Why Is Faith Important for Physicians during Discernment and Formation?

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In the spirit of “On Being a Catholic Physician,” we medical students of the Society of Saints Cosmas and Damian (SSCD) at the Vanderbilt University School of Medicine want to share our beliefs on an important question: exactly why is faith important for us in our discernment and formation?

We have reflected on why faith matters to us on our journey of becoming physicians and more specifically, why faith matters in our becoming Catholic physicians.

Calling oneself a “Catholic” in the world today seems to mean different things to different people. For some, being a Catholic means following a few rules or traditions at different times of the year—not eating meat on Fridays of Lent or coming to Mass on Easter and Christmas. To others, the Church may be more similar to a cultural heritage—the nuns may have taught you something at your Catholic school growing up, but the particulars may not have stuck. Perhaps you received First Communion and were confirmed, but your family stopped going to Church after that, and you slowly fell away. Or, you may have found the Church simply irrelevant—what does a church that is thousands of years old have to say that is relevant to the world today or to my life in science and medicine? Is it even possible to be a student of science and a person of faith?

Most of us have asked these questions and struggled to find answers that meant something, answers that challenged us to change the way we live our lives.

The SSCD, made up of the Catholic students at the Vanderbilt University School of Medicine, encourages proposing these difficult questions because we believe they are worth asking.

At the center of the Church and the Catholic faith is the belief that all human beings, men and women, are made in the image and likeness of God. Man was created to know God, to love Him, and to praise Him; however, through the introduction of original sin, man became separated from God, and death became a natural part of the human condition. This love story between God and man was embodied in the Jewish people of the Old Testament and in the covenants God established with Adam, Noah, Abraham, Moses, and David. In this common history, Catholics are the brothers and sisters of the Jewish people. But history tells us that these covenants were not sufficient, and man continued to turn away from the Lord. Eventually, a covenant would be established that would fulfill every previous covenant and prophecy and yet accomplish what had not been previously achieved: reestablishing full communion between God and man.

The Catholic Church and all Christian denominations assert the historicity of God’s plan for man, unfolding through the Incarnation of Jesus of Nazareth, fully God and fully man, born of the Virgin Mary, who was later crucified on a cross, buried, and resurrected from the dead, as told by the Gospel writers. After Jesus’s resurrection, hundreds of people saw Him alive, in the flesh, and heard His words as He demonstrated both His saving power over life and death and His ultimate good and perfect love for us. He prepared His Apostles for the coming of the Holy Spirit at Pentecost as well as the institution of the Church as His body actively working in the world after His ascension. The Church spread like wild fire throughout the East and West, consistently proclaiming the “Good News” of Jesus to the world even to this present day.

Now, for those not familiar with Christianity or those who choose to reject these events, this is quite a story. For others, and even for some Catholics, this may feel like old news, irrelevant news.

Lewis (1952, 55) once wrote in Mere Christianity that Jesus of Nazareth was either God made man or a lunatic, but he could not be just a moral teacher. The Gospel, or “Good News” of Jesus Christ, requires a decision, one made after much consideration, because acceptance of the Gospel requires every- thing—a choice to live not for oneself, but for the Lord, and in service to others, both our friends and our enemies. As members of the Church as the Body of Christ, we are uniquely called to have a personal relationship with Jesus, to be baptized and receive the Sacraments, and to live no longer for ourselves, but for the Lord. And the reward? Pure joy, meaning, deep peace, and eternal communion with the God who loves without ceasing!

So, Why Is This Faith Particularly Relevant to Medical Students, Physicians, and Other Healthcare Professionals?

Most of us entered medicine because we believed in something bigger than ourselves. For many, this “something bigger” is lived out in the service of others through the science of medicine. For a Christian, it is aligning this service with the teachings of Christ and His Good Physician model.

As medical students in the SSCD, we want to help others through the sharing and application of medical knowledge and research in the biomedical sciences. We believe that the extreme challenges of this fascinating and intellectually demanding career path will be most emotionally and spiritually reward- ing by allowing our faith to lead us. It is said that if you want to make God laugh, you should tell Him your plans. This essentially means that life does not

always go the way we all plan for it to go. This is especially true when it comes to medical school, choosing residency programs, navigating relation- ships within and beyond medicine, keeping crazy hours, and understanding our greater purpose in this process. Trying to keep all of these things in life balanced can be fraught with many pitfalls. Here, in the midst of our weaknesses and failures, is where faith really steps in for us in the SSCD.

As we search for balance, meaning, and purpose in our own lives, we are constantly challenged by the questions of our world and society and how faith may play a role in addressing them:

Is there such a thing as objective truth, and if so, can we even know it?

Are human beings different from other animals or merely the materialistic end product of natural processes?

When does life begin, and is it ever appropriate to purposely end a suffering life?

How can our faith help us better understand our patient’s journey through illness to recovery or death, respecting his or her own choice of faith, atheism, or agnosticism?

How can we nurture our faith as a driver of our love and vocation in the healing art of medicine and as a servant to others?

