One day at a time

“The Lord your God is with you, the Mighty Warrior who saves. He will take great delight in you, in his love he will no longer rebuke you, but will rejoice over you with singing” Zephaniah 3:17

I have relished my return to work....(I never imagined I would say that but...)...Returning after surgery has been enlightening to me. (If you have not been following my prior posts, I am returning to work after a brief medical leave while I recovered from surgery).

I feel like a layer of badness was shed from my outer self while I was away. The surgery itself was really life changing, but what happened to my spirit seems wholly different. Before I had the surgery, I had layers and layers of burden and stress covering me. I felt heavy and tired. I had trouble taking deep renewing breaths. I was weary and felt I had reached the infamous “burn out.” 

As it were, I planned to be out on medical leave for three weeks, and as I described in my last post, my surgery was more than a physical success. My whole self seemed to be rebuilt. While out, I spent hours reflecting and sinking into scripture, and realizing what God had worked in my life just through that operation. My strength was suddenly renewed and my eyes again opened to my purpose. After two weeks, I had no pain, and since I was up and about, I did not want to sit at home another week while my office staff and partners took care of my patients in my absence, on top of their already overbooked schedules. So after two weeks out, I returned to work on a “light” schedule of half-days. 

Although I was physically tired, my emotional state was entirely different. I felt as though my heart would truly melt with contentment when I returned. Seeing my patients and hearing their voices, and listening to what was happening with them, gave me a deeper sense of purpose than I had ever noticed before. I am having a difficult time putting these thoughts into words, but suffice it to say, I was happy to be back. Really deeply happy. 

The sadness of death was still ever present, and my heart is heavy for the family of a very special patient who went to heaven last week. Her family is still racked with grief and I am praying for them constantly. 

This week I was asked a very poignant and challenging question by one of my patients and I have thought of little else since our conversation. As a background, this patient has been suffering, with not one but two different cancers, both of which are tragically aggressive and both of which have been unrelenting in her case. She has always been healthy and always active, with no risk factors for the cancer she has (not that anyone ever deserves cancer regardless of their lifestyle choices or habits). As a result of the cancer’s ravaging effects on her body, she has trouble breathing most days now, and she has no stamina to enjoy anything in life that used to bring her great pleasure. She cannot travel, which was a way of life with her husband for more than 40 years. She has pain and anxiety, the severity of which are entirely new to her.  She cannot sleep. She is losing weight. Cancer is not discriminating and has sympathy for no one. It destroys the physical self and in the process can destroy the will to fight. Cancer can break oneself to a heap of tragedy that could never be fathomed.

“For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord” Romans 8:38

“Cast all your anxiety on him because he cares for you” 1 Peter 5:7

“For God has not given us a spirit of fear and timidity, but of power, love and self-discipline” 2 Timothy 1:7

Shortly after my return to work, she came in for her scheduled follow up visit. I thought of her a lot while I was out on medical leave, knowing how sick she had been, and I was relieved to see that she was coming back in for a follow up and that nothing too terrible had happened while I was away. When I saw her name on the schedule that morning, I wondered what shape she would be in when she got to the office. As it turned out, she was in terrible shape. 

She was breathless and weak, tearful, and particularly despondent. I admitted her to the hospital that day, since there was no way she could continue struggling at home in the shape she was in. She had fluid filling the right side of her chest, completely compressing her lung, so that she was effectively using only one portion of her left lung to breathe. She gave me no argument at all when I suggested hospitalization (always a very clear indicator of how sick someone is, how they respond to the idea of being admitted to the hospital...)

“Search me, O God, and know my heart; test me and know my anxious thoughts. See if there is any offensive way in me, and lead me in the way everlasting” Psalm 139: 23-24

She was placed on oxygen, and medications were administered to ease her discomfort that first night. But she had a very bad night regardless. She was restless and had panic attacks through the night. Her oxygen level was hovering just barely at a safe range. The nurses were wonderful in their efforts, but with a chest full of fluid, you can imagine the anxiety that can create - very hard to overcome the feeling of not being able to breathe. Anxiety medications that night seemed to make no difference whatsoever. She was miserable.

When I made rounds the next morning, she let me know how miserable she was. Through tears, she explained all of her symptoms. She told me that she just could not see things getting better and she could not understand what was going on with her body.  As we were speaking in her hospital room, she was desperately trying to reconcile what was happening to her. 

Of course, I cannot offer the explanation as to why this has happened. Why does someone get cancer and suffer?? I do not know why? There, in her hospital room, with machines beeping, alarms ringing from her low oxygen level and high heart rate, I try to offer words of support and encouragement and tell her I will do my very best for her to get her through this journey as comfortably as I possibly can. I explain the medical side of what is happening to her body, in hopes that with some practical understanding of why she is having the symptoms she is experiencing, she will be better able to emotionally deal with them. I explain the procedure we will do to try to remove the fluid. I explain the medications we will give to relieve symptoms. I believe, in my mind, that if I just tell her that her shortness of breath is because of fluid in her lungs, she will be able to calm her breathing and relax, just in the understanding of what is happening physically. Of course, this is wishful thinking on my part. Nothing had worked so far to this effect.

