“When Breath Becomes Air” Reflections

I finally got chance to read Dr. Paul Kalanithi’s memoir “When Breath Becomes Air” over Christmas break. It really was a heavy punch in the gut, and it couldn’t have come at a better time. It was such a needed reminder of the brevity of life, the sacredness of the medical profession, and the immeasurable value of our human relationships, particularly those between physician and patient.

Early in the book, Dr. Kalanithi asks the question, “If the unexamined life was not worth living, was the unlived life worth examining” (31)? In Dr. Kalanithi’s life is an example of both a profound reflection coupled with an active and intentional engagement of people, even at great personal cost.

I was particularly challenged by his view of medicine, and of his patients. Regarding his work, he writes, “People often ask if it is a calling, and my answer is always yes. You can’t see it as a job, because if it’s a job, it’s one of the worst jobs there is” (151). He was referring to his field of neurosurgery, but I think this can be said of the medical profession as a whole. Sure the pay is substantial, whatever field you pursue, but the personal cost is steep, even after the training is done.

And let’s not forget the enormity of assuming the care of a person. For Dr. Kalanithi, he was responsible for not just his patients’ physical health, but the entire weight of the whole of the individual. His call was to “protect life—and not merely life but another’s identity, it is perhaps not too much to say another’s soul…” (98). He understood that “all of medicine…trespasses into sacred spheres. Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most sacred, their most private” (49). It is a high calling , and a tremendous privilege to become a physician.

What hit most poignantly was the stark contrast of the sense of purpose and urgency reflected in Dr.Kalanithi’s life, even before his cancer diagnosis, to where I am at now. Sadly I confess that 2016 has slowly drifted into a complacency where personal relationship (both with God and people) and my own personal calling have become obligations, and entertainment designed for rest and renewal has crossed into the realm of numbing escape. This was a much welcomed wake-up call.

God, forgive me for mistaking physical presence with connection, thinking competency and efficiency was enough, and treating the sacred as ordinary. Grant me conviction and courage, by Your grace and through Your Spirit, to make 2017 different.

Be very careful, then, how you live-not as unwise but as wise, making the most of every opportunity, because the days are evil. Therefore do not be foolish, but understand what the Lord’s will is. Ephesians 5:15-17

Breast Engorgement and the Love of God

It’s a little weird writing about breasts in a Christian-themed blog, but I am a doctor so I can get away with it. Plus you can’t see me giggle and blush.

Throughout pregnancy, a woman’s breast can increase 1-2 cup sizes as the tissue changes in anticipation for milk production and breastfeeding. It’s quite remarkable really what the body is capable of to care for the new life on the way. Sometimes though, if breastfeeding does not go well, they can become painfully engorged.

While my breast tissue has remained the same (thank goodness), I feel like my heart has undergone an engorgement of sorts. I’m not talking about a cardiomyopathy of pregnancy (which could happen to moms), but it seems like in emotional capacity, and even ability, my heart has grown. It’s a change both in quantity and quality.

Quantitatively, there has been just a huge surge of emotions, especially after the delivery, but even in the months leading to the big day. A couple weeks ago I was reading a children’s book to Priscilla’s belly, and right in the middle I started to cry. And not a burning-behind-my-eyes manly cry, but tears actually broke free, sliding ever so tenderly down my cheeks. Where in the world did that come from? I can’t even remember the last time I had real tears. Just looking at Ansley doing nothing but sleep, I am sometimes overwhelmed by how much I love this little thing.

And this love is different. Qualitatively, it’s a different form– a purer form — of love than I have experienced. The love I have for my parents and for Priscilla comes close, but even that love has been influenced by their actions towards me. Of course I love my wife, but I didn’t love Priscilla the first time I laid my eyes on her. If I did, it would have been quite creepy since she was just a junior higher. For sure I love my parents, but much of that I think has to do with the care and love they have shown me. That’s conditional love.

But Ansley has existed for less than a week and has done nothing but eat, sleep, poop, and cry all night. Yet I know I love her and will love her no matter what (check back with me in her teenage years and I hope this is still true). It’s the closest thing I have come to experiencing pure, unconditional love.

They say that the love of a parent for his or her child is the closest thing we can get to understanding the unconditional love that God has for us. It’s no surprise, then, that one of the major pictures of God in the Bible is that of God the Father, and we as His children. Unfortunately, because of our fallenness, there are many broken families. As a consequence, there are many broken pictures of God.

Christian parents, we have the task of redeeming the picture of God’s unconditional love for us through our love for our children. A professor said in class once, “Our role as parents is to give our kids the most appropriate picture of God so that when ‘God comes around,’ they will recognize Him.”

