faith


I admitted a patient from the ER one night over the holidays. The ER called with a CT scan showing diffuse pneumatosis, and the most obvious portal venous air I’ve seen so far. The patient himself looked far better than the scan, and was amazingly comfortable, considering that he had a heart rate of 140 and was already in acute renal failure. He was so comfortable that it was very difficult to persuade either my attending, or the patient, that he needed emergency surgery. (“Pain out of proportion to exam, Alice. You can’t tell me he has ischemic bowel and no pain.” I insisted, so we didn’t really lose any time, but it was a little disconcerting.)

As for the patient, that was the worst conversation I have ever had to have. Telling a family that someone died is easier. Telling a man who’s chatting happily that he’s almost certainly going to be dead within 24 hours is nearly impossible, either to find the words, or to convince the patient. I had to not only convince him that matters were this serious, but also discuss the option of surgery – his only chance of survival, but a very slim one, with a significant chance of a long ICU stay and major morbidities, if he did survive. (Some might say that with that CT scan, we shouldn’t operate. 1) You can see pneumatosis and portal venous air from a bad bowel obstruction, which can be salvageable. 2) He was relatively young, and with few comorbidities. We never did figure out what caused his ischemia.)

In between talking to him, I was calling the chief and the attending and the OR and the ICU, getting iv fluids and antibiotics running, and moving him to preop holding. Not much time. No sooner had I settled him in preop, with a nurse to watch, and the attending about to walk in, than the trauma pager started going off with multiple gunshot wounds, so I had to leave him. Three hours and several traumas later, I found him and the chief resident in the ICU. The operation had been completely unsuccessful; there was absolutely nothing to be done. His body was shutting down, and there was barely time to have the family at the bedside before he died.

I felt awful afterwards. Not just because it was the holidays, and we had lost a previously healthy man suddenly, but because I had spent half an hour talking to him about his death, and had never talked about what would happen to him after death. I had watched somebody dying, and had never even mentioned God or heaven or hell. Which meant that I did him exactly no good at all. He died, as I knew he would, and had to face eternity, and I hadn’t even mentioned it.

Yesterday one of the PACU nurses came up to me. (At night PACU and preop are staffed by the same nurses.) “Remember that man with the ischemic bowel who died? I went to the funeral home. I had to tell his family something he told me that night. He said, ‘I’m not worried about this, because I’m putting it in God’s hands. He took care of me when I had surgery 30 years ago, and he’s taking care of me now. If he wants me to live, I will; and if not, it’s all right. If I don’t make it through surgery, tell my family I’ll see them in heaven.’ ” I started crying in the middle of PACU. He’s safe, after all. I didn’t do anything I should have, but he knew better than me. Next time, I won’t make the same mistake.

(As for the nurse, I have a whole new respect for her, going out of her way to comfort not only the family, but also the other caregivers.)

I’ve been listening to a Christmas CD from the Boston Camerata – An American Christmas, which contains few familiar carols, but many beautiful early American hymns, which demonstrate an understanding of [I cringe to use the cliche] the true meaning of Christmas far beyond that which pervades pop culture today. This song is called Bozrah, from the Biblical reference given further down; you can hear a rendition of it by the Rose Ensemble here, very similar to the Camerata version, but with different verses at the end.

Who is this that comes from far,
With his garments dipped in blood?
Strong triumphant traveller
Is he’Emmanuel, is he God?

I that reign in righteousness,
Son of God and Man I am.
Mighty to redeem your race -
               Jesus is your Savior’s name.

Hark the trumpet’s awful voice
Sounds abroad through sea and land.
Let his people now rejoice -
Their redemption is at hand.

I that reign in righteousness,
Son of God and Man I am.
Mighty to redeem your race -
                Jesus is your Savior’s name.

See, the Lord appears in view;
Heav’n and earth before him fly.
Rise ye saints, he comes for you;
Rise to meet him in the sky.

I that reign in righteousness,
Son of God and Man I am;
Mighty to redeem your race -
               Jesus is your Savior’s name.

The first half of the song is a paraphrase of  Isaiah 63:1. The  prophet asks,  “Who is this that cometh from Edom, with dyed garments from Bozrah? this that is glorious in his apparel, travelling in the greatness of his strength?” And Christ answers, “I that speak in righteousness, mighty to save.”

Messianic prophecies often refer to blood-red garments: either the Lamb’s blood, shed to cover his people’s sins, or the blood of the Lion’s enemies, spilled as he comes in judgment.

A lot of people have been known to remark at Christmas-time that they “relate best to baby Jesus,” or some similar nonsense; as though it is possible to believe only in Jesus as a helpless infant, and to ignore the rest of his life. Jesus’ birth was a real moment in time and space, when one Person of the Triune God took a human body. But he existed before that, indeed from all eternity, as the Son of God, the Word, the Wisdom of God who breathed life into creation (Proverbs 8, John 1). He existed after that, as a sinless man, the perfect sacrifice who died, and then rose from the dead. He exists now, reigning at the Father’s right hand, while all enemies are put under his feet.

