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.

 

Why God is Not Against Vaccines

I’ve been seeing a lot of news about vaccines lately in the social media headlines so I figured I would throw in my however much these thoughts are worth. A frustrating situation is when patients refuse medical treatment because they believe in God. But wait, I believe in God too, and I don’t remember the Bible ever saying we shouldn’t use medicine. The reasoning, I think, goes something like this: God is the all-powerful healer who holds our lives in His hands, and so if it’s His will that I get sick, then I’ll just get sick because if it’s His will to heal me, He can, and He will if I have enough faith in Him (and if I take medications, this would mean I don’t have enough faith).

While I do agree that God is the all-powerful healer who hold our lives in His hands who allows sickness in this world as a result of sin, and that if He wanted to, He could miraculously heal anyone of any disease, I do believe that medicine and faith are not mutually exclusive. God can do miracles, but usually God works through natural processes and the creative abilities and intellect that He has given to human beings, His image bearers. Those who would trust exclusively on God for medical needs probably would have no problem going down to the local store to buy food, or the mall to buy clothes. Even though God is fully capable of supernaturally providing food and clothing (manna for the Israelites and coverings for Adam and Even), He has chosen to meet those needs through people who He has given the knowledge and ability to harvest food and make clothing.

In the same way, God has given people the capacity to understand the workings of the human body, and the ability to do research to come up with ways in which to combat sickness. Yes, Jesus came and healed a lot of people of disease. But there were tons more who were not healed, because healing wasn’t the main purpose of Jesus’ ministry. Jesus came not to simply relieve physical suffering, but to usher in the kingdom of God. Jesus’ miraculous healings not only authenticated His claims to be the Messiah sent by God, but also pointed to the future reality of God’s kingdom that is without sickness, sin, or death. And so medicine is a means in which to bring creation back closer to how it was intended before sin entered the world.

In the Bible you don’t read anywhere a prohibition to use medicine. Paul even tells his fellow laborer in Christ Timothy to “use a little wine for the sake of your stomach and your frequent ailments” (1 Timothy 5:23), and not just pray for healing. The Gospel writer Luke, a traveling companion of Paul, was a doctor, and we don’t see Paul telling Luke to quit his job. Are there misuses of medicine? Of course, as there are misuses of everything else that is good because we live in a world of sin. We certainly can trust in what our hands can provide rather than God, but that can happen not just with healing, but with anything else (e.g., provision of food and future security). It’s a daily discipline to come before God in dependence even as we are active in using our gifts that God has given us for our provision.

All this is to say, the development of vaccines is an example of the grace of God given to us to combat the corruption of the natural order due to sin. Vaccines and antibiotics are probably two of the greatest medical discoveries in terms of lives saved and illness prevented. Are there side effects to vaccines? Sure. Is autism one of them? I can’t imagine the fear a parent would have hearing about the reports of children manifesting autism after routine vaccinations. I want to acknowledge those fears, but the vast bulk of scientific evidence would say no. 

Christ came to deal with sin in this world. And that means not just taking away the penalty of our sins against God by dying on the cross, but also ushering in a kingdom (that will come in full when He returns) that is how things were intended to be: no more tears, no more sickness, and no more death. In the meantime, let us use everything that God has given us to stay healthy so that we are best equipped to carry out the kingdom work.

Then I saw a new heaven and a new earth, for the first heaven and the first earth had passed away, and the sea was no more. 2 And I saw the holy city, new Jerusalem, coming down out of heaven from God, prepared as a bride adorned for her husband. 3 And I heard a loud voice from the throne saying, “Behold, the dwelling place of God is with man. He willdwell with them, and they will be his people, and God himself will be with them as their God. 4 He will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things have passed away. 5 And he who was seated on the throne said, “Behold, I am making all things new.” Also he said, “Write this down, for these words are trustworthy and true.” Revelation 21:1-5

 

Get Your Flu Shots!

It’s that time again….Halloween stores, pumpkin patches, no more hot summer days (except in Southern California)… and flu shots! It’s a mad flurry of activity in the clinic with nurses trying to get every patient flu shots on top of all the other orders they have. If you haven’t gotten your flu shot yet, go and get one!

