Sunday, April 30, 2006


Pride. . . again

I’m uncomfortable talking about pride in relation to myself, mainly because I don’t like to admit that I have a lot of it. I don’t like the feeling I feel when my pride is broken down, even though I know this is what must happen in order to be called a child of God. Things have happened in my life over the past several weeks that have secretly caused the pride within me to swell. It’s disgusting to think that I am so full of pride sometimes. I am caught up in pride about things that I have nothing to do with. Everything I have is a gift from God, not something that I somehow obtained on my own. My selfish mind has somehow distorted this truth into something more manageable and pleasing to it. I realize that even when I think I am relatively devoid of pride, even then my pride is an obstacle to authentic worship.

Proverbs 16:18 Pride goes before destruction, and a haughty spirit before a fall.

Mark 7:21-23 For from within, out of the heart of man, come evil thoughts, sexual immorality, theft, murder, adultery, coveting, wickedness, deceit, sensuality, envy, slander, pride, foolishness. All these evil things come from within, and they defile a person.

1 John 2:15-16 Do not love the world or the things in the world. If anyone loves the world, the love of the Father is not in him. For all that is in the world—the desires of the flesh and the desires of the eyes and pride in possessions—is not from the Father but is from the world.

It is evident that I cannot harbor pride in my heart and truly think my life pleasing to the Lord. I am ashamed of the duplicitous nature of my heart. It is so difficult to have the proper attitude, with the world screaming in my ear about what it thinks is important, and yet, I am called to be different. [Romans 12:1-21]

O Thou terrible Meek,
Let not pride swell my heart.
My nature is the mire beneath my feet,
the dust to which I shall return.
In body I surpass not the meanest reptile;
Whatever difference of form and intellect is mine
is a free grant of thy goodness;
Every faculty of mind and body is thy undeserved gift.
Low as I am as a creature, I am lower as a sinner;
I have trampled thy law times without number;
Sin’s deformity is stamped upon me,
darkens my brow, touches me with corruption:
How can I flaunt myself proudly?
Lowest abasement is my due place,
for I am less than nothing before thee.
Help me to see myself in thy sight,
then pride must wither, decay, die, perish.
Humble my heart before thee,
and replenish it with thy choicest gifts.
As water rests not on barren hill summits,
but flows down to fertilize lowest vales,
So make me the lowest of the lowly,
that my spiritual riches may exceedingly abound.
When I leave duties undone,
may condemning thought strip me of pride,
deepen in me devotion to thy service,
and quicken me to more watchful care.
When I am tempted to think highly of myself,
grant me to see the wily power of my spiritual enemy;
Help me to stand with wary eye on the watch-tower of faith,
and to cling with determined grasp to my humble Lord;
If I fall let me hide myself in my Redeemer’s righteousness,
and when I escape, may I ascribe all deliverance to thy grace.
Keep me humble, meek, lowly.

Lord, please hear my prayer tonight. I am full of pride, lust, greed, envy, idolatry. I am full of things You abhor, and yet You call me Your own. Please have mercy on this wretched sinner; please bear with me in patient love. Please humble me before You, that I would be able to offer something truly honoring to You. Strip away all sinful attitudes I currently cling to for “security,” showing me that my only true security is found in You. I ask You to close my ears to the things the world may say that would ordinarily cause me to swell with pride; instead, I beg You to make me keenly aware of my low station before You, that I would always be in a proper worship position before You. Lord, by Your grace alone, I resolve never to give over, nor in the least to slacken my fight with my corruptions, however unsuccessful I may be. No matter the situation, I will praise Your name, I will try to be a faithful servant. I know I am unable to do this on my own steam, so I cry out to You to strengthen me to accomplish this, not for my name, but for Your glory. Lord have mercy on this sinner.

Tuesday, April 25, 2006

Proverbs 16v9

The Lord establishes his steps. . .

Proverbs 16:9 The heart of man plans his way, but the Lord establishes his steps.

A little background: I was post-call today, and relatively un-tired at the time, so I decided to try to get in a bike ride. I spent about an hour on Google maps, plotting out my route, trying to avoid the mid-week traffic. After I decided on a route, I wrote out the legs of the route on an index card to carry with me, since it was too many turns to remember. All this to say, it took a while to plan this out. The ride was scheduled to take about 1h45m. About 30 minutes into it, as I’m cresting a hill, I can see clearly across the countryside a storm cloud and the thick streams of rain pouring down. I decided to turn around at this point, hopefully to avoid the storm. Well, about 5 minutes after turning around to head back, the rain is driving. The ride was otherwise uneventful, but it made me think of all of my planning, and how easily my plan was diverted. It is not my intention to spiritualize my bike ride today into minute detail, but I think it brought a good illustration to mind, allowing me to reflect on other areas of my life that this verse applies to.

