that were keeping her alive. 

I’m not sure if I breathed very much for the next few minutes.  I held her hand as I watched her face, and the cardiac monitor that hung just above her head.  She took very tiny breaths, and it looked for a very brief time like she might hang on for just a little while longer.  Within less than a minute though, her blood pressure tracing started to lose amplitude (meaning that the top and bottom numbers of her blood pressure started to get lower, and closer together).  I held her hand tightly as her body struggled to keep its grasp on this world, and she looked as though she were fighting with every last ounce of her strength.  The first to go was her breathing.  Her shallow guppy breaths ceased altogether, with the intermittent agonal gasp.  Her heart began to slow, and her blood pressure dropped to incredibly low proportions. 

And then nothing.  All the lines on the monitor became flat, and the heart tracing read “asystole.”  The nurse and I held her hands for another few moments longer, and then it was time for me to do the last part of my job.

I took off my stethoscope, and placed it gingerly on her chest.  I listened for breath sounds and heart sounds that I knew would not be there.  I pressed on her sternum with my knuckles and did a sternal rub with no response.  Finally, I took a flashlight and shone it into her blankly staring eyes, and her pupils did not move in response to the light. 

The next words out of my mouth: “Time of death, 11:27.”

I think my voice was devoid of emotion, but my eyes showed otherwise.  I could barely hold back the tears, but I managed.  And inside, I was a hurricane of emotions, beating against my insides. 

I left the room to go inform the family that this beautiful woman, a mother, a wife, and so many other things in life, had ended her struggle and had passed on.  I walked down the hall to the room where they were waiting, and stopped just outside the door.  Swallowing back my own tears, I took a couple of deep breaths, and then opened the door.  I simply said, “It’s time.  She’s gone.”  There wasn’t a need for any more words than that, but as I lead them to say their final goodbyes, I looked at each of them and said that I was sorry about the loss of their mother, their wife.

So I ended my role in the care of this patient.  I sat in the CCU, processing all that had occurred in the last three days.  I sat wishing that things had gone differently, that we had figured out her problem earlier, that I could have done something differently that would have saved this woman’s life.  As I sat withdrawn into myself, a mother and her young child were passing by my seat.  The boy, no more than 2 years old, looked at me and smiled and laughed.  I felt an overwhelming sense in the gaze of that child, that God was looking at me through his eyes, telling me that everything was ok.  There hasn’t been a child in the CCU before that day while I was there, and there hasn’t been since.  God works in amazing ways.

So now you know the story of my first one.  The first patient that I’ve ever lost, a woman that I don’t think I will ever be able to forget, whose memory I will carry as a burden and a blessing in my heart for the rest of my days.  Such is the life of a new doctor.  However, I am comforted by the fact that I have God on my side, for if God is for us, who can be against us?  Not even death.

The Healing of the Great Physician

The Stranded Man

When I was a child, my father told me a story about a man who lived in a house that was being flooded by a river that had swollen over its banks.  The story goes something like this:

A man lived in a community that was situated close to a river, and on this day, the river had risen above the riverbanks, and was beginning to flood the little town.  Most people had evacuated already, but this man stayed in his house, telling everyone that God would look after him.

The river continued to rise, and as it got to the front door, a rescue team dressed in hip waders was going door to door, and they told the man who had stayed behind that they had come to evacuate everyone left.  The man refused, saying that he had faith that God would keep him safe.  So the rescue team went on their way, unable to convince him to change his mind.

The river continued to rise, and the man was forced to abandon the ground floor, and headed to the second floor where he watched the rising waters, keeping faith that God would indeed save him.  As he was watching out the window, a rescue boat came through the town, motoring through the streets that were now well flooded.  They saw the man in the window, and called out for him to come and get in their boat, and they would take him to safety.  The man replied that he had no need of a rescue, because God would keep him safe.  Once again, the rescue team left man to his own devices.

The water continued to rise, and the man was finally forced up onto the roof of his house, the last dry place where he could take refuge.  A helicopter spotted him on the roof of his house, and lowered a basket for him to get into and be brought up to the helicopter and to safety.  Once more, the man refused to let anyone give him aid, firmly believing that God would save him against all odds. 