Through very tearful eyes, she asks so many questions for which I do not have answers. Finally she looks at me and says, “I have never been sick, I have always been okay, and now I am suffering like this and my life is over...I have been praying but nothing gets better. I believe in God, and I have prayed all along, but where is God in all of this?” 

Although I know people wonder this often, this I am rarely ever asked so bluntly. In fact, she and I had never really had a conversation about God and His role in her life, up to this point. We had prayed before, and I have prayed a lot for her, but we had not gone deeper than that. When she asks this question, I am at first speechless and we are alone in silence. In my mind, I question the same thing....Lord, this is a good question...where are you in all of this? Why is this happening? 

I considered saying prayer for her (and for us, and for her family), but for once, I did not feel that was what I was supposed to do at that very moment. She had just told me that she had been praying, but she did not think He was answering her prayers. Reflecting now, I do not think she could hear His response through her own anxiety and fear.  I thought of several scriptures all at once, and I suddenly knew. I pulled out my portable Bible (my smartphone, always well equipped for any emergency...) and I read to her. My devotion that very morning was directly from Philippians 4:6...

“Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God” Philippians 4:6. 

The fearful and anxious thoughts that were consuming her were not emotions placed on her by God. He gives us scripture telling us that He is with us through everything, and not to be fearful, not to carry anxiety over anything. The burden of fear and anxiety is not from Him, and we can be free of this heaviness, even in times of severe physical illness and peril. We suffer, yes, but in suffering we are drawn close to Him. I know that God does not want us to be sick, but illness is upon and among us and our bodies are frail. In this life, in our times of peace, prosperity and health, we rarely turn to God to ask for more, and I dare say we rarely turn to Him to give the thanks we should, to have so much in times of plenty. But of course when we are struck with illness or hardship, we desperately seek God. Even the nonbeliever will seek “the higher power” for answers to desperate prayers. Even when people consciously choose to deny God, He still yearns for our return to Him. And when we turn to Him in those desperate times, He is a gracious God! He does not grow angry with us because we finally turned back to Him. On the contrary, He rejoices when we come back to Him, regardless of the circumstance that brings us to Him! God rejoices over us, just as scripture tells us in Zephaniah. We draw close to him in hard times. Perhaps therein lies the blessing of cancer. What irony that there could be such a thing. 

After pouring out these thoughts, and scripture to this patient, I looked at her face and she was very still. Tears had stopped and she seemed to be deeply studying what was said. I prayed that God was giving her heart peace and rest and that she would carry no more fear. Regardless of whatever path this journey carries us on, I am desperate for her peace and comfort. I plead with God constantly that He will work this miracle for her. I pray for her total healing. I pray for her cure. I know what statistics say, and I know what experience tells me, and I have seen miracles. I do not rule anything out any more when it comes to trying to predict what can happen in this world, and in this occupation. 

I will tell you, on the weekend in a hospital, invasive procedures (such as what she needed) are only on an emergency basis, and she was stable enough that we decided to wait until the next morning to have the fluid removed from her chest. She had  been through that procedure before, and things had not gone well in terms of her pain during procedure (known as a thoracentesis), and so she would only agree to have the procedure done if she could be sedated. Again, difficult to arrange on a Sunday. I left her that day after our visit seemed to have calmed her somewhat. I had no nursing calls about her for the rest of the day or through that night. 

So on Monday I made rounds, and when I arrived in her room, I was completely amazed. She was breathing better. She slept through the night, soundly - stating it was the best night sleep she had in as long as she could remember. She had no pain. She was able to lie flat in her bed...again, an almost impossible feat with half her chest full of fluid. She said she had no anxiety or fear. She felt “great.” She was not the same person as 24 hours before. The fluid had not even yet been removed from her chest, and yet she appeared to be ready to be discharged from the hospital. She looked and felt well. 

‘When anxiety was great within me, your consolation brought joy to my soul” Psalm 94:19

I reviewed her CT scan from the night before. No improvement from the last scan, and in fact, things were looking worse on the x-rays. How did she look this good? 

We proceeded with the thoracentesis and she did remarkably well. No complications. She went home the next afternoon. I saw her in the office the next day. She again looks amazing. She looks like a picture of total peace. No fear, no anxiety. Even as I write this, I can honestly tell you, I have never seen her look so calm since I have known her. 

So I have no idea what tomorrow holds. As I have explained to her, there is nothing more that I can do for her cancer, as she has had all treatment she can tolerate, and if the last treatment does not work, there are no others. But as I tell her this, she calmly listens and then says, “I will just take this one day at a time.” I asked her if I could share her story here, and she graciously agreed, and even allowed her sweet picture to be enjoyed. She is grace and happiness before my eyes. 

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We will plan for many scenarios, but we will live this day that He gave us, and be joyful in it. If I let anxiety and fear take control of my day, then I have taken my eyes off of God and the life that He has for me. Even in the darkest hours, and most perilous times, He is there and He will carry us all if we only ask Him to. I have witnessed a change in this patient that I truthfully never could have expected if not for the miracle of prayer and His promise to us. I have seen in her the change that is possible in every one of us if we pray deliberately and believe He will hear our prayer and respond. He is so mighty and so powerful and so capable of more than we can even imagine. Truly, through Him all things are possible. 

“I am leaving you with a gift -- peace of mind and heart. And the peace I give is a gift the world cannot give. Do not let your hearts be troubled and do not be afraid” John 14:27

the thing about pain....