And now, when we remember his birth, we also remember and long for his second coming, which will be from the heavens, awesome and full of glory; when those who have denied and mocked him will see the One who was pierced for our transgressions, and weep at their fatal error; when those who have believed in him will realize in full the truth of his promise, “He who believes in me, though he be dead, yet shall he live; and he who lives and believes in me shall never die.”

As the historic church recognized in the observance of Advent, Christmas is a joyful time, not only because our Savior was born, but because he is coming again.

Belatedly, Merry Christmas.

Another magnificent piece of music: Haydn’s Te Deum, which was performed for a visit of Admiral Nelson to the Austrian court in 1800. It can be sampled (and even better, acquired) here.

This ancient hymn is glorious in itself, and Haydn’s triumphal score sets it beautifully. Some great lines:

Te Deum laudamus,
te Dominum confitemur.
We praise thee, O Lord; we acknowledge thee to be the Lord.

Te aeternum Patrem omnis terra veneratur. . .
Thee, the Father everlasting, all the earth doth worship. . .

Te gloriosus apostolorum chorus,
te prophetarum laudabilis numerus,
te martyrum candidatus laudat exercitus. . .

Thee, the glorious choir of the apostles,
Thee, the admirable company of the prophets,
Thee, the white-robed army of martyrs doth praise. . .

Tu rex gloriae, Christe.
Thou, O Christ, art the King of glory.

Tu Patris sempiternus es Filius.
Thou art the everlasting Son of the Father.

Tu, ad liberandum suscepturus hominem,
non horruisti Virginis uterum.
Thou, having taken upon thee to deliver man,
didst not disdain the Virgin’s womb.

Tu, devicto mortis aculeo,
aperuisti credentibus regna caelorum. . .

Thou, having overcome the sting of death,
hast opened to believers the kingdom of heaven. . .

Salvum fac populum tuum, Domine,
et benedic hereditati tuae
. . .
O Lord, save thy people, and bless thine inheritance. . .

Fiat misericordia tua, Domine, super nos,
quemadmodum speravimus in te.

Let thy mercy, O Lord, be upon us, as we have trusted in thee.

In te, Domine, speravi;
non confundar in aeternum.

In thee, O Lord, have I trusted;
let me not be confounded for ever.

That last line is absolutely magnificent, as Haydn plays it out into a minute-long meditation of confidence and faith.

I don’t know why, but somehow prayers and psalms mean more to me in Latin. Maybe because the language forces me to think about them slowly, rather than racing glibly through the phrases.

In te Domine speravi; non confundar in aeternum.

My patient is dying (again), and I can’t do anything to stop him.

That’s such a horrible feeling. I can’t help him. I can’t stop the disease, I can’t change anything anymore. It’s too late.

At that point, the thought arises, if I can’t cure him, at least maybe I could make this quicker, easier for him and his family.

I never thought I’d understand (dare I say sympathize with) that idea.

I understood today, finally, how doctors, whose purpose is to heal, can end up wanting to kill (because that’s what euthanasia is, in the final analysis). I wanted to do something, anything, for this man; and if I couldn’t fix him, that left only one thing.

The problem is that I’m not God. There’s a very old joke about the difference between God and the surgeons; and I think death is his way of reminding us humans of our place in the world. Death is not under our control. It’s not a thing that we can order around, or organize, or turn off and on at our whim.

Life and death belong to God. He gives life, and he controls its end. The time of death does not belong to us. That’s our human arrogance talking, to think we can control every aspect of our lives, right down to death itself.

So I had to let go. That man was God’s creation. God let me care for him for a while; but ultimately I and my colleagues were never the ones in control. As the psalmist says, “Man returns to dust, and his spirit returns to his Maker.”

In accordance with my resolution for the next [school] year to write more about the Bible:

The first ten or twelve verses of Ephesians 1 are amazing from many perspectives, but today I was noticing the emphasis on the role of God’s will and God’s choice in our salvation. Words denoting the supremacy of God’s will and purpose are mentioned at least twelve times in six verses:

“According as he [the Father] hath chosen us in him before the foundation of the world, that we should be holy and without blame before him in love;
Having predestinated us unto the adoption of children by Jesus Christ to himself, according to the good pleasure of his will, to the praise of the glory of his grace, wherein he hath made us accepted in the beloved.
In whom we have redemption through his blood, the forgiveness of sins, according to the riches of his grace, wherein he hath abounded toward us in all wisdom and prudence,
Having made known unto us the mystery of his will, according to his good pleasure, which he hath purposed in himself,
That in the dispensation of the fullness of times he might gather together in one all things in Christ, both which are in heaven and which are on earth, even in him. . .”
Ephesians 1:4-10

Which (if you don’t get along well with King James English, and that passage is particularly convoluted in both English and Greek) is to the point that God, from the beginning of the world, chose his children, and set his love on us and forgave us and planned everything for the purpose of bringing us together in Christ, for his own glory. He planned it all. It doesn’t depend on me – which is good, these days, because I haven’t always been paying as much attention as I should.

