The First One

Let me tell you about the first one. 

This one particular lady was brought in under my care for having a mild heart attack, and was waiting for a cardiac catheterization (otherwise known as a dye test).  However, she had several other issues that made it unsafe to have this test, and required some medical stabilization.  (I’m deliberately being vague, in the interest of patient confidentiality). 

A week later, this poor lady had another heart attack, but one that required an emergent trip to the cardiac catheterization lab, where the cardiologist opened up her coronary artery that was causing all the trouble, and her EKG seemed to go back to normal, and her chest pain was pretty much gone.   Awesome.  My only wish for her was that we could have gotten her other medical issues under control sooner, so that her second heart attack could have been avoided.  Still, things seemed to be going well for this special patient of mine.

A few hours later, I got called to the Coronary Care Unit, with a sense of urgency in the nurse’s voice as she said “we need you in bed 3, right away.”   A first for me, I’d never been called to assess a patient urgently, they’ve always been stable, and I can just mosey my way to the patient without worrying too much.

I arrived in the CCU, to see my patient from earlier that morning, writhing in the bed, agitated and moaning with pain.  She looked very grey, not the normal pink vibrant colour that healthy patients always have, and wasn’t responding all that appropriately to verbal commands and to speech.  It was quite easy to figure out that something was very wrong with this woman, but the difficult part was figuring out what the issue was.

So, with the help of some other residents who were on call that night, we did several investigations, the first of which showed that my patient’s blood had become very, very acidic compared to what is normally acceptable.  So, based on that fact, she was electively intubated (a tube put into her airway, so she could be hooked up to a machine that would breath for her).  We brought her over to the xray department, wheeling her stretcher through the narrow hallways, and into the CT scanner, and back to the CCU again to await the results.

The Code

That’s when it really started.  While the other residents were attempting to get IVs and ART lines (special IVs that go into an artery and measure blood pressure in real time), I noticed her EKG starting to change.  When I became convinced (which was very quickly) that her heart tracing looked an awful lot like VT (one of the rhythms that we’re taught in first aid that an Automated External Defibrillator will shock), I mentioned it to the other residents, and checked her carotid pulse at the same time.  Nothing. 

I have taught, as a first aid instructor, and one of the changes that was made in recent years was the elimination of the pulse check.  Initially I thought that was ridiculous, but now I understand; the uncertainty attached to not finding a pulse is excruciating.  Nonetheless, for the first time in my career, I called “a code.”

The nurses rushed into the room, and put a hard, clear plastic board underneath my patient’s back.  I climbed up onto the bed, placed my hands on her sternum, and proceeded to administer chest compressions.  The first compression is always the worst, because it’s the one that breaks all their ribs.  I heard that awful cracking sound, and felt the vibrations right through to my shoulders, a sensation that haunts me even now, and brings tears to my eyes when I think of it.

But there was no time for tears then.  I counted, cycles of thirty, for 2 minutes.  No need to count, really, because she was intubated, and so ventilation and chest compressions happen independent of each other.  Still, it’s ingrained, and I counted until I felt my compressions were deteriorating, and I asked another resident to switch with me.  Once I had gotten down from the stretcher, it then became my responsibility to “run the code.” 

Keep track of the time.  Monitor chest compressions for effectiveness.  Give 1 milligram of epinephrine every 3-5 minutes.  Rotate people through compressions.  Check for a pulse every 2 minutes.  Rinse and repeat.  4 milligrams of epinephrine, 10 units of insulin, 3 ampules of sodium bicarbonate, 1 ampule of calcium chloride, a sodium bicarbonate infusion and 2 Our Fathers (which I said quietly when I wasn’t telling other people what to do) later, we checked the pulse, and she had a perfusing rhythm (meaning that her heart was effectively pumping blood around her body).

Right, so back to what we were doing: trying to figure out why this poor woman was suddenly trying to die.  By this time, the results of the CT scan were back, and our patient was bleeding into her belly, and had lost a significant amount of blood.  The collection of blood was putting pressure on her other organs, causing her bowels to become starved for oxygen, putting her into a medical condition called ischemic gut. 

So we consulted the surgeons, all of who said that this patient was not a surgical candidate, because she would die on the table.  “For medical management.”   So we tried to establish better IV sites for large bore needles that would allow fast infusions of various fluids.  A new ART line was needed, but we couldn’t seem to establish one in her radial arteries, which had been put into spasm by the number of times they’d been poked with needles. 

So we started giving her units of packed red cells (which is what we mean when we say a blood transfusion), fluids and medications to keep her pressure above 90 mmHg systolic.  Then we sat back and waited to see if all our interventions would help her to improve. 

A relatively short time later, 2 nurses burst out of her room, and called the second code blue on this patient in a single night.  So I ran the code again.  By the grace of God, this code was mercifully shorter than the first, and we established another perfusing rhythm in our patient.  Nothing short of a miracle the first time, much less the second time.

I hardly slept at all that night.  Terrified to leave the CCU for fear that I would just get to sleep, and my code pager would alarm, and I wouldn’t wake up, I took a chair and propped myself up across from this patient’s room, and dozed for 5-10 minutes at a time over the course of an hour.  When I finally left that morning, my patient was still alive, and I was full of hope that we had kept her alive with the possibility of a full recovery. 