1 Peter 5:10: 

“And after you have suffered a little while, the God of all grace, who has called you to his eternal glory in Christ, will himself restore, confirm, strengthen, and establish you.”

“Cast not away your confidence because God defers his performances. That which does not come in your time, will be hastened in his time, which is always the more convenient season. God will work when he pleases, how he pleases, and by what means he pleases. He is not bound to keep our time, but he will perform his word, honour our faith, and reward them that diligently seek him.” 

~ Matthew Henry

Ethan, summer 2012, age 10

The day finally arrived. On February 1, 2013, eleven days ago today, my infertility became obviously permanent. This has been an incredibly difficult topic for me and I have mustered bravery from some unknown depth to be able to write about this anywhere but in the comfort of my own private journal, but here goes. 

I have a son, Ethan, who is 11 years old as of January 31 this year. So what I have experienced is technically termed "secondary infertility." Although I was completely unaware of my condition until several years ago, I have suffered with endometriosis since I was 13 years old. The problem with my pain was that I was always told "I just have bad cycles." In other words, deal with it. 

Romans 5:3-5

More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not put us to shame, because God's love has been poured into our hearts through the Holy Spirit who has been given to us.

I have lived the last 29 years in 28 day increments. Contrary to what you may assume by that description,  I was not waiting for the "bad week" every month. I was waiting for the one good week I would have each month. My cycles were one week of premenstrual pain, one week of menstrual pain and one week of postmenstrual fatigue and malaise. Each month was scattered with periodic flares of pain, frequent ovarian cysts which would inevitably choose to burst at the most inconvenient times.  I have existed on an alternating regimen of tylenol, ibuprofen, alleve, and most recently mobic, until I am certain I have done some irreparable damage to my kidneys/liver sometime along the way. I never traveled without heating pads, and self adhesive hot pads are one of the greatest inventions ever to reach the shelves of your local drugstore.

I took oral contraceptives for many years, and I had some relief then. I truly believe it was because of these pills that I was able to conceive when I became pregnant with Ethan. The oral contraceptives, in a way, suppressed the endometriosis for a while, and possibly lessened the toxic environment in my pelvis such that I was able to carry a pregnancy. 

8 months along...

Being pregnant with Ethan was one of the happiest times in my life. I had no idea of course, that it would be the only pregnancy I would ever get to experience. But I loved every minute of it. I cherished the kicks in my belly. I loved carrying around my big and expanding midsection, making room for Ethan to grow in my ever increasing maternity wardrobe. I even loved the heartburn....as it was the constant reminder that my abdomen was not just for me, but had to be shared with this miracle growing inside me. I fell madly in love with the creature inside me I had never even seen or touched. 

A big part of my appreciation likely developed early on at around my 11th week of pregnancy when I began to bleed one morning while making hospital rounds. I immediately sought medical attention and the initial Doppler failed to detect Ethan's heartbeat which had been present the week before. I spent about 4 agonizing hours mourning the loss of an early term baby, as the nurse practitioner told me I had certainly miscarried based on her assessment. She referred me for an ultrasound later that day - hence the 4 hour wait - that ultimately confirmed she was in fact completely wrong. Ethan was fine, had a strong heartbeat, and likely I was just having some benign spotting that later proved to be of no consequence. 

1 Peter 4:12-13

Beloved, do not be surprised at the fiery trial when it comes upon you to test you, as though something strange were happening to you. But rejoice insofar as you share Christ's sufferings, that you may also rejoice and be glad when his glory is revealed.

So my pregnancy continued and I ate and gained weight like I was in a competition. Food had never tasted so good, and for that matter hasn't been that good since then! 

When I went for my 16 week ultrasound I was faced with another potentially devastating finding...Ethan had a choroid plexus cyst in his brain. This is for the most part a completely benign finding, but according to my physician, the anomaly can sometimes be associated with a chromosome defect (trisomy 8) which is incompatible with life. Yes, the baby might survive the pregnancy with such a chromosome defect, but with trisomy 8 he could be severely deformed and have pronounced neurologic derangements, and would not live long after birth. I asked about a million questions and researched the topic for hours, as any new young mother-who-is-also-a-physician would do, and panic set in. The odds were overwhelmingly in Ethan's favor that he would be completely fine - in fact he had absolutely no other problems on his ultrasound - but my mind went to all the bad places you could imagine. An amniocentesis was offered - recommended in fact, so that I would have the "opportunity" to terminate my pregnancy should he have a chromosome problem. Of course, the amniocentesis procedure itself can cause spontaneous miscarriage, creating the proverbial "catch 22"...do this test to be sure the baby is ok, but the test itself may cause termination of the pregnancy. 

Ultimately, I knew there would be absolutely no chance I would terminate the pregnancy, regardless of the status of his chromosomes, and I opted against the amniocentesis. Therefore, I truly did not know until the day Ethan was born if he would be ok or not. Talk about an eagerly awaited delivery. Of course, for those of you who know us, Ethan is absolutely fine and amazing and had not a clinical consequence of the choroid plexus cyst. 

All these trials, I am convinced, strengthened the bond with my baby, and with God, and inevitably left me to cherish every moment of what I now know would be the only pregnancy I would ever enjoy.