Here are some common misconceptions about the flu:

1. It’s no big deal.

Part of the reason people don’t get so worked up about it is because the flu vaccine works, and more people don’t get it. But sadly, tens of thousands of people still die each year from flu-related complications. Most of these deaths are in adults over 65 years. The very wee are at risk as well.

http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm#study

2. I’m a strappin’ young lad, the flu won’t affect me.

Maybe. But the world does not revolve around you my friend. Chances are you live with young kids or older folks, or you have friends with asthma, diabetes, or other chronic diseases that can be made worse if they get sick.  While the flu might just inconvience you for a time, you can easily pass it to someone who won’t be so fortunate.

3. The flu shot gives me the flu.

Most flu vaccines do not contain live flu virus so the flu shot does not give people the flu. You might feel sore, maybe a little off, but that’s just the body’s immune system mounting a response to the flu shot. And trust me, that’s nothing compared to what you will feel like if you actually got the flu, so it’s a small price to pay.

http://www.cdc.gov/flu/about/qa/misconceptions.htm

4. I’ll just get the flu shot when everyone starts getting sick.

It’ll be too late. It takes about 2 weeks for the body to make the antibodies to protect you from the flu.

5. Flu shot is unnatural, God doesn’t want me to use that stuff.

I think this will be a post on its own, but I will just briefly say that people who believe solely in healing prayer and will not accept medical intervention are misguided in their beliefs. While I commend their faith, a God who heals and a God who gifts people with the intellect and ability to bring about healing are not exclusive. We don’t wait in faith for food to appear, we work to produce it or make money to buy it with the gifts that God has given us (although there are times we can pray for God’s provision, again not exclusive).

Sin is a corruption not of just the spiritual, but the physical as well, and I believe God has given us the gift of medicine to combat the consequences of sin and give us a glimpse of the kingdom to come where there will be no more sickness and death. Yes there have been abuses in medical advancement, but that’s the case for every other good thing God has given us.

So with that, I hope you will all make an appointment with your doctor or go to your nearest pharmacy and get your flu shot (unless there’s a reason you can’t)! Here’s to a flu-free flu season.

 

Medical Injustice

If you didn’t know, the new health insurance market opened last week as a means to increase access to care amongst the uninsured. If you would like a brief overview of Obamacare, read this previous post. Hopefully the computer glitches will be smoothed out soon and people can be enrolled into health insurance plans.

All politics aside, I am happy as a primary care provider working with the underserved that more people will have access to basic care. Early detection and regular care can potentially prevent the chronic diseases that burden the healthcare system today, e.g., diabetes, heart disease, stroke.

But unfortunately, the scope of the new healthcare reform will not be as vast as previously thought. This was a pretty sad article to read from CNN talking about the gaps in coverage under the new plan. The Affordable Care Act (AKA Obamacare) had the provision that each state has the choice of expanding the programs that would help provide coverage for the poor.

Sadly, half the states have opted out of the program, and hence the uninsured living in those states will not receive any aid in purchasing health insurance. The article estimates there are some seven million working people who make too much to qualify for existing state aid programs, but not enough to receive subsidies under obamacare to purchase insurance.

Millions of people unable to get care that they need. Sad as that is, numbers are just statistics. Maybe a story will be more helpful. Here’s an excerpt from my book:

I was working in the ER one time and this guy came in for abdominal pain. I did the standard history, getting all the gory details. Then I went to do an exam. Heart sounds were good, no murmurs. Lungs, pretty clear. Abdomen feels okay … wait, I feel a mass? Is this stool in his intestines? So I follow it and it’s no stool. It goes down into his pants and there I find that his scrotum is the size of a grapefruit. I hope he didn’t see me go bug-eyed.

I asked him how long he’s had this and he told me four months. Four months? Are you kidding me? I asked him why he didn’t come in earlier. He simply shrugged. I found out later he had a cancer of his testicle and it had spread all the way into his belly.