First the patient, then the doctor

My patient was the first to go into shock, but of the physical kind.  When I left the hospital, and decided I was going to forgo sleep for another while and go straight to church, the stress of the entire night washed over me at once.  I fought back tears, reminding myself that the patient was still alive, and I had done everything I could.  I made it to the church, where I met my wife who was already there, got a cup of coffee, and we started to walk to our seats in the congregation.  I got a half dozen steps inside the sanctuary, and I suppose I had let my guard down enough by then that I was able to slide into emotional shock.  That’s when I broke down.  I walked out the back door of the sanctuary, wife in tow, sat down and sobbed. 

Until that day, I had never been prayed over.  I had prayed over others, and other people had prayed for me, but never over me.  Our good friend Ron, who had previously prayed for my salvation many years before I’d ever met him, saw my distress and came to talk to me.  He prayed over me that day, and I don’t even remember much of the prayer, but I do remember knowing that God was with me in that moment.  Then Ron said something that I carried with me for the days to follow: “God knew you could handle it.  He’ll never give you more than you can handle.”  I didn’t think I was qualified to handle what God brought my way that day, but God knew otherwise. 

I went home and read the sermon on the mount in the Gospel of Matthew later that day.  What spoke to me most on that eventful day was this:

“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more important than food, and the body more important than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? Who of you by worrying can add a single hour to his life?

And why do you worry about clothes? See how the lilies of the field grow. They do not labor or spin. Yet I tell you that not even Solomon in all his splendor was dressed like one of these. If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, will he not much more clothe you, O you of little faith? So do not worry, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For the pagans run after all these things, and your heavenly Father knows that you need them. But seek first his kingdom and his righteousness, and all these things will be given to you as well. Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.”  (Matthew 6:25-34) 

I found a peace after reading this, feeling like I could face whatever the outcome was to be for myself and for my patient that was hanging on to life by a thread.  I prayed to God for her, knowing full well that she may not be alive when I came back to the CCU for my next shift.

Still Alive?

Return to the CCU I did, repeating to myself as I walked through it’s heavy double doors “Do not be anxious” and “God never gives you more than you can handle.”  I looked into the room where my patient had been, to find her still lying on her stretcher, with the sound of the mechanical ventilator essentially the only sound in the room.  I read through her progress notes from the night before, and found that she hadn’t required any CPR since I had left, but that she did need to be cardioverted (shocked with defibrillator pads) for a rapid heart rate that caused her to lose all her blood pressure. 

I spoke with the nurse who had worked with her through the night, and found that she had a list of problems that were new since I had seen my patient last.  She hadn’t made any urine in 48 hours, which meant that her kidneys had shut down, and her electrolytes had now begun to shift in a way that would require dialysis.  There was blood in her stools, which meant that her bowels had begun to break down from the previous lack of blood pressure and oxygen.  She was on multiple drugs to keep her heart going and her blood pressure at an acceptable level.  Her liver enzymes were at a level I didn’t even know were possible, indicating a condition called “shock liver,” which is another sequela of having no blood pressure for a period of time.  Worst of all, she had stopped responding appropriately, and even though she was no longer sedated, the only thing she could do was withdraw from pain.

So I consulted the surgeons again, but got the same answer as before – not a surgical candidate, would not survive the operation.  I consulted the kidney specialists wondering about dialysis, and received an equally dismal response – would not survive the drop in blood pressure associated with dialysis.

All that, combined with a CCU nurse’s proclamation that what we had done to this patient wasn’t in the patient’s best interests any longer, I knew then what God had in store for me that day.  I summoned up my courage, and asked the nurses to call the patient’s family.  So I had my first family meeting, just myself, one of the CCU nurses, and the patient’s close loved ones.  I explained that it would not be in her best interests for us to provide CPR if her heart stopped working again.  I emphasized the gravity of the situation, and I told them in very frank, honest words, that the only one who could save this patient now was God, because there was nothing we could do to cure her current condition.  To add to this, we all agreed that the patient that we had all talked with, laughed with, smiled at so few precious days ago, was no longer really with us.  So it was that between myself and the patient’s family, we decided that my patient would have her treatment withdrawn, and her life placed firmly in God’s hands, where it had been all along.    

I returned to the CCU, and informed the nurses there of the new developments.  I went into the room with my patient, while the family waited outside, unable to bear to watch what was about to happen.  One of the nurses took the patient’s hand, and I followed suit and held her other hand, which also had a set of rosary beads tenderly wrapped around her fingers.  A respiratory therapist disconnected her from the ventilator, and another nurse pressed the power buttons on all the IV poles that were running the drugs that were keeping her alive. 

I’m not sure if I breathed very much for the next few minutes.  I held her hand as I watched her face, and the cardiac monitor that hung just above her head.  She took very tiny breaths, and it looked for a very brief time like she might hang on for just a little while longer.  Within less than a minute though, her blood pressure tracing started to lose amplitude (meaning that the top and bottom numbers of her blood pressure started to get lower, and closer together).  I held her hand tightly as her body struggled to keep its grasp on this world, and she looked as though she were fighting with every last ounce of her strength.  The first to go was her breathing.  Her shallow guppy breaths ceased altogether, with the intermittent agonal gasp.  Her heart began to slow, and her blood pressure dropped to incredibly low proportions. 

