Priorities

We had an interesting discussion in class today revolving around the idea of a system of financial compensation for excellence in providing health care. We had a lengthy discourse on the "fight for justice" paradigm, this idea that if I've EARNED something, I'd better get what I've earned. Everyone was squabbling about how to insure that no one who didn't deserve their reward got it.

In one of my more abrasive moments, I challenged our class to aspire to more than merely working for the payday, but to be motivated by altruism and sacrificial giving. We must renew our minds now so that when confronted with a choice, we naturally react by nature of our virtue. I got a mixed response, varying between those demanding that a lucrative salary was a great reason to be a physician and those who were visibly stirred to think that there is something more to life than "getting their just desserts."

It really made me reflect on authenticity and honesty with one's self. It's a question I've asked myself before and will ask many times again: If I really believe what I say I believe, what practical choices will I make?

If I say I care most about loving my patients, I won't care about how well I'm compensated so long as I earn enough to continue to love my patients.

If I say I care most about getting what I deserve, I will do everything I can to protect and promote myself and do nothing that hinders me getting mine.

Just expressing the first of those dichotomous viewpoints brings over me a rush of peace and Godly wisdom, the principle of freely giving because I have freely received. The second reeks of futility, greed and frustration, characterized by a life lived surrounded by others, but alone.

It took some encouragement from one of my dear friends to get the ball rolling in class today, further confirming the importance of community in my life. I wasn't sure it would go over too well, and with some, it didn't. However, as class ended, several of my classmates approached me with gratitude for expressing what needed a voice.

We are surrounded by a great number of allies, no matter what our position, who will encourage and support us if only we will rise to the occasion.

Reminiscing

I've spent the last 30 minutes or so reading over some of my old posts. I could almost taste the curry in Siem Riep, feel the bites of the bed bugs in Phnom Penh and see the smiles of my friends as we lounged at Amok. A long night of laying on a wooden mat contrasts sharply with the luxurious bed that I will sleep in tonight. Dreams of 50 cent noodle plates and glasses of Angkor beer give way to $10 burgers and $4 pints.

A 90 dollar CT for a dying child and a 180 dollar coat for an outdoor enthusiast.

A day of mending deformed faces and a day of listening to the mechanisms of the intrinsic clotting pathway.

A 3 hour bus ride to a fishing village to work in a clinic and a morning listening to a patient tell her story.

An endless day by the bedside of my best friend and an endless night absorbing pages upon pages.

Life measured by constant surprises and unknown horizons and life predictable, yet imposing.

Undecipherable foreign jabber and complex guarded conversation.

The green, the stone, the sea and the green, the clouds, the buildings.

Dust blown in my face by the countless sea of motos and wind blown in my face as I navigate the city.

Poverty at every turn and the homeless with their empty stares.

Clambering orphans with incessant chatter and the people of cell phones, oblivious to the world.

A seat on a bus, bound for the horizon and a seat on a bus, bound for downtown.

A borrowed computer, barely responsive and borrowed internet, efficient and impatient.

Captures of a life lived. Parades of the past and possibilities for the future.

Sentiments of sacrifice. Joy at the return to haphazard paradise.

A Trip to the ER

I realized today that I've told this story multiple times in person, but have neglected to inform the world at large of my exploits, so here goes.

It all started in our PBL group (that is, Problem Based Learning) when we got a case centering around a "curbside" consult which is medicalese for professional courtesy, or more simply put, free health care because you happen to be in the club. The issue was raised: is this case centered in reality, or is it merely pop fiction that docs can get free care from other docs. I took that issue home as a "learning objective."

My learning objective took me to Smallville Hospital ER [names have been changed to protect the victims]. I cased the joint. Up front was an administrative assistant, who are usually pretty sharp and able to keep the riffraff from getting to the docs. I almost knocked on the back entrance so a janitor I had spied would let me in, but figured she might sound the alarm. Then it came to me: the security guard. A venerable spot in the defenses.

"Excuse me sir, I'm a second year medical student and I need to speak with an ER doc. Is there any way you could let me in?"

After a little finagling, I was past the first obstacle.

A complication! The security guard didn't just let me into the ER to wander about aimlessly, but escorted me to the physicians' desk. As I stood there awkwardly, he explained that I had a question for one of the ER docs. I willed him to go away, but he was impervious to my mind control. So I suspiciously leaned down with my back to the guard, only to be met with a startling,
"Is this a personal health question?"

from the ER doc of choice. Yikes! I wasn't the first with this idea. Not one to be perturbed, I pressed on.