The Catholic Church proposes remarkable answers to these questions, and we have found many of these answers to be worthwhile and intellectually satisfying, though still challenging. The members of the SSCD want to be a part of this conversation because we believe these questions matter. While we might come to our own differing conclusions, we see great value in respectful dialogue with any- one willing to converse with an open mind. This dialogue is particularly important in the area of bioethics, where topics such as abortion, end-of- life issues, and stem-cell research involve not just biomedical research but also important philosophical and ideological principles.

In practicing as Catholic physicians, we will encounter people of all faith backgrounds. We are called to the vocation of medicine, a holy calling, in order to serve our fellow human beings, to reduce human suffering, and to magnify dignity. As we endeavor to pursue those goals, we will encounter people of many faiths, agnostics, and atheists. Our universal Catholic faith, embraced to its fullest extent, calls on us to bring Christ’s eyes and ears to each and every person in the most loving way possible for that human being. Our faith, the truth of the

Schuering et al. 15

person who is Jesus Christ, and his life path and teachings found in the Gospel—these are the tem- plate for how to achieve this calling.

In thinking about our beautiful interactions with patients of so many faith backgrounds, we would like to leave you with one thought put forth by then Cardinal Ratzinger as he was interviewed by Peter Seawald for the book Salt of the Earth. Seawald, himself a nonbeliever, asked Ratzinger how many paths there were to God, expecting perhaps for Rat- zinger to say “one” or “a few.” Ratzinger, now known to us as Pope Emeritus Benedict XVI, replied brilliantly, “As many as there are people” (Ratzinger and Seewald 1997, 32).

We embrace this sentiment wholeheartedly as we continue to learn from and minister to our secular campus at the Vanderbilt University. Through open on-campus encounters between people of various beliefs at our SSCD-sponsored events, we believe that the Catholic faith opens our eyes to the unique path to which God calls each student, physician, nurse, and patient. We pray that with his insight we can walk with each other to bring healing of mind, body, and spirit not only to our patients but  to ourselves, our community, and our world.

References

Lewis, C. S. 1952. Mere Christianity. New York: Harper- Collins. p. 55

Ratzinger, Joseph, and Peter Seewald. 1997. Salt of the Earth: The Church at the End of the Millennium. San Francisco, CA: Ignatius Press. p. 32.

Biographical Notes

Kelly M. Schuering grew up in St. Louis before graduating from Duke University with degrees in public policy and global health. She is currently a fourth year medical student at Vanderbilt University where she is a co-president of the Society of Saints Cosmas and Damian. She is matching into internal medicine and hopes to work providing primary care for medically and socially complex patients in the future.

Kathleen Anthony is a fourth-year medical student at Vanderbilt University, where she is a leader of the Society of Saints Cosmas and Damian. She is interested in underserved primary care and Catholic Soxcial Teaching, which was formed by her undergraduate studies at Notre Dame.

Logan LeBlanc is an Internal Medicine resident at Louisiana State University Health and Science Center. She received her undergraduate degree in chemistry from Louisiana State University and graduated from Vanderbilt University School of Medicine in 2018. Her professional interests include biomedical ethics, particularly those sur- rounding end-of-life care, and she hopes to one day complete a fellowship in Palliative Care.

Brittany Gatta grew up in Iowa and received her  BS from Iowa State University. She attended Vanderbilt University Medical School from 2012-2016, during which time she served as a president for  the  Society  of Saints Cosmas and Damian. She is currently a resident in internal medicine at Duke University Hospital and plans to be a fellow in hospice and palliative medicine next year.

Kelly M. Schuering, BA1, Kathleen Anthony, BS1, Logan LeBlanc, MD1, and Brittany Gatta, MD1

The Linacre Quarterly 2019, Vol. 86(1) 13-15 Catholic Medical Association 2019

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Catholic Medical Association Taps Nashville as Top Guild

CMA Best Guild Award 2019-2

The Catholic Medical Association showered the Nashville Guild, its chaplain, and its president with honors during the 88th annual Educational Conference held Sept. 26-28 at the Opryland Hotel in Nashville.

The Nashville Guild and its sister organization, the Society of Saints Cosmas and Damian for medical students at Vanderbilt University School of Medicine and Meharry Medical College, received the Outstanding Guild Award.

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What happens when a patient says, ‘Doc, help me die’

Dr. Wes Ely assesses George Scharber, a patient in MICU, using the RASS scale.

“But can’t you help me die, Doc?”

My 54-year-old patient was alone in the intensive care unit, with no family or friends in his life. He slumped in his bed, gasping, staring up at me. Admitted with lung fibrosis and pneumonia, he had scars and infection aggressively replacing his airways, despite our best treatments.
As a newly minted doctor years ago, my mind was usually occupied with beeps and buzzers providing me technical information to help calculate choices about patients’ care. Having developed gray hair over many years at the bedside, my first priority is now more straightforward: to hear the voices of the vulnerable people looking up at me from their bed. That is what I try to do as a physician, including, of course, what they tell me in the silences.
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Death by organ donation: Euthanizing patients for their organs gains frightening traction

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How should society respond to the increasingly long list of people waiting for organs on a transplant list? You’ve no doubt heard of “black market” organs in foreign countries, but are there other options that should be off the table?