We might find that story incredulous. Why did he wait that long to come in? You would think if your scrotum was the size of a tennis ball that would raise some red flags…

To give my patient credit, he was uninsured and didn’t have access to regular medical care. If I was faced with a decision to fork up money to see a doctor or put food on the table, I wouldn’t go to the doctor either. That breaks my heart. This is just one small example of the injustices that exist in our medical system…

Worth the Cost?: Becoming a Doctor Without Forfeiting Your Soul

One charge God had against the the Israel nation was that they failed to care for the poor and needy in the land. I can’t imagine God being happy with the state of healthcare, even with the new changes. I’m still wrestling with how the church (and the individual Christian) is to respond to this need, but I do my best using medicine to carry out God’s heart for the poor. If you have thoughts, feel free to share!

“Is not this the kind of fasting I have chosen: to loose the chains of injustice and untie the cords of the yoke, to set the oppressed free and break every yoke?

Book Ordering Info:

Print: http://amzn.to/170kMjU, http://bit.ly/15JhbXd

Kindle: http://amzn.to/16E337O Nook: http://bit.ly/19juMEV

Marijuana to Treat Diabetes??

I wasn’t going to post today but I ran across this article talking about a recent study published in The American Journal of Medicine that found marijuana users had lower insulin resistance, higher good cholesterol, and a smaller waist circumference. Funny that a group of us was just talking about the issue of legalizing marijuana yesterday. I am by no means an expert in this area, but I’ll just throw in my two cents.

The article opens with “Toking up may help marijuana users to stay slim and lower their risk of developing diabetes, according to the latest study, which suggests that cannabis compounds may help in controlling blood sugar.” I find this statement a bit misleading since the study itself makes no such claims and is unable to because of its study design (cross-sectional, which is just an observation of a particular sample at one point in time).

Based on their statistical analysis of the data, the authors of the study concluded that “current marijuana use is associated with lower levels of fasting insulin, lower HOMA-IR, and smaller waist circumference.” This simply means they observed that participants who used marijuana had lower levels of insulin resistance and a smaller waist without making any claims of causality.

The CNN article does point out at the end that it is much too early to make any claims of possible benefits of marijuana in the realm of diabetes, but I wonder how many people actually make it through the whole article (especially with all the statistics and science talk in the middle). The article also doesn’t mention any of the adverse effects of marijuana use, but I suppose that is outside the scope of what the author is trying to accomplish.

At the end of the day, though, even if it was shown that smoking marijuana lowers diabetes risk, I’m not sure it would change the way I practice. Just as I don’t counsel people who don’t drink to start drinking because of the heart benefits, or those with obesity to pick up smoking because it can help with weight loss, I wouldn’t endorse marijuana use to improve diabetes risk, especially when diet and exercise for sure can lower the risk of developing diabetes (and high blood pressure, coronary artery disease, high cholesterol, and many other diseases for that matter).

Anyway, a hotly debated topic. Just some initial thoughts, feel free to share yours.

Medical Training Advice: International Rotations

For those of you who are in medical sch0ol, an international rotation is a great idea if you can work it in your schedule (and if you can afford it). It’s an opportunity to see how healthcare is delivered elsewhere and just good in general to travel and see more of the world. The best time to do that is the summer between your first and second year (your last real summer) or during your 4th year. Even if you are just a first year, now is a good time to start thinking about this because it does take some planning.

Start exploring different options in your administrative office. Some schools already have partnerships in place with different hospitals/clinics, which make things like getting credit and scheduling much easier. The staff can usually get you in contact with other students who have gone before. Each school has their own policy and paperwork that is required.

Of course there are also many resources online. The international elective section here provides some good info if you are interested in family medicine. If you are planning to practice in California, I would highly recommend a medical Spanish immersion program that is part of the rotation. During my fourth year, some of us went through CACHAMSI, which is a program based out of Riobamba, Ecuador, which was an amazing experience.

It was a one month rotation and was structured for medical experiences in the morning (there were different sites like primary care in the rural setting and the ER in the local hospital) and Spanish didactics in the afternoon. We were each set up with a host family so it was a total immersion experience. The weekends were free for travel and exploration.

4th year of medical school is a great year, especially after your sub-internships and residency interviews. Plan ahead to make the most of it!