By the way we love our kids, our kids will be introduced to their heavenly Father, and those around will catch a glimpse too. When they read about the amazing love of God, that love will seem familiar, inviting, because they have already felt it from you. John 3:16 would not just be a cliche, but an experience based in reality. Parenthood really is a high calling, your prayers are much appreciated.

To all my recently married Christian friends, do take some time to enjoy marriage and build up your relationship before the babies come. But don’t wait too long though. The world needs more examples of God’s unconditional love.

“For God so loved the world that He gave His one and only Son, that whoever believes in Him shall not perish, but have eternal life” (John 3:16).

The Hardest Thing About Medicine

If you ever wonder about a patient’s prognosis, you can make use of the “Niceness” test. Is your patient a really sweet lady with a breast lump who has young kids and volunteers in her free time? It probably is a malignant cancer. Is your patient a selfish jerk who has made poor decisions resulting in a decline of his health? He’ll probably be fine for awhile. It seems like more often than not, the nicer your patient is, the poorer his or her outcome will be.

Obviously I’m being facetious, but there’s an element of truth in that jest that hits a little too close to home. You don’t have to go to medical school to be hit with the question, “Why do bad things happen to good people?” You’ll just get it a lot during your training. Sure residency is physically challenging with the ungodly work hours, but I actually think the hardest thing about being a doctor is the emotional toll of seeing suffering firsthand day after day.

And if you believe in God, nothing shakes your faith more than struggling personally with suffering. Sadly, many have walked away from their faith because they are not able to reconcile the idea of a loving God with the existence of evil. It’s hard to tell someone that God loves them when they just found out they had cancer, or when their loved one passed away. But God does love us, and His existence actually gives meaning to suffering. If God doesn’t exist, the reality is that suffering still does, and hardships that come would then just be a matter of bad luck. [1]

I don’t know why some people get better, but some people die from their illness. I don’t know why kids are born with disabilities, or why some don’t make it at all. But I do know that if God did not exist, that all the suffering I see from day to day is the result of random chance, then I wouldn’t want to be a doctor.

The promise of the resurrection is that there is more to this life than random chance and bad luck. There is a God who is sovereign over all evil and even uses it ultimately for the good of those who love Him. There is a God who entered into our suffering in order to restore our relationship with Him so that one day we can enjoy life as it was intended, without tears, pain, shame, sin, and death. Happy Easter everyone!

Blessed be the God and Father of our Lord Jesus Christ! According to his great mercy, he has caused us to be born again to a living hope through the resurrection of Jesus Christ from the dead, to an inheritance that is imperishable, undefiled, and unfading, kept in heaven for you, who by God’s power are being guarded through faith for a salvation ready to be revealed in the last time. 1 Peter 1:3-5

[1] For a great treatment of the problem of evil, see this article by Stand to Reason.

Match Day!

The results of the match, the process in which medical students get hooked up with a residency program for the next x number of years, came out today. My congratulations go out to you all, whether or not you got into the top residency of your choice. And regardless of whether or not you matched your dream residency, or had to scramble, or even didn’t match this time around, surviving medical school is no minor accomplishment.

I never really understood how the match worked. This article was pretty helpful, and pretty amazing that the guys who came up with it won the Nobel Prize. I’m sure the algorithm is super sophisticated, but from our standpoint, it seems like we rank the top choices, the residency programs do like-wise, and we just sit back and wait…and pray… that we get matched into one of the programs we ranked. The hardest part of it I think is just how out of our hands this part of the process is. We can do all that we can to buff up our resume and maximize our chances, but still results can turn out that don’t quite make sense.

As Christians, it’s a great time to remember that while we may not be in control, God certainly is. Somehow God’s sovereignty is still at work despite what we do (and don’t do), and His hand is still over not just our successes, but our setbacks (at least setbacks from our perspective) as well. Reading through the book of Acts recently, I saw how God used even the not so good things to further His kingdom. Jesus in Acts 1:8 commissioned His disciples to bring the Gospel to Judea, Samaria, and to the ends of the world. They did a great job bringing it to Judea, with thousands of people being added to the church.

Then the persecution came, Christians were jailed, beaten, and even put to death. Why would God allow such badness to happen? Well, as a result the believers were scattered throughout the Roman Empire, fortunately bringing the Gospel with them. Perhaps the disciples would have been perfectly happy worshipping and fellowshipping in Jerusalem, and so God allowed the persecution to prompt them along.