Ethan age 2

Ethan's arrival into the world was one of the most amazing times in my life, and has continued to be a daily journey of happiness and gratitude. After he was born, I was unable to get pregnant again. 

Ethan age 9

My monthly pain over the years escalated, and ultimately I underwent a laparoscopic procedure which confirmed the diagnosis I had most feared, stage IV endometriosis. I immediately knew the impact this could have on my chances of ever getting pregnant again. I had an "endometrioma" on my left ovary which was quite large, and caused the ovary to adhere to the side wall of my pelvis. I went on to have three more surgeries, all in an attempt to surgically remove (by various methods) the endometriosis implants that were causing me so much trouble. I was unable to let go of the idea that one day I may be able to have another child, and furthermore, I did not want to be postmenopausal yet. I was only 36 years old when all of this was unfolding in my life. 

Deuteronomy 32:4
⁴ He is the Rock, his works are perfect, and all his ways are just. A faithful God who does no wrong, upright and just is he.

I spent many many many nights questioning God about this. Why why why did this happen to me? I hear about women all the time who get pregnant but did not want to. Women get pregnant who were not even trying! Women get pregnant with far worse medical conditions than I had, why can't I?? I knew I wanted another child more than anything....if the Lord didn't want that for me, then why did he put this so heavy on my heart? My life was so full - I have a healthy son, a wonderful marriage, a great job, precious stepchildren and even now I am a "step-" grandmother, but yet there was an emptiness that was palpable in my heart. Where was the Lord in all of this? And furthermore, on top of all of that, each month I was greeted with the evil monstrous pain that only served as the reminder of my failing reproductive system. 

Galatians 5:22-23 

But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness,  gentleness, self-control; against such things there is no law.

That saying, "no one thinks about you more than you do" is painfully true. When we are faced with any trial or tribulation, we feel like no one else could possibly have felt the same grief or anguish that we have. Of course, in my profession, I see the grief and anguish of many, and yes that has helped me keep perspective that my own troubles are really pale in comparison to what could be. But it is all relative isn't it? When we are in pain, we hardly notice anything else. Whether it is physical or emotional pain, or both, the pain takes precedence over everything else in our lives. 

As I have coursed along this journey of endometriosis and all that it brings with it, I have repeatedly tried to outsmart it, deny it, accept it, and then repeat the cycle. Nothing, however, made it go away. Over the following years, the option of hysterectomy was offered many times by my physicians, although carefully so. The doctors working with me - bless their souls - knew how tender my heart was for another child, and they gingerly stepped around the topic of the permanence of a total hysterectomy. I just could not accept that Ethan was the only child I would ever have. And I could not understand why God was letting me continue to suffer through all of those years. And if I was not to have another child, why did I have one in the first place? When so many other women with endometriosis are not so fortunate? 

with my step granddaughters, Phoebe and Rosemary
Thanksgiving 2012

Finally, this past November, I guess the Lord grew tired of my stubbornness...He is a patient God after all, but really enough is enough...I knew when I woke up with the most horrific pain just before Thanksgiving, that my decision was made. The mobic - tylenol - advil cocktail no longer worked and I was trying to function as a physician with uncontrolled pain. Narcotics are just not an option for obvious reasons, and so my journey was in the midst of a serious turn. I called my physician and scheduled my hysterectomy, and on February 1, 2013, the pain that haunted me for nearly 30 years came to an end. 

Perhaps the greatest miracle occurred in November on that very day when the decision suddenly came to me so quick and easy. My heart had softened and I suddenly had no remorse any longer about my inability to have more children. My God had heard my cries and felt my tears all along, but He also heard my pleas and felt my resistance to making that next step of having the hysterectomy. He gave me space and time, all along though carrying me in His grace and love. I had questioned, "Why are you letting me suffer like this?" When in reality, I was the very reason I was suffering. Had I listened to His words years ago, when I clearly remember Him telling me -- countless times in fact -- that more children were not in my future, I would have had this surgery long before now, and my pain would have ended. When I stopped fighting His plans for me and I conceded to His will, my suffering ended. Why is this so hard for us to grasp as human beings? 

Hebrews 13:5-6, 8 tells us "...be content with what you have, because God said "Never will I leave you; never will I forsake you." So we say with confidence "The Lord is my helper; I will not be afraid...Jesus Christ is the same yesterday and today and forever." 

God was with me through the entire journey, even in the days of my pregnancy with Ethan before I even knew the future plans he held for me. My pain lasted far longer than it needed to in many respects, all because I was stubborn to give in to what God was telling me. But in a way, my suffering ultimately is what brought me closer to Him at this very time in my life. 

The truth of pain is this exactly. In no way does God want us to suffer...indeed I see many times looking back when He told me the truth of what I did not want to hear. But in our suffering, we can draw close to Him. For in Him is the only place where peace can be found. In Him I have been freed from the anxiety of my future and the sadness of an inability to have another child. So while yes, my infertility became obviously permanent to me on February 1st, it had been permanent long before then and God walked the journey with me at a pace I needed so that in the end I could have comfort in only His love. Yes, He is the same yesterday, today and forever will He be my gracious, loving, patient, gentle amazing God.

Finding balance Every day

Finding balance

James 1:2-4

Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing.