P.S. Don’t forget about vaccines and prophylaxis depending on where you go! International health insurance is not a bad idea either.

Here’ some pics! Fellow Travel buddies: Farshid, Charles, Regina

Picture 085 Picture 035a Picture 042 Picture 216 Regina SD Card #1 073 Picture 063

 

 

 

On Call 24/7

Probably the most dreaded thing about residency is taking call in the hospital, whatever the rotation. Call is when you have to spend the night at the hospital to cover the patients when the rest of the team goes home. Someone needs to be around to admit new patients and respond to patient needs and emergencies overnight. Sometimes you just cover patients on your own team. Most of the time though, you are covering other team’s patients that you have never met before.

I still remember my very first night on call as an intern. I was covering all the patients from the three different surgical services at Harbor. I was already peeing in my pants, but some time into the night, I discovered that my pager (yes we still use those) was turning off by itself if I didn’t press the on button periodically.

That added a little more stress, but it was fine as long as I kept it on by pressing the button. But then I fell asleep when things were slow and woke up several hours later in a sheer panic because my pager had turned off.  I can’t even describe the fear that came over me thinking I may have missed some crazy emergency. I actually went to every single floor where there were patients to ask if anyone had paged me.

I probably over-reacted since there was a trauma team in place over night that would respond to any emergencies (they know better to trust real emergencies to new interns). I was just the intern so my job was to babysit. But what did I know. Thankfully everything turned out fine and I survived my first call, and every subsequent call.

Praise God that we have a God who is always available to us. He never forgets his pager, and his pager never runs out of batteries. In Christ, we have a direct line to our creator God, and He invites us to come to Him. Not just in emergencies, but in the everydays of life. Thank God that He knows what He’s doing too.

When was the last time you talked with God?

In him and through faith in him we may approach God with freedom and confidence. Ephesians 3:12

How to Cope

In my last post I talked about how difficult it is for those in medicine to repeatedly come face to face with human suffering. Whether it was the consequences of personal choices or due to unfortunate circumstances, the burden of caring for the sick can weigh heavily on the soul. It’s sad that even though medical training strives to raise up compassionate healers, people often come out jaded and cynical instead. Here are just a few things that have helped (and continue to help) me on the way.

1. Take a time-out

Medical training is such a hectic process, especially during your intern year. There is just so much to do you’ll be running around like a chicken with its head chopped off, rushing from floor to floor, patient room to patient room. Sometimes you just need to mentally check out for a moment. There was this place outside the hospital I would go to from time to time just to re-group. Even if you can’t escape the clinic or hospital, pausing for a minute before seeing the next patient can help to let your emotions catch up to your body so that you can be fully present.

2. Learn your patients’ names

It’s amazing how there are days I can’t remember a single name of the patients I saw that day. This might seem counter-intuitive, that the more you get to know a patient, the harder it will be emotionally  if things take a turn for the worse. But I think it is the dehumanizing of our patients that makes our jobs seem pointless and futile. Our patients become just another thing to fix, another obstacle asking of us our energy and time that is already so limited. But connecting with patients as people can help us celebrate with them the small victories even if there’s no ultimate cure.

3. Journal

Our experiences are meant to be processed, not buried away. I started my book project wanting to be helpful to others. After I finished writing, I found that there was something hugely therapeutic in revisiting my training experience and working through the lessons that I learned. If no one buys or reads the book, it would have played an important role in helping me articulate one of the hardest seasons of my life. You don’t need to write a book, but who knows, maybe one day your ramblings can turn into one.

4. Connect with others

This is along the lines of number 3. Medical school and residency were my loneliest times, even though their were plenty of people around. It’s hard to talk to others about our experiences because either we don’t want to be a burden, or we don’t think others will understand. The problem is that we are created as relational beings, so we do need others to help us process. Don’t forget your relationships, particularly your spouse. And sometimes professional help might be necessary. There’s no shame in this; some of the situations you’ll face will be intensely traumatic. There are resources available through your program so don’t be afraid to seek those out.