If you were on a transplant list, would it matter to you if the organ was obtained from a living person who died because of the donation procedure itself? What if she had volunteered?

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Can Catholics Get to Heaven?

Catholic doc talking to Protestant doc – ecumenism between friends

A Catholic and a Protestant Friend Talk About Faith

I pray in thanks for Pentecost with a growing “bonfire” of love for the Holy Eucharist
Link
E. Wesley Ely

Two Christian doctors sat down over dinner in Brussels while attending an international medical meeting, feeling worn-out from intense pro-con debates over involuntary euthanasia that is occurring in that region. The discussion shifted to focus on commonalities and differences in our Catholic versus Protestant beliefs. This led us to explore a recent post by John Piper asking whether Catholics can get to heaven.The Protestant took the question seriously. Soon afterward, two other Catholic friends, an American priest and an Australian nurse, joined me in a hearty exchange of approximately 100 emails with our Canadian Protestant friend, deeply diving into our faith in response to that post. We focused heavily on issues related to sola scriptura/sola fide versus Catholic tradition/magisterium. This blog post is a summary I wrote to him as a letter to conclude our dialogue, focusing primarily on points about which evangelical Protestants differ from Catholics on sacraments and salvation:

To my dear Protestant friend,

In Jesus’ prayer for believers, he says to the Father, “I pray … that all of them may be one” (John 17:20-21). And yet, we know that, although we are one body of Christ, we are a fractured body. To wit, our extensive conversations, stemming from Rev. Piper’s recent article, made clear the extent to which many Protestants think the Catholic path to salvation is heretical. An executive summary is warranted.

Catholic belief is that both Scripture, the inspired word of God, together with sacred Tradition, the handed-down teaching of the Apostles, essentially form one source of divine Revelation, in whichbishops, in union with the Pope, exercise faithful interpretation. We call this interpretational authority the magisterium. This twofold aspect of revelation truthfully embraces the scriptural centrality of the apostolic teaching, the teaching role of the Church and the reality that the written word cannot contain all that Jesus said and did, as evidenced by John 21:25.

Much Protestant understanding of man’s path to salvation is that the words of Scripture alone, without any mediating ecclesial authority, are sufficient for a proper interpretation and fidelity to Christ and his teaching.

Catholics distinguish sacred Tradition (the teaching of the apostles) from many traditions (small ‘t’) and customs that have developed over the last two millennia, such as certain prayers, including the Rosary, specific devotions and some liturgical practices, including adoration of the Blessed Sacrament. For us, such traditions are consistent with all Revelation and part of a mystical, beautiful and joyful path through which we come fully into relationship with God, while you view them as heretical.

I was not at all expecting that both of our Christian churches would accept the magisterial articulation of sacred Tradition represented in the Apostles’ and the Nicene-Constantinopolitan Creed. That was very affirming: Though you hold firm to a Scripture-alone position, you readily admit that the critical terms “substance,” “nature” and “person” found in the creed are binding in articulating scriptural teaching on the Holy Trinity. You maintain that the creed is binding because it is faithful to Scripture, yet we remain at an impasse in that, at the same time you hold that the councils that generated that language have no “binding” or “mediating” authority.

Our discussions also taught me that your “word-only” belief does not mean that Protestants necessarily interpret Scripture more literally than Catholics. Many core Catholic doctrinal and sacramental beliefs and practices, contained in sacred Tradition and biblically established, are matters that Protestant churches consider purely metaphorical. I had naively misunderstood sola scriptura to mean that you always more literally interpreted the Bible than we.

For example, many “Creationist” Christians deny the science of evolution, believing that God created the world in seven days or “day-like” intervals, whereas the Catholic Church believes and teaches that proper interpretation of creation texts recognizes the highly symbolic and liturgical nature of these texts. Proper hermeneutics enables us to identify the genre of literature for maximal understanding and context.

This undergirds the 2,000-year witness of the Christian community to the apostolic faith in the realism of Jesus’ teaching on the Eucharist (John 6). We believe that Jesus meant (and the apostles taught) exactly what he said (e.g., “This is my Body … this is my Blood” Matthew 26:26-28 and John 6) and that the Eucharist is the “real presence” of Christ’s Body. Indeed, for us, the Eucharist is “the source and summit of the Christian life” (Catechism, 1324). Yet you believe that Jesus spoke of his Body and Blood only as a metaphor, even when the biblical account shows contemporaries of Jesus abandoning him precisely because of this radical realism. You do not accept early Christian writers such as Ireneaus, Cyril of Jerusalem and Gaudentius regarding the change (“transubstantiation”) they professed takes place in the Eucharistic bread and wine.

We both believe baptism brings about a real change in the soul of the one baptized. You contended, though, that early Christian witnesses (Justin Martyr, Irenaeus, Cyril of Jerusalem, Ambrose, Augustine) were wrong about baptismal “regeneration” — the baptismal wash — being a source of the forgiveness of original sin.