In high school and growing up, I was never athletic. I never had the desire to be. I participated in sports but I was uncoordinated, uninterested, and self conscious. All the attributes of a tall lanky teenager worried about what her friends would think, I was uninspired. My talents were in the classroom. I excelled in school, bookwork that is. I never dreaded class, or tests. That part came easy to me. I guess I realize now that my path was headed towards medicine at a very young age, since math and science were absolutely my favorite classes in school. I looked forward to the science fair more than I looked forward to homecoming. Even now, I have a hard time admitting that!

But a particularly strange thing happened to me a few years back. All of the sudden, I found myself exhausted every day, with no energy to even last through a typical work day without feeling like I wanted a nap. My joints and bones started aching. I had a hard time standing up from a chair if I had been sitting too long. I felt like my body just would not cooperate. All at once I felt I had aged 30 years. I have always tried to maintain some type of exercise. I went swimming before work when I was an intern in Richmond at MCV hospitals. I would walk on the treadmill. I like to go to the gym and get on the stairclimber or elliptical. But at this point in my life, even those activities were increasingly difficult to fit in my schedule, and when I finally found the time to go to the gym, I was simply to tired or achy to work out. I gained weight and basically felt miserable. I was increasingly relying on Starbucks to get me through the day. Caffeine was effective, but even that lost its power after a while. Work suffered and I was irritable with my job, my staff. I dreaded going in every day. I didn't want to get out of bed in the mornings. I was clearly sinking into an abyss of darkness and I did not even have a desire to climb out of it for a while.

One very fateful afternoon, I remember sitting in the living room with my husband watching the 2008 summer Olympics. The marathon was on and I remember feeling totally captivated watching the runners. They were so lean, and so fast, and so limber. I had tried to run a VERY FEW TIMES in my life....I am sure never more than 10 minutes per effort...and I simply gave out of breath. I concluded with certain confidence that "I am just not a runner." I rationalized that some people are runners and some are not. Clearly, I had been in good shape before...I mean, I could climb a Stairmaster for 45 minutes straight...but since I could not run for more than 10 minutes, there must be something genetically different about me that renders me incapable of being a runner. I had friends who were runners, but I was just not like them.

But as I sat there watching the Olympic runners participate in the marathon, and hearing the commentators talk about their stories, I was struck with the idea that I should give it another try - an honest try. I needed something, after all, since my body was clearly falling apart by the day, based how bad I had been feeling.

My first half marathon Richmond VA 2009

So I started running. At first on the treadmill for 30-60 second intervals....yes, 30 to 60 SECONDS. Running was hard....especially at the age of 37, when my body had NEVER experienced such TRAUMA. Running was worse than being up all night on call working in the ICU in downtown Richmond at MCV...What a wimp I was! How had I let this happen to my body!! But I perservered, and gradually I worked up to 30 minutes running on the treadmill. I set my sites on running outdoors.  After letting my legs adjust to the different surface....asphalt is much harsher on the legs than a cushioned treadmill surface...I again gradually worked up to about a 30 minute walk-jog. I found a friend to run with, which turned out to be one of the greatest blessings in my life. A running partner quickly becomes a great friend when you endure literally hours together pounding the pavement and talking, solving all of the world's problems by the mile.

Romans 5:3-4  

More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope

Finishing with a new 5K personal best Thanksgiving Day 2012
Asheville NC

Eventually, I started running longer and I joined a group of amazing friends with the Orubo running group here in town. I have learned that the running network in Greenville is full of amazing and inspirational people. Local road races are like BFF reunions! But perhaps the most amazing thing I have witnessed is how God has used this experience to bring me so much closer to Him. No longer have I been walking around in a fog of fatigue and malaise, but now I have such greater mental acuity and I feel so much better. I have experienced the morning air in frigid temperatures and something happens to my thoughts throughout the day that constantly bring me closer to God. I have peace at work. I have motivation to get up in the morning - - even at 4:15 am to go out in the cold and run. I began craving His word and time with God every day. I began noticing God more and more in everything happening in my life. It was not that "God showed up," but rather He had been there the whole time...I just finally took the time to really notice Him in everyday life!

And this led me to a painfully obvious conclusion about my relationship with God.

finishing my first marathon with my stepson Alex 2010
Richmond VA

Just as I remain committed to getting out of bed each day and heading out for a run that can be hard and grueling, the rewards are 100-fold. And my relationship with God is much the same. He expects me to work hard. And He puts some seemingly insurmountable challenges in my path. But He has equipped me to do the work He puts before me. And when the day is done, the reward is great. I have a very hard time putting into words how I feel when I know I have just done something that should have been miserable and impossible, but is instead amazing and wonderful. God's plans for me fill up my heart with an indescribable joy.

Colossians 1:11

May you be strengthened with all power according to his glorious might, 

for all endurance and patience with joy

People ask me all the time, "how do you do what you do?" Or, "your job must be so depressing...I could never do it." And certainly when I step back and look at what I do from the outside, I can see how people would perceive that. Yes, there are hard days. Just like some long runs are hard....but life is not a walk in the park. It is a marathon. And we have to train daily for what God has ahead for us. Sinking myself in His word every day is my training plan. I cannot lie back idle and ignore the race that is ahead of me. God has given us a great gift....a plan for our life, with the tools to run the race. Our Bible is our instruction and proof that He is coaching us through this life.