5. Keep the eternal perspective.

As high a calling it is to care for people’s physical body, we have to be reminded that there is a higher, spiritual reality. In the words of Dr. Cox from Scrubs, “Sooner or later, you’re going to realize that everything we do around here, everything is a stall. We’re just trying to keep the game going, that’s all. But, ultimately, it always ends up the same way.” The decay of our bodies and eventual death is inevitable, and while our job is to hold back the tide, our job as Christian physicians is, through our care of the physical, to point people to a deeper spiritual healing that we all need. This is where we need to remember God’s promises that He will one day make all things new.

This is just a short list of things I found helpful that I am still learning to do as I continue in my career as a physician. The road is a difficult one. My prayers go out to those who have embarked on this journey.

What has helped you from developing cynicism and becoming jaded?

 

 

 

 

Why God Doesn’t Just Heal Everyone

One of the most difficult things for me is seeing all the sick people in the hospital and wondering why God doesn’t cure people anymore. It’s tough.

This is a recent comment I got from a medical student. Thanks for your honesty, it certainly is tough. For me, it was especially tough seeing kids with terrible diseases. I remember being present at the still-born deliveries of twins and thinking, “God, how can you let stuff like this happen?” The question I was really asking was, “God, if you are good, why do you allow suffering to happen?” The follow-up to that question is, “God, if you are good and all-powerful, why don’t you do something about it?”

This is a hard one. I think the best answer I’ve heard was from a sermon by John Piper who said that suffering and tragedies ought to remind us of our initial rebellion against God.  It is a reminder that the world as it is was not the way it was created, but what we see now are consequences of our sin against God. I mentioned this in a previous post that because of Adam and Eve’s sin, not only was our relationship with God broken, but the whole natural order was corrupted (Romans 8:19-21).  That means diseases (as well as natural disasters) are as much a result of sin as all the terrible things that people do to one another.

But knowing that suffering is ultimately the result of our separation from God, while true, isn’t very helpful when we come face-to-face with the ugly realities of this world.  We can kill ourselves asking the why’s but, often times, God doesn’t give us the answers.  Instead He says, “Look to my Son.”

I don’t think we’ll ever figure that out why God created the world knowing all the suffering that was going to result. But, somehow because of His love, it was worth it to create despite knowing that we would fall into sin.  But God didn’t just create and run away.  No, God was here. God entered into this world of suffering and sin in the person of Jesus, the incarnate Son.

When Jesus came into this world, yes He did heal the sick and make the lame walk.  He even raised the dead.  But there were multitudes that were not healed and even more who remained dead.  God was here at one time, but He was not here to end all suffering.  God was here, shared in our brokenness and suffering, and died on the cross to meet our ultimate need: to be reconciled with our creator God. Jesus’ healings and other miracles merely backed up His divinity and His ability to forgive our sins.

The story doesn’t end there. Not only was God here, but God is also near: Jesus is going to return.  While He didn’t come the first time to end all sickness, poverty and natural disasters, when He returns, that’s exactly what He will do.

I don’t want to minimize the sufferings we encounter because the pain we experience is real. We should care. God cares. While we may be angry with God, without God there is no good answer for the problem of suffering. Without God, tragedies ultimately have no meaning; they just happen. But we have a God who took on the ultimate suffering, bearing the burden of our sins on the cross.

So back to the question, why doesn’t God just cure everyone?  He actually still does heal (worthwhile read), but miraculous healings are the exception rather than the rule because there’s a spiritual reality that our sufferings point us to. More often, God uses ordinary people to be his hands and feet in order to love someone in their time of suffering to help them see their ultimate need for God, pointing them to Christ.

For future healers, this is not an easy calling to battle against the consequences of sin. In my next post I’ll write about some ways to process through these difficult experiences. For starters, let us remember the words of Revelation 21:4-5 that one day God “will wipe every tear from their eyes.  There will be no more death or mourning or crying or pain, for the old order of things has passed away.  He who was seated on the throne said, ‘I am making everything new!’  Then he said, ‘Write this down, for these words are trustworthy and true.’” 

For those of you in the medical field (or any field for that matter), how do you deal with the suffering that you see? Please feel free to comment.

Adapted from a previous post in response to the Sandy Hook shooting

3/30/13 Found this video that has some good insights