We believe in the unique role given to Peter in Matthew 16 and the authority/power to forgive sins given to the apostles in John 20, whereas you were emphatic that Jesus is the only mediator between God the Father and man and that no other mediation can exist.

In suffering, Catholics believe we join Christ in his passion, through which he accomplished our potential for redemption (Philippians 3:8-11). You interpreted redemptive suffering to imply that we in some way erroneously believe that we “add to” his passion.

We believe in ongoing conversion, whereas you believe that being “saved” by declaring belief in the death and resurrection of Christ is completed conversion, followed by ongoing sanctification.

We honor Mary, the Mother of God, and acknowledge that she has an active role to play in the assembly of believers. While we both agree that no mediator is required to have a relationship with Christ, you hold it heretical to consider Mary as one who efficaciously prays with and for us. This approach minimizes the depth of the scriptural passages that show Mary as a model of faith called “blessed” by “all generations,” whose “pierced soul” was prophesied by Simeon and who averted disaster by her solicitude at Cana.

My Protestant brother, what became surprisingly clear in our monthlong discourse was that no manner of evidence (even biblical), persuasion, passion or history stemmed the tide of our disagreement related to sacred Tradition as an inspired instrument of Jesus’ revelation to the Church for our daily worship and conversion.

Let’s return to Jesus’ prayer for unity in John 17:20-21. As Pope Francis indicated in praying with other major church leaders at Christ’s tomb at the Church of the Holy Sepulcher, we must take pleasure in knowing that we are all facing toward the Lord. We are all asking for God’s mercy. We all want to make him large and ourselves small (John 3:30). As St. Maximilian Kolbe defined sanctity via the equation“V=v,” where God’s Voluntas or “will” must become our voluntas. I pray in thanks for Pentecost with a growing “bonfire” of love for the Eucharist and for the advocacy of Mary and the saints in our ongoing conversion, or, as you would say, sanctification.

E. Wesley Ely, M.D., M.P.H., is a professor of medicine and critical care at Vanderbilt University and president of the Nashville Guild of the Catholic Medical Association.

Comment

The Dachau Cross – bearing the weight of suffering in light of Easter

For more on the Dachau Cross from Dr. Ely:
The Dachau Cross: Bearing the Weight of Suffering in Light of Easter
National Catholic Register

or

The Power of the “Dachau Cross”
Mike Allen Show (podcast)
beginning at the 25 minute mark

“Bear the Cross cheerfully and it will bear you.” Thomas à Kempis, author of The Imitation of Christ

We are people of Easter, who have just experienced the risen Lord yet who careen daily towards life’s certain pitfalls, large and small, which challenge our ability to live like Christ. It must be our hope, our resolute commitment, to imitate Christ through a focused understanding of His Passion. The happiness of our Easter message and the smiles of Spring and new life all around us are dramatically enhanced when we contrast the season to the reality of the burden Jesus bore for us. As a lung doctor, I often imagine His weight, while He hung on that thick wooden cross, caked in blood, pulling His thorax down towards the ground and making each breath more and more difficult and painful. Dying of shock and suffocation would be beyond misery, and yet He bore on that Cross not only His precious weight, but that of you and me piled onto His shoulders. Jesus’ cross never breaks, and I’d like to draw on two historical religious relics to explain how that relates to our life today and always …

It is said that Thomas à Kempis’s book The Imitation of Christ is the second most reproduced book in the history of the world (translated into over 50 languages) behind the Bible. Years ago, as we wrested with a burned house, Kim and I were gifted a modern translation of the famed guide to “imitating” Christ by the Nashville Dominicans. In its introduction, the translation mentioned that the original c.1441 autographed manuscript, which was carried by Thomas in his pocket as he traveled Europe converting and guiding others, is held in a hermetically-sealed safe in the Bibliothèque Royale in Brussels. After locating this Royal Library last week, I managed to coerce the unyielding librarian to soften up and consider opening the safe to allow me to see this precious religious artifact. Thanks to my phone camera, you can see the worn 570 year old book pictured here, complete with his signature on the last page.

From Belgium, I traveled to Utrecht Netherlands, where the spiritual lesson unfolded in a surprisingly stark, yet timely manner that holds instruction for you and me in our daily imitation of Christ. In the Dom Cathedral, the most famous building in Utrecht, I found displayed renditions of a cross the curator said was housed in the rear. Curious, I went to see this cross and was struck by the fact that it was broken, as you can see in this picture.

On returning to the curator to find out more about the broken cross, he told me that it was cast in Dachau by the prisoners. I mentioned that it was a shame and surprising that it has been broken in subsequent years, especially since it was made of such thick metal with no signs of rust or corrosion whatsoever. That is when he looked away.

Almost instantly, his eyes began to water and he murmured something under his breath. I was struck by his change in demeanor, and felt compelled to find out what he’d said. “What, Sir?”

“It was made that way.” he whispered, “It was made broken by inmates in Dachau.” Empty, we walked away from one another. Nothing more could be said.