Some of you are undoubtedly excited right now, praise the Lord! Others, though, not too excited about where they ended up. While it’s absolutely fine to be disappointed, the encouragement is to praise the Lord also. Perhaps God has prepared a good work for you to do that you may not have chosen on your own. Whatever happens, we know that we have a good God who gives good gifts to His children. While sometimes those gifts don’t come in the way we would like, we can trust that God will take care of those who call on His name.

So again, a hearty congrats to all. Enjoy your last break before residency!

And we know that for those who love God all things work together for good,for those who are called according to his purpose. Romans 8:28

Medical Hypocrisy

Wow, it’s been quite awhile since I last posted. After taking a little break over the holidays, it’s been hard to overcome the vacation inertia to start writing again. That’s a spiritual lesson in and of itself.

I read Medscape’s Family Physician Lifestyle Report 2014 this morning and I found it quite interesting. I’m not sure where they got the numbers, but in this study, 48% of family physicians reported being overweight, with a BMI >25. This is second only to surgeons, who came in at 49%. If you are curious, dermatologists were the least heavy at 23%.

Whatever the specialty, it does seem like not many doctors (or any healthcare provider for that matter) lead the healthy lifestyle that they preach to patients day in and day out. It’s always funny (and sad at the same time) to see cardiologists taking smoking breaks between doing caths and stress tests. Most people know I have quite the sweet tooth.

Dr. Nick always talked about how he was practicing medical hypocrisy, promoting health when he himself weighed more than 400 lbs. If you haven’t taken the time to watch this short clip of his testimony, it’s an encouragement. By the way, happy belated birthday Dr. Nick.

http://www.youtube.com/watch?v=QqnOnMUT6cU

Our patients are better served when our lives are congruent with the healthy living that we are promoting. In the same way, as Christians, our testimonies are more powerful when our lives line up with what the Bible teaches. Unfortuantely, many are turned away because of the hypocrisy that they see in the church and in professing Christians.

How are we doing? Do our outward actions match our inward convictions and the truth of Scripture? For the legalists among us (myself included), do our outward “good” actions come out of a transformed heart? Or are we doing things simply out of duty because it is what “good” Christians do.

Obviously all of us are not where we should be, and we need the grace of God not just to save us, but to sustain us as we seek to obey Him. But my prayer is that we would not just do loving things, but become loving people as we grow more in Christlikeness so that we are transformed both inside and out.

Rollerblading to Health!

I got into rollerblading recently and it’s been a lot of fun! I think ever since I watched The Mighty Ducks as a kid I have secretly wanted to play some sort of hockey. But alas, hockey is not one of the typical sports for growing Asian boys. Now I get to live out my childhood dream.

And even better is that rollerblading is actually a good way to work out. According to this article, skating is the number 1 way to burn fat! The author writes:

1. Inline skating Burns 425 calories in 30 minutes

Surprised? While skating might be so much fun you forget you’re actually working out, it’s also numero uno on our list when it comes to blasting fat and calories.

The big burn stems from the side-to-side movement of your thigh and butt muscles (demanding more from your body than the straightforward motion of our number-two activity — running). And your core gets involved in a big way to keep you balanced.

What’s more, you get all these benefits without putting too much stress on your knees and other joints. Skate at a strong, steady pace. Don’t forget your helmet, wrist guards, and knee and elbow pads.

Boost the burn: Alternate one minute of hard skating with one minute of medium-paced strokes.

Reid, Su. “The 7 Best Fat-blasters.” CNN. 6 October 2010. Web. 16 Sept. 2013.

It seems like after you hit 30, something turns off and it’s no longer easy to maintain the weight. I blame it on the fall corrupting our natural bodies. (And probably my extra helpings of ice cream play a role, but only a small one.) And even though we await a glorious heavenly body when all things will be made new, we are given a physical body now to carry out God’s kingdom purposes.

Dr. Nick Yphantides, one of my mentors and heros, once said, “Your health, your life is a gift. Honor your God by taking care of it.” Let us be good stewards of all that God has given us, and that includes our health. By the way, if you have tips on rollerblading, let me know!

What are you doing to take care of your body?

Obamacare Overview

In case you didn’t know, some big changes are coming soon as a result of the Affordable Care Act (AKA Obamacare) that was passed in 2010 and subsequently upheld. Some things have been implemented, but much of it will be rolled out through 2020. This is one massive bill, and unfortunately pretty hard to understand, even by people in the medical field. I came across this video recently that gave a helpful overview so I’d thought I would share. Enjoy!

As one who sees mostly patients without insurance or are underinsured (and see firsthand the consequenes of a lack of preventative care), I’m happy about the expanded coverage. But, according to the video, dropping the number of uninsured people from 50 million people to 30 million, while significant, still leaves a huge chunk of people without access to care. I guess only time will tell how things will turn out and whether or not this will actually cut healthcare costs and promote better health.