We simply have to get up each morning and head out for the run. The rewards are greater than we can even imagine. Jesus is our greatest fan and the only reason we can endure the job we have here.

I know this because He runs along with me every single day.

Finishing the OBX race 2012 with some of the greatest people I have ever known in the Orubo Running Group

Hebrews 12:1 

Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles, and let us run with perseverance the race marked out for us.

I will dwell in the house of The Lord

Psalm 23:6

"Surely your goodness and love will follow me all the days of my life and I will dwell in the house of the Lord forever"




With my job comes an insurmountable task of paperwork....writing notes about the daily patient visits, signing paper orders for medications to outpatient hospice agencies, signing off on electronic chart summaries, hospital orders, medication orders. That is not even to mention the amount of paperwork the insurance companies require. If I write a prescription for an expensive medication, I will then have to complete no less than 3-4 pages of additional forms explaining why the patient needs the medication (as if I am not really prescribing it for the right reasons...but I will try to hold back my cynicism here), and then usually re-writing the same prescription order on a form that the insurance company requires. I cannot begin to understand how creating such a lengthy paper trail and increasing the work load on so many people saves money somehow, but that is the reason I am given for why I have to do all of this extra paperwork. Easily, on any given day, I may spend 5 or more hours actually face to face with patients. For that level of patient care, I will have no less than the exact same amount of time spent in paperwork just for that day. I never seem to finish. It is quite literally one of  the must burdensome aspects of medicine these days!

Hebrews 10:36 

For you have need of endurance, so that when you have done the will of God you may receive what is promised.

Perhaps making the problem worse is the fact that I am somewhat of a perfectionist. (My coworkers and staff please don't laugh here...).  I want my charts to have all complete details, and I do everything I can to leave no stone unturned when reviewing patient histories. Every detail can be important. I sometimes lie awake at night feeling like I have missed something....And when I have that feeling, I have no option but to get up and look over a chart that is nagging me, to figure out what I have overlooked. The shocking thing is, I usually haven't forgotten anything, but those trips to the computer to review "one more time" always lead to an important discovery somehow.  I may run across a telephone message that came in after I left the office. Or I may see a test result that just came through. What is it that pulls me in the direction of my patients, or of anything, when I should otherwise have my mind off of work? I honestly know the answer to this question, and yet I am still always astonished when this happens to me. The Lord prepares me for work, and He expects me to respond to His calling.  And yet I constantly feel compelled to "do it myself." I feel like I am the one in charge, and I have the responsibility to comb over all details and make all of the decisions.

Romans 8:28

And we know that in all things God works for the good of those who love him. who have been called according to his purpose.

This "perfectionism" and need to feel like I am in control interferes with my ability to listen to God.  I lose the ability to hear Him when this happens. I think I need to check off my list of things to do: sign the charts, dictate my notes, go home, spend time with family, help my son with homework, shower, go to bed...check, check, check things off the list. When I get in the rut, sooner or later I get blindsided. I am in the routine and comfortable with my abilities. Patients are doing well. No catastrophes. The chemotherapy worked just like it was supposed to. No patients are getting the "rare 1% side effects." Then a storm rolls in and all of the sudden things fall apart. I am once again humbled and I realize...I was never in charge at all. I never was in the driver's seat. How could I be so proud? And yet the Lord knows this about me. Psalm 139 speaks so clearly on this.

You have searched me, Lord,

    and you know me.

² 

You know when I sit and when I rise;

    you perceive my thoughts from afar.

³ 

You discern my going out and my lying down;

    you are familiar with all my ways.

⁴ 

Before a word is on my tongue

    you, Lord, know it completely.

⁵ 

You hem me in behind and before,

    and you lay your hand upon me.

⁶ 

Such knowledge is too wonderful for me,

    too lofty for me to attain.

God is patiently always waiting for me to acknowledge that He is in fact, the one in the driver's seat, if only I will get out of His way.

I recently took care of one of the sweetest souls this earth could ever know. She was quite ill, but her cancer was not so terribly rare, and the treatment had a greater than 80% chance of a complete remission as long as she could take chemotherapy. There was NO chance, in my mind, that she would not get better. She sailed through her treatments, always getting the chemotherapy doses on time and without any complications.




Through our relationship, we just fell in love with each other. I loved her family. I felt I had known her for years, not just months. We became great friends. She was incredibly grateful, thanking me profusely every time I saw her. This is always astonishing to me - that people thank me for giving them treatments that make them feel so terrible. And after all...I am just the instrument writing out the recipes that will heal the cancer. I did not create the solution...but I have been placed here to implement what God has been behind for far longer than I have even been alive. But nonetheless, she was grateful for her treatments, and I was grateful to be a part of her life.

But when we did her final scans, her cancer was strangely still there. What the heck?? That was not the plan at all!  I looked at her scan and felt I had been hit in the stomach. At that time, I did not turn to God to question anything. I felt like He had a plan for all of this.  I immediately knew what needed to happen. I felt despair for literally a few moments, and then as quickly as those feelings came, they left, when I came up with the solution...she just needed radiation therapy and she would be fine. I knew in my heart that she would be okay.

So I met with her and her daughter, we reviewed her scans, and she was ready for radiation. I felt relief that we had a "plan B." But in the back of my mind, I had a nagging feeling that I cannot to this day put into words. Something just was not right.