I went back and prayed before the cross. It immensely hurt to consider the prisoners’ pain that led to that Dachau cross, just like it hurts today when we lose a child or a grave, seemingly unjust occurrence happens in our life. As a person of Jewish heritage whose relatives were incinerated in the holocaust, I suffer at the thought of the heartache that led the inmates to think that Christ’s cross no longer held hope for them. And yet, could any amount of pain that we will ever endure come close to the mental anguish of the God-man being spit on by us in our daily life, those He brought into the world?

Jesus’ cross never broke, and to this day and always He offers himself and holds us on His shoulders, bearing the weight of any suffering we will ever experience, whether we know it or not. We get confused by life’s events, and only one thing ultimately makes any sense of it all: the mystery of the Cross and its message of God’s forgiveness, mercy, and love. Today and every day, this is what we must carry with us out into the streets. The Dachau cross is a message of our brokenness, not Christ’s. This is our Easter message, replete with immense joy, as Thomas à Kempis’s book directs us: “If you seek Jesus in all things, you will surely find Him.” The Imitation of Christ, Book II, ch. 7

AMDG, E. Wesley Ely, MD, MPH

FOLLOW UP CONVERSATIONS between me and an Agnostic Jew

From: MH
Sent: Friday, February 24, 2017 6:05 AM

Dear Wes, I remember discussing the broken cross with you a few years ago, perhaps after I visited Holland. I wish there were a way to know whether your interpretation of the cross and the prisoners’ interpretation were the same. So many people lost faith because of the Holocaust and, even today, then fact that the Holocaust happened is cited as proof that a loving God could not exist because a loving God would not have allowed it to have happened. For this reason, I could imagine the prisoners made a broken cross to symbolize loss of faith. Additionally, since the cross was also the device by which Jesus was killed, and since the prisoners heroically resisted being killed, the broken cross could also symbolize defiance.

Of course, my interpretation represents only the Jewish agnostic’s perspective.

Warmly, MH
On Feb 24, 2017, at 7:15 AM, Ely, Wes wrote:

MH, there were two reasons for me to send this to you. One, to share myself. Two, to learn from you. I acknowledge the truth of what you write below…and out of deep respect for you and my Jewish brothers and sisters, I can only answer you from the mouth of another Jew who lived in Auschwitz:

From Frankl’s 1948/1975 preface to his “The Unconscious God,” p.16… “The truth is that among those who actually went through the experience of Auschwitz, the number whose religious life was deepened – in spite, not to say because of this experience – by far exceeds the number of those who gave up their belief. To paraphrase what La Roche-Foucault once remarked with regard to love, one might say that just as the small fire is extinguished by the storm whereas a large fire is enhanced by it – likewise a weak faith is weakened by predicaments and catastrophes whereas a strong faith is strengthened by them.” Viktor Frankl

From: MH
Date: February 24, 2017 at 6:29

Thanks Wes, that’s helpful. I hadn’t read that book and was more familiar with the alternate perspective. It seems like evidence that core beliefs are unshakable. That deep and abiding faith cannot be killed, even by the worst tragedies. Also that challenges to our beliefs lead most of us in the end to believe more strongly.

wes.ely@vanderbilt.edu

RELEVANT PICTURES:

Thomas à Kempis’s book The Imitation of Christ, the original manuscript, worn leather and parchment, carried by him circa 1441 over 570 years ago and now held in a vault in Brussels

dachu-2 dachu-1

A “broken” cross caste of thick metal by inmates at Dachau Prison Camp, WWII Germany.

dachu-3

dachu-4

Comment

Christmas Fire: A Finding Amidst the Ashes

by E. Wesley Ely, MD, MPH and Kim A. Ely, MD
Published by Dobson’s Focus on the Family, 2003

It was Christmas night past, and we were indeed sleeping quietly as mice, when the alarms went off. “Rrrr, rrrr, rrrr, rrrr,” was the deafening sound I heard at four a.m. I first thought that the noise was a false alarm since the security had malfunctioned often in the past. Bolting out of bed to turn off the box before my wife and daughters woke up, I was shocked to see heavy black smoke pouring into the hallway. Was this a nightmare? Ducking down in order to breathe, I made it to the den where I saw flames two feet high! This was no nightmare; this was real!

“Kim, get the kids out of the house and call 911,” I screamed, while I ran for our only fire extinguisher. Spraying frantically, I put out the flames and thought we had time to call neighbors for more extinguishers. But to my horror, within only about five minutes, the fire surged up and advanced so rapidly through the house that I knew we had to get out immediately. (The fire marshal later instructed me that a fire grows at a rate of 50 to 100 times per minute.)

Yelling at the top of my choking lungs, I ran back to where I had last seen Kim and the girls. They were gone. I ran out to the street, where I found them still half asleep and bewildered. Shaking and crying in the winter night, the four of them stood in a tight knot, watching our home burn. I grabbed for them, hugging and patting and saying over and over, “It’ll be all right, it’ll be all right.” But deep down I couldn’t help thinking that if I’d simply had more extinguishers it might have been possible to have saved the house.