The core issue I think is whether or not healthcare is a right or a privilege. Should healthcare only be available to those who can afford it, or is it a basic human right that everyone should have access to. It’s interesting that although as Christians we have a future hope as eternal beings, the God of the Bible cares very much about people’s physical well-being on this earth.

Passages like Isaiah 58 make pretty clear that God cares for those who are hungry, naked, and without shelter, and expects His people Israel to care as well. One of the things backing up Jesus’ claim of being the Messiah was that He went around healing the sick. Somehow, physical health is one aspect of the perfect peace that exists in God’s eternal kingdom.

Just as God was displeased by the lack of care Israel had for those in need, I can’t imagine God being okay with people suffering from preventable diseases because they can’t afford to go to the doctor. Anyway, just some food for thought. No posts for the next week, will be gone for a church retreat!

Help

The sisters of our church threw a brother’s appreciation night this past weekend. The theme was “Heros” and the encouragement was for us to be strong and courageous in the Lord (Joshua 1:6). A big thanks for all the work and love that was put into that night, it was amazing! It made me think a bit about strength, and what it means to be strong in the Lord. It’s a very different picture than what this world paints as being strong.

It’s a bit ironic that those of us who spend our lives helping others find it so hard to seek out help ourselves. We make the worst patients, most of us refusing to go to the doctors until we absolutely have to. We probably won’t admit it, but I suspect most of us see neediness as a weakness. It is weak to have to ask for help, because that is acknowledging that we can’t do life by ourselves.

Society tells us that we need to be strong in ourselves, that weakness is bad. If we aren’t careful, we might think the Bible teaches that too. We might point to the example of Paul. 2 Corinthians 11 gives us just a taste of what Paul endured and triumphed over: shipwrecks, beatings, prison, even stoning! Yet his words in 2 Corinthians 12:10 is shocking to our western sensibilitiies: “For when I am weak, then I am strong.” God gave Paul an affliction to remind him that it’s only in his weakness that he experiences God’s strength.

It shouldn’t surprise us that those who have learned to depend on themselves find it difficult to feel close to God. It’s the old problem of our pride, wanting to be our own God rather than to surrender to our creator. It isn’t until we come to the end of ourselves, understand our inability to save ourselves, that we can truly experience the power of God in our lives. The medical journey is hard, and we might think we are being humble by not complaining and plowing through. That’s actually our pride, and Satan is pleased by that.

It is a huge tragedy that depression and substance abuse in the health profession is more common than we would like to admit, and much of this is related to our inability to put to death our pride and call out for help. It is not weak to need others. It certainly is not weak to need God. We were created to live in relationship with both. When we try to fight against that, we can get into deep trouble. Is there a burden in your life that you need help carrying? Let’s lay aside our pride so that we can really embrace and experience life as it was intended.

⁹But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me. ¹⁰That is why, for Christ’s sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong. 2 Corinthians 12:9-10

Boo to Sickness Part 2!

Ugh..achy joints, I hardly want to move. Actually it’s not from being sick anymore, I’m feeling much better. It’s from picking up tennis for the first time in almost a year. I had stopped after throwing out my back when I got a bit over-zealous in trying to relive my glory days. I really thought I herniated a disc, but it was just a bad strain. I have then high schooler Jefferey Chen to thank for that.

Earlier this week a friend who’s in town asked to play, and after playing just two days with him, I can barely lift up my right arm. I did beat him though, so I guess there’s something left. Nevermind that he just graduated the 8th grade, victories are victories.

I guess when we don’t consistently use the muscles, movements that were once second nature can become so hard and painful. Part of me wishes I can just coast off of past accomplishments and training when I was younger and expect to perform at the same level without putting in the due effort. But unfortunately, my body just continues to break down as the years tick by.

I think spiritually we can fall into this trap as well, thinking we can ride the energy and growth of our years soon after conversion. For many, college is that time when one’s faith and passion really takes off being around so many other believers seemingly “on fire” for the Lord. Unfortunately there is a falling out after graduation when people are out of that environment.

We can’t rely on the past to maintain a vital, fresh relationship with God today. Let’s go back to the basics, exercising our faith muscles daily through the spiritual disciplines. And let’s make sure to be balanced, giving attention to all the different aspects of our spiritual life, whether taking in the Word, prayer, evaneglism, fellowship, and worship to name a few. Otherwise we might end up like this guy.

Which spiritual discipline would you like to see more of in your life?