How quick my heart is to make plans based on selfish desires, unaware that it is the Lord who is in control of them coming to fruition. [James 4:13-16] Where do the desires of my heart fit in with the rest of my life, and more importantly, with Scripture? The Bible clearly says that I can have desires [Psalm 37:4], but I don’t think it’s talking about the same ones I frequently have. There are so many verses that direct me to desire things that are pleasing to the Lord, I feel overwhelmed to list them all here. As far as other things that I desire that are not necessarily spiritual (like the bike ride), I can desire these things, but I am not to cling to them. I can sit down to read the Word and pray about wanting to please the Lord, only to get up, and immediately leave Him out of the rest of my day’s plans. It scares me how short-sighted my heart is and how prone to wander I am.

O Thou that hearest prayer,
Teach me to pray.
I confess that in religious exercises the language of my lips and the feelings of my heart have not
always agreed, that I have frequently taken carelessly upon my tongue a name never
pronounced above without reverence and humility, that I often desired things which would
have injured me, that I have depreciated some of my chief mercies, that I have erred both on the side of my hopes and also of my fears, that I am unfit to choose for myself, for it is not in me to direct my steps.
Let thy Spirit help my infirmities, for I know not what to pray for as I ought.
Let him produce in me wise desires by which I may ask right things,
then I shall know thou hearest me.
May I never be importunate for temporal blessings, but always refer them to thy fatherly goodness,
for thou knowest what I need before I ask;
May I never think I prosper unless my soul prospers,
or that I am rich unless rich toward thee,
of that I am wise unless wise unto salvation.
May I seek first thy kingdom and its righteousness.
May I value things in relation to eternity.
May my spiritual welfare be my chief solicitude.
May I be poor, afflicted, despised and have thy blessing, rather than be successful in enterprise,
or have more than my heart can wish,
or be admired by my fellow men,
if thereby these things make me forget thee.
May I regard the world as dreams, lies, vanities, vexation of spirit, and desire to depart from it.
And may I seek my happiness in thy favour, image, presence, service.

Wednesday, April 12, 2006

On Call - Code 01

On Call

I was on call from 6am on April 11, until 12noon April 12 for surgery, and just like it has been every other time so far, it was an adrenaline pumping one. I think the thing that most intimidates me at this early point in my training is carrying the code pager. This pager is the alert pager that goes off when anyone in the hospital “codes;” in other words, needs CPR/medical resuscitation. My apprehension stems mainly from the fact that I’m still so early in my training, that I don’t have a great deal of experience in these emergency situations. Usually, during the day, carrying the code pager isn’t so bad, because there are so many physicians also carrying code pagers in-house to respond to the pager with more knowledge than I, who can help out. The difficulty, if there is any, usually comes in the night hours, when everyone has left the hospital except for the few residents who are on call. Not all of them are carrying code pagers, so there is a limited response. Anyway, I’m getting a little off topic.

It was about 3pm yesterday. I was visiting with the nurses on 6 south, mostly quoting Napoleon Dynamite back and forth with them, when the code pager alarms. I stop mid-sentence and run out the door and down the hall, not yet knowing where I’m running, as I grab the pager from its holster to read where I’m running to. “Code 500 on 4N-408.” Great, this is not a wing of the hospital used to seeing codes. As I arrive on 4N, the pager goes off again, announcing that the code had been cancelled. I turn the corner into the room, to see that I’m the only physician there, and no one else is likely to show up, since they have cancelled the code on the pagers. I walk in to get the story, since I’ve only first laid eyes on him about 10 seconds ago, and just to make sure everything is resolving, whatever had happened. The patient is rolled on his side in bed, panting / moaning, with a couple of nurses over him to support him. The nurses think he might have had a seizure, but no one is sure. It’s about this time that he stops breathing. Oh crapola! No other physicians are here to help me! Oh wait, now we’re not able to get a blood pressure reading on him, and his pulses are very slow (35bpm) and faint. Double crapola. Remember, no one else is coming because they had “cancelled the code.” Brilliant. I’m not sure why, but no one re-called the code, even after I asked for more help. I was the only resident in with this guy for about 20minutes. My armpits were sweaty; actually all of me was sweaty. Thankfully, through this all, there were “rapid response” nurses present, who have critical care experience, who provided me with some much needed help in this case. This guy needs to be intubated, since he’s not breathing, and he’s actively tanking on me. I take my position at the head of the bead, to see this guy has vomited all over the place…..perfect. I hear vomit is really good for the lungs once it gets down in there. Normally, a little medication is given to sedate and paralyze patients before they are intubated, but this guy was so unresponsive that he needed nothing. There was no movement when I stuck the laryngoscope blade down his throat. Grabbed the suction tip to clear out his throat of vomit so I could see his vocal cords. There’s the epiglottis and the vocal cords. Held out my right hand, the ET tube is placed in my hand, and I place it through the cords into this man’s trachea. Ok, so he now has an airway; time to move on to fixing this low heart rate and blow pressure. Still, have no idea why this gentleman is crumping. Still, no other residents have arrived. Still, just another day in paradise. Quickly hang fluids and give 1 of atropine to jump start the heart rate, which seems to work. At this point, I have a second to get upset that they haven’t re-called the code to get more help in the room. I politely, I think, but firmly ask the nurse, again, to re-call the code, and do whatever she needed to do to get more experienced help available. I move over to the patient’s right side to try an arterial line to measure blood pressure, since we weren’t able to with the cuff. This involves feeling the pulse and sticking a needle into the artery and hooking it up to a machine capable of measuring pressure waves. Only one problem: you need a pressure to feel a pulse. Crapola, again, this guy has no pressure, and I can’t feel a radial pulse. By this time, the pulmonary fellow has showed up, and is starting a femoral central line on the left side. Most of the acute resuscitation is finished, and we are just trying to get this guy packaged and ready to go to the ICU. I abandon the a-line, after several unsuccessful attempts, and we head out to the ICU. As we’re rolling out the door, a couple more residents show up……thanks. We roll him to the ICU, at which point I turn over care to the ICU physicians, thankfully. It’s over, for me. Still, no idea what’s going on with the patient.