Looking back to that terrible night, Kim and I can now see how God had already begun to prepare us for this challenge of faith. The five of us on Christmas Eve had done two things to help focus attention on the real Christmas. We spent three hours watching and discussing Nativity, a wonderful movie of the trials and tribulations of Mary and Joseph, living by simple means, yet struggling in their quest to bring Jesus into the world despite Herod. Following Mass, we helped at a shelter to cook and serve dinner for forty homeless men, all down and out, though all working at least one job; we provided them with clothes, shoes and other gifts. We explained to our six-year old twins and their eight-year old sister that it is our duty to serve those less fortunate than we. We stressed that despite their lack of a home, these people were still deserving of all the good things with which God had blessed us. How were we to know that very shortly we, too, would be homeless and without clothes, shoes or gifts?

On Christmas the fireplace and its hearth had been a constant source of amazement and wonder for our family. For example, that morning after the children confirmed that Baby Jesus had indeed been born in our own nativity scene, they had found sooty footprints coming from the fireplace. Could they have been from Santa? Kim and I enjoyed watching the three excited sleuths decide that indeed they were from the jolly soul. Yes, he had eaten the cookies and milk left by them, and had even sketched the requested self-portrait (as they said, they wanted to know what he looked like “for real life”). But most importantly, when inspecting the chimney itself more closely, they had found a shred of red velvet clothing hanging from some metal within. Obviously this was from his coat or pants!

This sort of magic continued to warm our spirits throughout the day and into the night. We spent the early evening with some of our best friends in front of a classic crackling fire, enjoying each other and looking over wedding albums and family photographs. In fact, we never left the neighborhood a single time that day. Once our hearth fire had died down, the kids informed us that they had arranged a slumber party. Our upstairs had just been completely renovated, and was especially nice and fun for the kids, who had been waiting to have a sleepover! As we tucked the five children into bed at nine o’clock that night upstairs, our friends went home and we prepared to go to sleep.

Alas, due to their excitement, the kids couldn’t sleep. The neighborhood guests eventually went back across the street to sleep with their parents. Following that, our three children asked if they could come sleep in our bedroom. It had never happened that all five of us had slept downstairs in the same room before. Was this clearing of upstairs an accident or a well-orchestrated divine intervention?

Presumably, the fire started from a spark flying out from the fireplace onto the carpet several hours after we had gone to sleep. When the smoke alarms finally woke us up, I had run to the tunnel-like staircase that was immediately across from the room that was in flames. Looking up, I couldn’t see beyond the third step! This narrow staircase was acting as a chimney. The entire upstairs was already black as night with smoke — surely a death trap. Considering the fact that piercing alarms do not typically wake children (which is well-documented), it is highly likely that I might have struggled to no avail to rescue five sleeping angels from upstairs that night.

In this instance, one might ask God why He allowed such a fire on Christmas night. This common yet misdirected question in our opinion would be better restated as a prayer: Dear Lord, we thank You for protecting us during this immensely dangerous fire. You were watching over our entire family and that of our neighbors by clearing the upstairs in advance. In addition, you prepared us to handle the misfortune through your Christmas message during the previous 36 hours.

Many psychologists have written that a house fire of this magnitude is akin to death in a family. In your life, an array of similar tragedies may sometimes befall you and your loved ones, temporarily weakening and sickening your spirit. From our experience during the weeks following the fire, we will tell you that the most strengthening medicine for us was the collective outpouring of love and support from the community — neighbors, friends, clergy, teachers, classmates and even complete strangers. The tendency of some is to wonder “What have we done to deserve such a disaster.” Rather than believe that God causes such tragedy, we believe that he comes to us in its midst to minister to our souls during the long healing process. As Job remained faithful after repeatedly harsh blows, so all of us must continue to know that our Father will never leave us. Let my daughter’s observation provide you the evidence…

While the Christmas tree is perhaps the most visible sign of Christmas in a home, all that remained of ours was a ten foot long black wooden spear. Alongside this remnant, however, we found the vestige of our charred nativity scene. This previously beautiful and hand-painted nativity was one that we had bought as a young couple, thinking that we would display this sign as the focal point of Christmas for our future children. The blackened porcelain baby Jesus, now missing an arm, was alarming at first. With the unencumbered wisdom of a six-year old (I write this with all sincerity), and a healthy and unshaken faith, our daughter Brooke spoke words of the Spirit, “Look, Daddy, we knew Jesus was born on Christmas and he didn’t leave us. He’s staying right here to help us now.”

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On New Year’s Day, we received a note from a friend with whom we had lost contact about 10 years earlier. His family’s house had also burned down a few years ago, and so he offered me a practical and well thought-out emergency list of things to do. The last and most important “to do” was to remember 1 Thessalonians 5:16-19 – “Be joyful always, pray continually; give thanks in all circumstances, for this is God’s will for you in Christ Jesus. Do not put out the Spirit’s fire.”

The healing from this loss is going to take a while and will come in waves. I have just spent the last hour going from bed to bed in my house comforting Kim and our three daughters. Even as I type on my knees in thanks, I can smell the smoke in my clothes, but at least I can smell! Having both studied the scientific aspects of breathing, we are more overwhelmed than ever in considering this miracle that was almost ripped from our grasp by lifeless black smoke.