Psalm 46:1-3 

God is our refuge and strength, an ever-present help in trouble. Therefore we will not fear, though the earth give way and the mountains fall into the heart of the sea, though its waters roar and foam and the mountains quake with their surging. "Selah"

She had completed a few days of radiation therapy but was getting sicker. She had to be hospitalized, and she continued to decline. Her inpatient evaluation unveiled another problem, one that would require a major operation just to save her life. We were at the unfortunate 'fork in the road.' With surgery, she may survive and proceed to radiation and everything will be okay. Without surgery, she may not survive. She decided to go ahead with surgery, and again I felt relief. Okay God, thank you for showing us the way to her healing!

She survived the surgery, and everything on paper and on her x-rays looked promising. I could see no reason at all that she would not recover. She did not, however, regain strength. We as her doctors believed that she would make a full recovery. We pushed her to get up and about. We gave her nourishment. We gave her pep talks. And she wanted more than anything to do all that the doctors were telling her to do.

But for some reason, her body was making a different journey than we had planned. At last, we realized that she was in fact dying. Despite all of the medicine, all of the support, and all of the tests indicating she should be getting better, she was dying.

Her daughter was at her bedside when she went to heaven. She told me of the miracles she witnessed that night. There is no greater gift than being next to the one you love when they get to go to heaven. Her mother's healing came, but not in the way we all expected or the way we wanted. We had to let go of our control, of our perfectionism and our expectations and accept what God's plan was for her. God was gracious to us. He did not take her too soon, before we were ready. He led us to the point where we could join her journey, and understand what was happening. And when we were at that place, with His comfort and grace surrounding us, only then did He take her home.

Heaven got a new angel that night. She told her family before she went that she was ready and she wanted to be with Jesus.  And there, with Jesus, she will wait for the rest of us to one day join her.

Her daughter of course has given me permission to write about her here, in case you recognize her story. As I was in the midst of this very recent journey, I did not even realize what was really happening until close to the very end. I became so attached to her, my sweet darling patient, I could not let go of the control I wanted to have when it came to her treatment. I must always be careful about that - - listening to God's plan is sometimes hard to do. It is sometimes - OFTEN - very different than the plans we have ourselves.

But our loving wonderful ever-present God is gracious. He knows we hurt and we miss our loved ones when they leave us. And looking back, I know now that the entire journey my patient took was not a journey to healing her physical earthly body, but rather a journey to prepare her spirit and to prepare her loved ones - the ones that would be left behind for a while - to be ready for her departure. Her family was blessed with so many more memories even after her sickness came. Even at the time of her death, her family witnessed the miracle of her last breath...when they were strangely awakened without a stir in the room in the middle of the night, in a quiet hospice room, just in time to see her final breaths here as she went to heaven. What an awesome moment.

In your loving sweet memory, until we see each other again...I will miss you

Matthew 11:28-30 

Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light.

A beautiful season

Isaiah 43:2

"When you pass through the waters, I will be with you; and when you pass through the rivers, they will not sweep over you. When you walk through the fire, you will not be burned; the flames will not set you ablaze."

This has been a beautiful Christmas season in so many ways. I was blessed to have been able to spend time with my family. We are fortunate to have each other and our health. But there has been a lot of recent sadness, not just with my routine work, but in our community. My heart has been heavy this week for those of us left behind to mourn losses. And to try to make sense of it all, I have struggled.

Perhaps we have no greater fear in life than that of death. Although, I do not think it is really death that we fear as much as the process of dying, or dying too soon, or dying before we have had a chance to live the life we dream of. We don't want to leave our children behind to grow up without us. We don't want our children to go before they are grown. We fight with every ounce of our beings to prevent death, and illness, and pain. Paradoxically, we go through misery and pain to prevent misery and pain. Cancer seems like the worst form of suffering. The treatment can be worse than the disease. Chemotherapy itself is pain. But every day, I meet people who willingly let me give them drugs which they know will cause many adverse effects, all in the name of healing.

I have real trouble with this. I know with the simple stroke of my pen that I can order a treatment that can save a life....not that I take credit for a life saved on any level. I know very plainly that the only lives that are saved are through the miracles of God's great healing power. I do believe His great works are done with modern medicine in many cases...indeed I believe our discoveries of medicines ranging from penicillin to morphine to paclitaxel chemotherapy were all orchestrated by His guidance. But in the same way these medicines can heal, they can harm also. So there is the paradox. I have given drugs to heal cancer, and I have seen people die from the side effects of their treatment, even after the cancer has been cured.

How can I reconcile what is happening in these events? I treat a patient's life threatening cancer, giving chemotherapy drugs that certainly work, and then watch another problem develop that has potential to take a life. Robin Roberts, now not only famous as the host on Good Morning America, but also for her battle with breast cancer, was treated with chemotherapy in an effort to permanently cure an early stage breast cancer in 2007. Only 5 years after that she developed a rare condition known as MDS (Myelodysplastic syndrome), a likely direct result of the damaging effects of her initial chemotherapy on her bone marrow. The prognosis for MDS is very poor, many patients only surviving a few years. Cures from MDS are quite rare.  Surely, the odds of developing MDS are only 1-2% of all patients receiving chemotherapy for breast cancer.  The bottom line is, when I look at the odds of curing the breast cancer that my patient already has, compared to the risk of MDS or some other devastating outcome (there are many), there seems to be a clear answer: give the chemo and save a life, and take your chances with the possible bad outcomes too.