He makes us accepted in his beloved Son. What else is left to desire?

(Ok,  now we can discuss predestination, if you like. . . )

For someone who spends as much time communicating as I do, I’m obviously still not very good at it.

Since between work and Pascha services this week I don’t have much time, let me, as the fastest way of saying what I really think about Mormonism, refer you to a post I made this spring, back when Romney was a viable contender. You can find it right here. Basically, I conclude that Mormonism is a false religion, just as much originated by Satan as Islam is, in that he probably inspired two men (Mohammed and Joseph Smith) to write blasphemous lies against Jesus. Mormonism, unlike true Christianity, does not regard Jesus as divine, the only-begotten, unique Son of God. Mormonism teaches that God was once a human, and that all humans (or at least all males) can become gods in their own private universes, peopled by the offspring of their subservient wives (so yes, Mormonism, like other false religions, tramples on women, and, unlike Christianity, regards them as lower in kind than men).

Regarding polygamy, I agree that it’s illegal in America, and that even the biblical patriarchs limited themselves to two wives, and those of an age to consent.

What I was trying to say about the FLDS branch of Mormonism is that 1) I think most Americans’ visceral reaction to them is based on lifestyle choices that have nothing to do with polygamy, but which do present a glaring challenge to the culture of hedonism and free sex that prevails in America today; and 2) I respect groups which hold to the original tradition when it’s not politically correct to do so. The mainstream LDS church threw out Joseph Smith’s original teaching on polygamy because it made their life easier to do so. The FLDS hold onto it; even though that may involve brainwashing women, it’s at least the original form of Mormonism. Similarly, I respect “radical” Muslims more than “moderate” Muslims, because I think the radical Muslims understand and obey the original commands of Mohammed (kill the unbelievers until they submit to you, make no friends with Jews or Christians) better than the watered-down, secularized, moderate Muslims. That doesn’t mean that I approve of suicide bombers; I simply think they’re acting on the logical conclusions of their beliefs.

Does that help at all? Maybe I should also mention that in my personal beliefs, I try to stick to the Bible exactly as God gave it, without making alterations for modern sensibilities. God created the world out of nothing, in the space of six days, and all very good, until it was marred by man’s sin and the entry of death. God condemns sinners to hell in the next life because of their infinite crimes against him, and he is righteous and loving to do so (we can take this up in a later post). God offers free forgiveness and eternal life to all who confess that they have broken his laws, and accept his merciful gift in Christ, who died for us and rose from the dead on the third day, and sits in heaven until his kingdom is established through the whole world, and all nations kneel down and worship him. And along the way, women should submit to their husbands, men should have one wife and be faithful to her, and Christians ought to love their neighbors as much as they love themselves. This is absolutely true, and I make no apology for any of it, except to say that I wrote it as forcefully and bluntly as possible in order to parallel my wild statements about Islam and Mormonism.

They and I are at least in agreement about the existence of absolute truth and the extreme importance of finding it out; just as I had more in common, regarding modest clothes, and avoidance of wild parties, and chastity, and taking time out from studying for religious observances, with the Muslim girls in medical school, than with the nominal Christians.

I look forward to reading your comments.  :)  And I guess I had better also put out an apology in case any of the above is needlessly offensive, as I may not have time to answer comments till late in the day. I don’t mean to be insulting, but to state the truth as I know it, forcefully. The lateness of the hour may make some phrases ill-judged.

You know the reason everyone is really so rabid about the polygamists? It’s not just the matter of teenage mothers (who, after all, are a common enough phenomenon in this society; here, at least, they’re respected as legitimate, and the fathers are involved with their children).

No, it’s the women’s clothes. Modern Americans take one look at their appearance – which I would describe as graceful, elegant, sweeping, modest dresses and beautiful swept-up hair – and react viscerally, I believe because they’re convicted by this total contravention of modern society’s flagrant embrace of everything vulgar and obscene. It’s almost as though men think they have a right to see barely-clothed women, and are affronted by these women denying them that privilege; as though women think that they earn respect by flaunting their beauty in the eyes of all, and are defied by these women’s refusal to do that.

That, and the large families. In a society where a single child is pondered before years before being accepted, and where two children are an imposition, three unheard of (in the professional circles I seem to be in these days), the idea of having many children is shocking – the 400 kidnapped children (since I don’t see where the government gets the right to take all of them without specific evidence against everyone’s fathers) are described as a crowd of toddlers and 4-5 year olds running around under foot.

Plus, their rejection of the modern world. My friends talk as though it’s evil not to have TV and internet and cell phones. Who am I to talk, of course; but I think I can at least recognize the beauty and possible desirability of such a lifestyle (the Amish, for instance), while still choosing to use some of modern technology myself. So far, I’ve refrained from pointing out to my colleagues that I was raised without TV (although they may have figured that out from my profound pop culture illiteracy), and regard my cell phone as a necessary evil.

(I have previously described Mormonism as a heresy. But I respect the FLDS people for being consistent and true to the original spirit of Mormonism in spite of intense persecution.)

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