Faith is like a muscle, which will either atrophy from disuse or grow stronger when put to the test. For us, faith is being exercised in a healthy way. This itself is a gift from God. Like parents who know what is good for their children, so the Father knows what is good for you and me (Matthew 7:7-12). The wonder of God is that he chooses unexpected ways to bring us closer to him. Hopefully, my family will respond to this Christmas birth of Jesus with trust and a keen sense of closeness. Forever, we will have this Christmas blaze to thank for our bolstered relationship with God. We wish the same clarity, and even more, for you and your family!

P.S. We had chosen to send the following message inside our Christmas card, mailed 5 days before the fire:
Heaven’s Hues – “Looking back you will see that every step was planned. Leave all to Me. Each stone in the mosaic fits into the perfect pattern, designed by the Master Artist. It is all so wonderful. But the colours are of Heaven’s hues, so that your eyes could not bear to gaze on the whole until you are beyond the veil. So, stone by stone, you see, and trust the pattern to the Designer.”
from God Calling, entry from November 11th

Dr. Kim Ely is an Assistant Professor of Pathology, and Dr. Wes Ely is an Associate Professor of Medicine in the Division of Allergy/Pulmonary/and Critical Care. Both practice at Vanderbilt University Medical Center in Nashville, TN.
Email address: wes.ely@vanderbilt.edu

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Swimming Pool in the ICU

This true story was originally published in the Wall Street Journal on Friday, June 17, 2016 (http://www.wsj.com/articles/a-swimming-pool-in-the-icu-1466117000). It is republished here for a medical audience to allow a wider communication of the events that unfolded in respecting a dying man’s wish in the ICU while undergoing life support with mechanical ventilation.

“A swimming pool in the ICU? You must be nuts.” The nurse’s voice was almost lost amidst the whooshing ventilator and infusion pumps. Another nurse snapped, “Look, I’m an atheist and even I don’t think its nuts. It’s dignified. We are granting a man his dying wish!”

Five days earlier, we admitted Bennie and met his family. Frail and wrinkled, his look of utter confusion and furrowed brow would pluck the heartstrings of even the most calloused physician. Decades spent in Southern tobacco fields left him looking old enough to remember Hoover’s presidency. Double pneumonia and too much sedation made him delirious, and I was thankful for his family. His daughter and son, Laura and Len, implored, “Take good care of Dad. He’s all we have. Being on a ventilator is terrifying, but we believe in miracles.” While loving, such a mindset could become problematic since his situation had the makings of a fatal illness despite our best technology.

With antibiotics and fluids, Bennie improved dramatically and was taken off the ventilator several days later. That same night, though, a massive stroke paralyzed his entire left side, and he went back on life support. We quickly administered clot busting medicine, and he rallied again, remarkably regaining movement of his left arm and leg. The following day, the intern reported, “His delirium has cleared, and he’s mouthing words around the endotracheal tube despite his wicked aspiration pneumonia.”

I sensed an unexpected window of opportunity. We revisited Bennie’s life goals in light of what had happened and spoke directly about the big picture. With his children looking on, I held Bennie’s hand and looked him in the eyes. Choosing my words based on what I knew about his background and the family’s expectation of miracles, I said, “Bennie, just like tobacco plants eventually wither and wilt, so do we. You have improved in some ways, but overall you are very weak. How can we serve you best?”

The next morning, Laura and Len were upbeat, which confused me since Bennie looked weaker than ever. They pointed to words on a whiteboard in the room, explaining they were Bennie’s goals, “Stable vital signs. Baptism.”

I spotted Kelly, our charge nurse, smiling like a cat who’d swallowed a canary. In her arms she clutched a box containing a large vinyl swimming pool. First I made sure this was actually Bennie’s request and not the family’s. My next thought was that we’d have a chaplain anoint him with holy water in his bed, but Laura disagreed. “Jesus wasn’t sprinkled, Doc, he was dunked.”

A senior physician, said, “Wait, this man is on a vent! I’ve never seen a baptism like this in 50 years of practice.” Indeed, there was no shortage of opinions about whether this was appropriate, safe, or even possible.

A large area next to Bennie’s bed was cleared and an electric pump inflated the pool. When a multi-person bucket brigade proved too difficult, an engineer rigged dialysis tubing to circulate the pool with a stream of warm water. Bennie was then hoisted high into the air via a patient-transfer lift, and the ventilator was unplugged before lowering him into the pool.

Len gently took his father, the man who’d shown him how to farm, into his arms. He slowly submerged Bennie’s head completely under the water saying, “Dad, I baptize you in the name of God the Father, Son, and Holy Spirit.” On cue, the palliative care social worker began belting out “Amazing Grace.” The rest of us stood frozen in time.

First out of the water was blue corrugated ventilator tubing. Then his face appeared around the breathing tube. Bennie’s huge smile seemed to say, “Better late than never.”