But then I see a patient who is the "1%." Statistics mean nothing when you are the 1%. And this is where I struggle the most. Why would God let me get so far along in a decision and treatment plan, only to come out on the other side to face yet another deadly sentence? I feel betrayed at times like this! I get angry at God, and at myself. Could I have done something different to have prevented this from happening? Should I have somehow known that this one patient would be the one to have a bad outcome from her treatment? Could have somehow predicted it? Will she survive this?? In much the same way, I question him even in other circumstances...like why does He 'let' a young mother get a horrifying cancer and lose her life before she has really had the chance to live - to raise her children or grow old with her husband? Or why does God 'let' a child suffer with cancer and then 'lose' the battle?

It is a crazy thing even as I sit here writing this, to have such an accusatory tone with God, my creator, who is so all knowing. How can I ask Him, "Why did you let that happen? Why was that life lost?" In fact, He knows that no life is lost. Our bodies are just earthly shells of the beautiful souls created in His perfect image. He knew us and loved us before creation and when we depart this place, He has a perfect heaven waiting for us. Psalm 139 tells us: "For you created my inmost being; you knit me together in my mother’s womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well." God tells Jeremiah "Before I formed you in the womb I knew you, before you were born I set you apart." (Jer 1:5). God in fact tells us many times in the Bible that He knows us, knows the plans He has for us, He knows our journeys. He has great plans for us. (Psalm 121:3, Zephaniah 3:17, Psalm 62:1, 2 Thessalonians 3:16, Matthew11:28, to name a few...). But He never promises an easy journey. In fact we have all experienced that through our suffering is the greatest opportunity to grow closer in our relationship with Him. 

Although we are left behind here to mourn those souls who move on before we are ready for them to go, they are blessed and free of all sadness, sickness and pain. I truly know God was with them on their journey and continues to be with them. They are no longer suffering to prevent more suffering. There is no need for chemotherapy to heal, no need for morphine to ease pain. God has cured everything by allowing their souls to leave this place and move on to a more perfect place next to Him in His kingdom.

I have been directly and poignantly asked many times, "How do you know this is true? What if there is no heaven? Isn't this belief just a comfort to help us feel better about the loved ones we have lost?" I certainly have asked that of myself many times, and as an old friend once said best, "you never really know God exists until you start asking questions." Maybe that is a bit of a simplistic way of stating it, but I do know there is a lot of truth there. I have been with many people as they make their journey to heaven. I have been in many hospital rooms and have felt the presence of the Holy Spirit in a way that words cannot describe. I was at my father's bedside when he died. I saw my father leave his body and go to heaven and without a doubt it was the most precious moment in my life to be able to witness that miracle.

But how I know for sure is somewhat of a complicated and convoluted explanation, and I have many examples I can share. I look back on experiences and see much more clearly how God has been present. Often in times of stress God is hard to see so vividly...we are wrapped up in our own grief and panic and we lose sight of the big picture. But take a moment and look back at one of the most stressful periods in your own life. Then look back beyond that in the days or months leading up to that time, and remember how a series of otherwise seemingly unconnected events came together in a way that clearly impacted the crisis you were going through. God was carrying you through the storm when you did not even realize a storm was brewing.

My father, about a year before he died

My father passed away when he was only 61 years old. He had always been organized, thoughtful and compassionate towards his family, and to his friends. He was giving always to others, giving of his money, his time, his prayers. He was devoted to his family, and he adored his only grandson, my son Ethan. My father was a small business owner, a contractor in eastern North Carolina. When he began having health problems, his business suffered for 2 years before his death. He had been ill - more than we even knew - and was unable to tend to matters of his company. He ultimately had to declare bankruptcy. He was inattentive to bills, and creditors were calling. He let life insurance policies expire. He even let his health insurance policy expire. All of this, I know now, was the result of his illness taking its toll on his mental clarity. But when he died, somehow, every bill was paid just before benefits ran out. The bankruptcy cleared just before his death, unknown to him. My mother was strong through everything, her strength no doubt a miracle from God. My father's funeral costs were significant. Shortly after he died and not long after the funeral, when we were trying to figure out how to pay the bills, my mother was again miraculously taken care of...my father had a single remaining life insurance policy that paid exactly enough to cover his remaining expenses for the funeral.


No one will ever convince me that God did not know the journey we were taking. Even before we realized what was happening - that his death was imminent, God was there, carrying us and making provisions that we would all be ok. And we have been. More importantly, so is my father. He is there in heaven waiting for us to one day be with him again. And I know we will be.

So to reconcile why does God let these things happen? I cannot exactly explain why we get sick, or why we hurt, or why young mothers have to go to heaven far before their time here seems to be done. But I do know that we never make the journey alone, nor are we left behind without the help of God getting us through those difficult times. That is our comfort. And that is His message to me daily. We are never without His presence, even when we do not ask for Him to be with us, He carries us. And even when you do not realize the storm is coming, He is preparing the way to bless you even then. 

"Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff, they comfort me." Psalm 23:4