"Kind of. I've actually been fasting for several days and I'm worried about my ketone levels causing kidney damage. Is there any way I could get a urine dipstick."

Here's the shocking part. Without a pause:

"Can you do it yourself?"

Not a "Get out of here kid." No hint of "Your behavior is completely out of line." And definitely no nod toward security to dispose of me properly.

My response: "Sure!" And the doc: "Let's get you a dipstick."

Now my assignment was to find out if a medical professional could actually get lab tests done without being an official patient, so my work was done. I sheepishly explained that I didn't actually need the test and mumbled something about it being an assignment for a class before I took my nervous, sweaty self off the premises. I don't think the doc was too impressed with my covert op skills, but neither seemed too put off at my imposition on his time (for which I expressed my gratitude).

Is this a sad commentary on our medical system? Nah, I think it's pretty cool that we haven't become so bureaucratic as to totally abandon professional courtesy. Medicine seems like a pretty tight-knit group at times.

I'm so in.

A Tribute to Tributes

In honor of my 99th post, before I spring into the triple-digit blogging world, I feel compelled to reflect.

This all started one morning when I poured myself a bowl of Captain Crunch with Crunchberries cereal (it was on sale, I'm not usually a sugar cereal fiend... really) and a lone blue Crunchberry went skittering away from my bowl upon application of milk. I reached to retrieve it only to find it well-fortified under the microwave. I bent down to see a collection of various items, mostly bread-tabbie-like things and set to pondering the location of various by-gone possessions to which this post is dedicated.

[Interruption]

This post had genius written all over it, I had a great mental list of things gone by. Then life happened. Mostly I couldn't find a picture of my old Ford Ranger which was going to be the first thing on my list. Oh how I miss her... Unfortunately, at this point in my life, I've realized I have little time for putting together creative little projects, and so what you get instead is a brief apology for not writing a creative post and scattered thoughts. Enjoy.

But gosh I love tributes and I think it's great to remember the good that once was while being thankful for the good that still is.

On a larger scale, I think that pattern speaks a lot to my current situation... Life was so good in Girdwood and Anchorage, but that doesn't negate the good that I'm finding in Seattle. I declare this post, my 99th, a tribute to good ...everything... gone by: possessions, friends, seasons of life, sports, cities, relationships, dwellings, adventures... the list goes on.

In that spirit, I am now free to write about whatever pops into my head. Who knows, maybe post 100 will be totally mundane.

Mistakes

That feeling where your stomach drops out from under you, indicating that melting into the ground and out of existence would be preferable to exerting the strength to remain standing... yeah, I get that. Vivid images flash through my mind... snapshots of my past forever mentally preserved by the sheer impact of their arrivals. Time is a great analgesic, but despite the transition from sharp to dull, the pain remains.

Envisioning the next shot of sorrow directly dependent on my choices could paralyze me. Indeed, the aftermath of a single incident is near crippling. However, accumulating the combined weight of my future failures in the present borders on insanity. To achieve peace in the face of such opposition, I become mindful of the words of my Master.

Your heavenly Father already knows all your needs, and he will give you all you need from day to day if you live for him and make the Kingdom of God your primary concern. So don't worry about tomorrow, for tomorrow will bring its own worries. Today's trouble is enough for today.

I don't understand how to manage my impending mistakes, but the one who made me understands life much more deeply than I do. When I accept the reality that He offers, I lose the motivations of guilt and fear and can confidently move forward in love and thankfulness. This is not a ploy to shirk responsibility, but to embrace my own limitations as a necessary state of my dependence on the unlimited one. In Him I find mercy for my mistakes and stern admonition to be His hands and feet to those in a broken world.

I share in the sorrow of those I hurt. And I will hurt many in my life. As my character grows more and more like that of God, and my medical knowledge increases in depth and breadth, and my judgment and wisdom gain firm holds on my heart, I will learn to do less damage and do more good. But in this life, I will always be limited.

By the grace of God, I have the blessing to recognize my own weakness and fallibility. By the love of God, I am forgiven because He he taken the burden of guilt upon Himself.

Now all that I have to do is really believe that.

Closing Thoughts on Physicianhood (part 3)

Seeing as this series of reflections is due tomorrow, I thought I'd better wrap it up.

I know who I am at my core and want to paint a picture of how that could possibly play out in my role as a physician 10 years from now.