When he died a week later, Laura implored me, “Doc, tell other people about Dad. We hope it will make them realize that we can all become strong through our weakness.” In fact, I have seen scores of patients and families use profound “outer wasting” as a catalyst for deep inner renewal. The two most important “frames” of our life are birth and death. We typically associate baptism with the former, yet Jesus spoke of his death as a baptism to indicate the formative next step dying represents for our journey.

The ICU team’s bold yet careful response to Bennie’s unusual request taught me an enduring lesson regarding sympathy versus empathy. Sympathy is feeling sorry for someone; empathy is feeling “with” someone. Amidst all the surrounding insanity of the hospital that day, diving deeply into Bennie’s life through his baptism on the breathing machine allowed all of us to be reborn, too. Being “with” him in that pool, and rising with him out of it, we walk into other’s lives better prepared to serve.

E. Wesley Ely, MD, MPH
Professor of Medicine
Assoc Director of Aging Research, VA Geriatric Research Education and Clinical Center
Pulmonary and Critical Care Medicine Vanderbilt University, Nashville TN USA
ICU Delirium and Cognitive impairment Study Group – www.icudelirium.org

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Humility Before Mercy

I tried to walk into the exam room with a smile.  To give the impression I was glad to see him.

I knew I had not succeeded.

I did wonder why he continued to return.

Every three months he came back for his scheduled appointments to check his A1C.  And, at regular intervals we checked off the quality measures programmed into my clinic’s EMR.  His urine microalbumin was creeping up.  The ophthalmologist reported mild diabetic retinopathy.

I wasn’t surprised.  As long as I had known him his A1C had never been below 8.  More often it was over 9.  Microvascular complications of long-standing, undertreated diabetes could not be held off.

Not untreated diabetes.  I had prescribed metformin and refill requests came from his pharmacy at intervals that convinced me he was taking it.  But metformin alone wasn’t doing it.  I had recommended adding a sulfonylurea.  No, he didn’t want that.  He had read about those medications on the internet, having searched Google, and had even printed out pages for me to read.  It was at best pseudoscience — completely unrelated to evidence-based medicine.  Did he really think I was going to acknowledge the validity of his “research”?

He had insurance.  So I could offer him other options, GLP-1 receptor agonists and DPP-4 inhibitors.  He agreed to consider those – and again came back with website pages printed out to share with me.  No, not those either.  “But thank you,” he said.  He was always appreciative.

Insulin?  No again.  He had read it would cause weight gain – now that was true! – and I had told him that losing weight would improve his A1C.  So he reasoned insulin would worsen his glucose levels.  I tried to explain – to no avail.

He said the same thing at every appointment.  “I need to work on my diet and start exercising.  I promise I will do it.  You’ll see a difference next time.”

But there was no difference.

I was dumbfounded.  Yes, he was smart enough.  He knew enough to use technology – but only to his detriment, I thought.  I was the one with four years of medical studies at a prestigious academic center, graduating in the honor society, three years of training in internal medicine, board certification, ten years of experience in practice, fellowship in my professional organization.

He didn’t have any of that.  He needed to admit that I knew more than he did about the appropriate treatment of diabetes – but he wouldn’t do it.  He continued on in his stubborn pride thinking he knew what was best.  He was paying me to provide medical care but then wouldn’t let me do it.  

Medical care – as in I cared about him!  I had seen other patients like him – losing their kidney function, their sight, their limbs.  Sometimes those consequences would finally convince them – and sometimes not even then.

Mercy requires humility, I had heard.  I was trying to offer mercy – one of the corporal works of mercy, caring for the sick.  But his lack of humility wouldn’t let me do it!  Without his humility, he couldn’t accept mercy.

So it is with us and the Lord.  Without our humility, without our willingness to admit that we need help, that we need forgiveness, that we need redemption, His mercy can’t reach us.  I have to admit that I can’t save myself.  Mercy requires humility.

And I couldn’t do anything to save this man from the ravages of diabetes without him.  Without his humility.

But perhaps there was another way.

Maybe I was the one who needed the humility in order for him to receive the mercy of my medical care.

Maybe I needed to admit that I had not yet found the right way to help him.  Perhaps I needed to understand him better, to learn what his concerns were, to explore what he knew about diabetes.  Maybe I had to admit that my threats of diabetic complications were never going to win him over.  I was so sure that I had all the facts, all the data, all the answers.

But unless I was humble enough, unless I accepted my lack, my inability, my inadequacies, I would never be able to help him.  To give him mercy.

And wasn’t this, too, the lesson God taught us about His mercy?

For to give us mercy, Jesus, the Son of God, humbled Himself, emptied Himself.  He took on the form of a slave, made in the likeness of men.  God took on humility.  The Word was made flesh, and dwelt among us, and worked among us, and taught us, and healed us, and ultimately suffered and died for us.  That we could receive His mercy.  

For me to bring mercy to my patients then, in the light of Jesus the Divine Physician, I was the one who needed to approach them with humility.  Yes, using the knowledge I have – yet emptying myself dying to self, humbling myself before another made in the image and likeness of God.

Next time – I would walk into the exam room with a genuine smile.  I would be glad to see him again.

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