The water rose even further, and the man was washed off the roof of his house, and he drowned.  When he came before God in heaven, he asked Him, “God, I prayed to you to save me.  I don’t understand why you let me die.”

God answered him, “My son.  I answered your prayers three times.  First I sent a rescue team on foot.  Next I sent a boat.  Finally, I sent you a helicopter.  Each time, you refused my answer to your prayers.”

What Happens to the Stranded

A Christian may sometimes refuse medicine on the basis of faith in God, believing that they don’t need human drugs/interventions to heal them.  A secular individual will do exactly the same thing, but refuse medicine on the basis of faith in themselves, believing that doctors can’t help, hospitals only make you sicker.  They believe they can figure out an answer or simply live with their suffering.

Let me give you an example of one such patient.  I once had a patient who came to the emergency room with some shortness of breath.  For a lady in her mid-sixties, she was remarkably healthy, and on no medications – or so I thought.  There are two types of people in their mid-sixties who don’t take any medications: those that are remarkably healthy, and those that just don’t visit their doctor.

This lovely woman was complaining of some shortness of breath, which had limited her ability to be mobile since she couldn’t get to the top of a flight of stairs without being very winded.  So I started to ask questions, and it seemed like a straightforward case of congestive heart failure (CHF). I could hear fluid at the bases of her lungs, her legs were swollen and I could leave my fingerprints in her legs.  Her JVP was visible at the angle of her jaw when she was sitting upright.  (Don’t worry if you don’t know what JVP is, it doesn’t make much difference to the story!)  So I thought I’d give her some medicine to make her urinate to get rid of some of the extra fluid.  However, part of the investigation is finding out why the patient has CHF.

I did an EKG that showed remarkable ST depressions, which in the absence of chest pain, and a troponin (an enzyme we use to check for heart damage) of less than 0.01, pointed toward a heart that was starving for oxygen, and working very hard.  Alright, further down the rabbit hole, why did her EKG look like this?

The remainder of her blood work showed this woman to be a very sick individual.  She had only about 1/3 the amount of hemoglobin that she should have had normally, which was starving her heart of oxygen, which was in turn making her short of breath. 

This woman turned out to have bowel cancer.

The astounding thing was that she had been suffering for over a year with symptoms that no person should just accept as part of their life.  She had been unable to lie flat on her back for a year, due to the overwhelming shortness of breath, and to go along with that, something called Paroxysmal Nocturnal Dyspnea (PND).  Essentially, waking up in the middle of the night with the sensation of being unable to breathe, as if you were smothering.  So this delightful woman chose to sleep in a chair, upright, for a year, rather than visit her doctor.  Her bowels were also causing her grief, and instead of seeing a real doctor, she just consulted Dr. Google and Dr. Wikipedia.  (Neither of these “doctors” have a medical license, by the way.)  She diagnosed herself first with lactose intolerance, so she cut out milk from her diet.  Then when that didn’t help, thought maybe it was celiac disease, so she eliminated wheat products.  That didn’t work either, so she became a vegetarian.  Unfortunately, she combined all these things, and just made herself malnourished to go along with everything else.

I watched this woman cry, with tears in my own eyes, as she told me the story of her suffering over the past year.  It is a difficult enough story, without also knowing that her suffering was for the most part unnecessary.  When I asked her why she didn’t come to see somebody earlier than this, she simply sobbed, “I don’t know.”

God’s Saving Answer

Just like the stranded man who refused a rescue party, a boat and a helicopter in favor of his faith, some people refuse modern medicine in the same way.  This is not to say that God doesn’t perform miracles of healing, but more often than not, God refers us to the medical system that he has so graciously given us, just as he sent men on foot to rescue the stranded man. 

“While Jesus was having dinner at Matthew’s house, many tax collectors and “sinners” came and ate with him and his disciples.  When the Pharisees saw this, they asked his disciples, “Why does your teacher eat with tax collectors and ‘sinners’?”