The wind blusters at my back as I reach out to unlock the door, spawning snow swirls and depositing a few more crystals into the drift at my feet that has built up overnight. Before wrenching the door open, I look over my shoulder to admire the fresh ski tracks the full moon is illuminating on the mountain face rising behind me. Another good weekend.

My office is cozy at this hour of the day, more resembling a private study than a place of business, but if an outsider were to peer in, they might think the coziness had won over, exiling me again to the lands of sleep. This is not the case. My thoughts fill with anticipation of the day to come and prayerful presentation of my concerns to my Lord. In a few minutes, I will be dashing about talking, testing, evaluating and diagnosing. But for a few minutes, I am still and quiet before my God, seeking His strength and wisdom for the day to come.

I know the answer to my first case before I even walk in the door. Ellen was one of the first people to welcome me here and despite her warm tone, already had concerns about her heart that she wanted addressed on my first day of business. Her heart is perfectly healthy, but she's convinced that no one can make it 91 years without heart trouble. I'll of course do a thorough exam and refill her hypertension meds in hopes of encountering nothing more than a little pleasant banter with a feisty old lady.

As lunch time rolls around, I look forward to seeing my wife and kids as I step back out into the cool Alaskan midday. Clearly a highlight of my day. My wife and oldest always have stories to share about their days at school and the little guy is just starting to form full sentences. The other teachers now know that I'm a regular in the lounge and always try to update me on the latest gossip, which leaves me feeling a little awkward, but accepted.

We talk about our plans for the evening and how we'd all like to get outside and do something, just not sure what. In the back of my mind, I'm making allowances for tomorrow when I'll, weather-permitting, take my Cub out to the closest village. It's been a while since I've checked on them and the PA should be able to handle anything urgent that comes through the doors at the office. I tune back in just in time to hear a lingering question about "Are we really all going to Africa this year?" from my daughter. I smile and say "Lord willing," which gets me a frustrated look. She doesn't quite grasp that our lives are not our own and wishes her parents were a little less kooky sometimes. I really think she is starting to grasp the freedom and joy that come from walking with God though. In small ways.

As I walk back toward the clinic, I lift my eyes up to the mountains and begin to sing a song of praise. Joy overflows, and I thank God for the life I have been given.

Grace

I cannot even begin to explain how refreshing Christmas Break was for me. I've expressed frustration with words like "awesome," "amazing," and "incredible" before and this is no exception. In light of their insufficiency, I will resort to expressions such as life-giving. restorative. nostalgic. heart-warming. spiritually filling. enlightening. and emotionally fusing. In short, being surrounded by people who know me deeply and understand and share the things most important to me reminded me of who I am.

I can't describe each facet of this restoration, but a different need of mine was met in Anchorage, in Girdwood and in Kenai. If you'd like the details, I guess you'll just have to ask. I'd be more than happy to share but I anticipate an inverse relationships between the length of a blog and the number of people who finish reading it.

The heart of what I want to say and what I experienced.

You cannot choose your actions independently of outside influence. We make choices daily that demonstrate what is in our heart. Sometimes we love what we do, sometimes we don't. How is it that we do things we dislike? It's counterintuitive. It is the core of who we are, our heart, that dictates the choices we make, despite our thick rationalization and heavy brooding.

How then do we have any amount of say into what happens to us? How can a man choose his course in life? Or even in one day?

By grace alone.

Most of what I'm saying was revealed to my dear brother Adam after intense study and prayer and seeking after wisdom from God. Through revelation, he challenged my understanding of grace and what it meant before we Hallmarked* it. I did a quick search just now and found a website with an awesome description: In most of the passages, however, in which the word "charis" [grace] is used in the New Testament, it signifies the unmerited operation of God in the heart of man, affected through the agency of the Holy Spirit.

Simply, grace is the direct influence of God upon our hearts.

We may not be able to control our decisions as much as we would like to, but we have a great deal of control over what we allow to influence our hearts. Our hearts may remain wild and untamed, subject to whim and circumstance, but they will be shaped into the image of that which influences them.

For those who don't yet know God, this still leaves an important principle dictating that we pour into our hearts that which we wish to become. What source is worthy of emulating? Who can we look to in perfect admiration?

To truly shine, we only need ask for grace to become more like the Holy One. He is faithful and eagerly awaiting those who desire to know Him.

An unlikely source to leave a lingering thought, but fitting nonetheless, Bloc Party's "The Prayer:"

Lord give me grace and dancing feet...





*the act of Hallmarking is where you take something beautiful and mysterious and reduce it to warm platitudes often expressed on cheesy cards that cost six dollars.