I stopped by this morning to check on him in the unit. He died yesterday evening, from an apparent intra-abdominal bleed. I found out he had liver cancer that was advanced to the point of eroding some abdominal vessels, which subsequently led to bleeding. The cancer was beyond curative treatment anyway, so this was expected at some point soon.

I don’t know what I feel about this event. I guess I experienced a sense of awe, as I do everytime I see someone die. Life is so fragile, and we can do nothing to preserve it. Only the Lord holds the power to preserve or take life. I wish more people saw this.

I have more thoughts brewing, but I don’t want to write them currently, because I think they might sound a bit forced, until I’m able to ponder them more in depth. There might be more to follow.

Monday, April 10, 2006

Colossians 2v8-14

Colossians 2:8 See to it that no one takes you captive by philosophy and empty deceit, according to human tradition, according to the elemental spirits of the world, and not according to Christ.

I have, at times, been taken captive by the philosophy of men. I have been enticed to adopt the trappings of this world. And for what? Temporal pleasures. I have knowingly abandoned the joy of Christ for the fleeting pleasures of this world, and yet His love for me remains. He draws me back to Him once again. I praise the Lord He doesn’t simply leave me where I lay, covered with soil, wallowing in the mud. Rather, He restores me to His banquet table and places a banner over me, marking me as His own, for all to see. The only way I can recognize the beliefs of the world (which are in opposition to God) and refute them, is by devoting myself to the Word and to prayer. The only way I can devote myself to these things in a lasting manner is by the sustaining grace of God. I find it incredible that the Lord has mercy on me, yet I will forever be thankful for this.

Psalm 119:9 How can a young man keep his way pure? By guarding it according to your word.

Joshua 1:8 This Book of the Law shall not depart from your mouth, but you shall meditate on it day and night, so that you may be careful to do according to all that is written in it. For then you will make your way prosperous, and then you will have good success.


Colossians 2:13-14 And you, who were dead in your trespasses and the uncircumcision of your flesh, God made alive together with him, having forgiven us all our trespasses, by canceling the record of debt that stood against us with its legal demands. This he set aside, nailing it to the cross.

O, I love that last sentence. Only the Lawgiver has the right to set aside the record of debt. Only the One who has been sinned against has the power to forgive the sinner. I was dead in my trespasses. I had no opportunity to justify myself before the Lord. “Dead” is such a great word here because it conveys a clear meaning. Death provides finality in our minds that we are not able to overcome by simply imagining what is on the other side of it. This verse says the Lord made me alive, as He is alive (that is, truly alive; not the illusion of life we see now), and He did this by canceling the debt against my account. The Law brought knowledge of sin, and with sin came death (Romans 7:10; Romans 6:23). The Lord provided a perfect sacrifice in order to atone for the sins I have committed. I love this sentence: This he set aside, nailing it to the cross. It’s such a wonderful statement I don’t even know what to say about it! It overjoys my heart to read it!

Again, after all I learn, I’m returned to this: Psalm 69:6 Let not those who hope in you be put to shame through me, O Lord God of hosts; let not those who seek you be brought to dishonor through me, O God of Israel.