On hearing this, Jesus said, "It is not the healthy who need a doctor, but the sick.  But go and learn what this means: ‘I desire mercy, not sacrifice.’  For I have not come to call the righteous, but sinners.””  (Matthew 9:10-13)

Jesus himself made it clear that sick individuals need a doctor, just as sinners need Him.  We live in a broken world, a world that unfortunately is plagued by so many diseases that most medical students at some point have to realize that despite the size of their textbooks, people actually do make it to adulthood. 

“There are different kinds of gifts, but the same Spirit. There are different kinds of service, but the same Lord. There are different kinds of working, but the same God works all of them in all men.

Now to each one the manifestation of the Spirit is given for the common good.  To one there is given through the Spirit the message of wisdom, to another the message of knowledge by means of the same Spirit, to another faith by the same Spirit, to another gifts of healing (emphasis mine) by that one Spirit, to another miraculous powers, to another prophecy, to another distinguishing between spirits, to another speaking in different kinds of tongues, and to still another the interpretation of tongues.  All these are the work of one and the same Spirit, and he gives them to each one, just as he determines.” (1 Corinthians 9:4-11)

The power of modern medicine is given to us by the Spirit, and the gift of healing does not need to look like Jesus’ healing, simply by laying hands on a person, or simpler yet, having the person touch Jesus’ robes.  We should try to be like Jesus, but we are not, and cannot be, Jesus.  We cannot all look at a crippled man and say, “Get up, take your mat and go home.” (Mark 2:11)  I’m not saying that this is impossible, but for the most part we work within the constraints of the physical world that God has created, and that means medicine.

As the bible states, “Don’t you know that you yourselves are God’s temple and that God’s Spirit lives in you? If anyone destroys God’s temple, God will destroy him; for God’s temple is sacred, and you are that temple.” (1 Corinthians 3:16-17)  It also says, “Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your body.” (1 Corinthians 6:19-20) 

We should all follow God’s instructions, and do our best to take care of ourselves, to honor God with our bodies and recognize that our bodies are God’s house.  We should strive to follow medical advice, though there is nothing wrong with being critical of the evidence that is currently available.  That being said, it is reasonably clear that a healthy diet, exercise and a regular medical check-up are worth doing.  And of course, don’t smoke, follow the bible’s instructions on the consumption of alcohol, and stay away from random plants and chemicals that one might consume for recreation. 

One last thing – I have had patients whose families have blamed the patient for their own sickness.  One gentleman accused his wife of being sick because she didn’t pray enough.  If you agree with him, you need to read your bible more often.  As a starting point, go to the book of Job, and you’ll find that despite the fact that God himself said of Job “There is no one on earth like him; he is blameless and upright, a man who fears God and shuns evil,” (Job 1:8), he was still afflicted with terrible circumstances, including “painful sores from the soles of his feet to the top of his head.” (Job 2:7)  It is possible to be a follower of Jesus, or a biblical hero that God Himself praises for his conduct, and be afflicted by disease.  Pray, yes.  But don’t think that you or your loved one has become sick because the relationship they or you have with God is somehow not strong enough.  Since the Garden of Eden, the world is a broken place, and people become sick.  The last thing a sick person needs is an accusation like this from someone close to them. 

Treat your body like a temple of God; look after yourself, and seek medicine when you’re not well.  We are complex, multidimensional creatures, with physical, emotional, mental and spiritual needs.  None of us can afford to neglect any aspect of our overall well-being, and while it seems obvious to many, that includes the physical body God has created for us.  David Martin Lloyd Jones (who was a physician before becoming a preacher), when preaching about Psalm 42 said, “Does anyone hold the view that as long as you’re a Christian, it doesn’t matter what the condition of your body is?  You’ll soon be disillusioned if you believe that.  There are some in whose cases it is clear to me that the cause of their depression is mainly physical.  On the other hand, people who are physically weak are more prone to attacks of spiritual discouragement and depression.  But if you recognize that the physical may be partly responsible for the spiritual condition and make allowances for this, you’ll be better able to deal with the spiritual issues.”  (I actually got this quote from a sermon by Timothy Keller, entitled “Finding God.”)  Recognize that God has given us a body that needs taking care of, and realize that God has given us the gift of medical care.  When you pray for healing, modern medical care might just be the answer he’s given to your prayer.