And then nothing.  All the lines on the monitor became flat, and the heart tracing read “asystole.”  The nurse and I held her hands for another few moments longer, and then it was time for me to do the last part of my job.

I took off my stethoscope, and placed it gingerly on her chest.  I listened for breath sounds and heart sounds that I knew would not be there.  I pressed on her sternum with my knuckles and did a sternal rub with no response.  Finally, I took a flashlight and shone it into her blankly staring eyes, and her pupils did not move in response to the light. 

The next words out of my mouth: “Time of death, 11:27.”

I think my voice was devoid of emotion, but my eyes showed otherwise.  I could barely hold back the tears, but I managed.  And inside, I was a hurricane of emotions, beating against my insides. 

I left the room to go inform the family that this beautiful woman, a mother, a wife, and so many other things in life, had ended her struggle and had passed on.  I walked down the hall to the room where they were waiting, and stopped just outside the door.  Swallowing back my own tears, I took a couple of deep breaths, and then opened the door.  I simply said, “It’s time.  She’s gone.”  There wasn’t a need for any more words than that, but as I lead them to say their final goodbyes, I looked at each of them and said that I was sorry about the loss of their mother, their wife.

So I ended my role in the care of this patient.  I sat in the CCU, processing all that had occurred in the last three days.  I sat wishing that things had gone differently, that we had figured out her problem earlier, that I could have done something differently that would have saved this woman’s life.  As I sat withdrawn into myself, a mother and her young child were passing by my seat.  The boy, no more than 2 years old, looked at me and smiled and laughed.  I felt an overwhelming sense in the gaze of that child, that God was looking at me through his eyes, telling me that everything was ok.  There hasn’t been a child in the CCU before that day while I was there, and there hasn’t been since.  God works in amazing ways.

So now you know the story of my first one.  The first patient that I’ve ever lost, a woman that I don’t think I will ever be able to forget, whose memory I will carry as a burden and a blessing in my heart for the rest of my days.  Such is the life of a new doctor.  However, I am comforted by the fact that I have God on my side, for if God is for us, who can be against us?  Not even death.

The Healing of the Great Physician

The Stranded Man

When I was a child, my father told me a story about a man who lived in a house that was being flooded by a river that had swollen over its banks.  The story goes something like this:

A man lived in a community that was situated close to a river, and on this day, the river had risen above the riverbanks, and was beginning to flood the little town.  Most people had evacuated already, but this man stayed in his house, telling everyone that God would look after him.

The river continued to rise, and as it got to the front door, a rescue team dressed in hip waders was going door to door, and they told the man who had stayed behind that they had come to evacuate everyone left.  The man refused, saying that he had faith that God would keep him safe.  So the rescue team went on their way, unable to convince him to change his mind.

The river continued to rise, and the man was forced to abandon the ground floor, and headed to the second floor where he watched the rising waters, keeping faith that God would indeed save him.  As he was watching out the window, a rescue boat came through the town, motoring through the streets that were now well flooded.  They saw the man in the window, and called out for him to come and get in their boat, and they would take him to safety.  The man replied that he had no need of a rescue, because God would keep him safe.  Once again, the rescue team left man to his own devices.

The water continued to rise, and the man was finally forced up onto the roof of his house, the last dry place where he could take refuge.  A helicopter spotted him on the roof of his house, and lowered a basket for him to get into and be brought up to the helicopter and to safety.  Once more, the man refused to let anyone give him aid, firmly believing that God would save him against all odds. 

The water rose even further, and the man was washed off the roof of his house, and he drowned.  When he came before God in heaven, he asked Him, “God, I prayed to you to save me.  I don’t understand why you let me die.”

God answered him, “My son.  I answered your prayers three times.  First I sent a rescue team on foot.  Next I sent a boat.  Finally, I sent you a helicopter.  Each time, you refused my answer to your prayers.”

What Happens to the Stranded

A Christian may sometimes refuse medicine on the basis of faith in God, believing that they don’t need human drugs/interventions to heal them.  A secular individual will do exactly the same thing, but refuse medicine on the basis of faith in themselves, believing that doctors can’t help, hospitals only make you sicker.  They believe they can figure out an answer or simply live with their suffering.

Let me give you an example of one such patient.  I once had a patient who came to the emergency room with some shortness of breath.  For a lady in her mid-sixties, she was remarkably healthy, and on no medications – or so I thought.  There are two types of people in their mid-sixties who don’t take any medications: those that are remarkably healthy, and those that just don’t visit their doctor.

This lovely woman was complaining of some shortness of breath, which had limited her ability to be mobile since she couldn’t get to the top of a flight of stairs without being very winded.  So I started to ask questions, and it seemed like a straightforward case of congestive heart failure (CHF). I could hear fluid at the bases of her lungs, her legs were swollen and I could leave my fingerprints in her legs.  Her JVP was visible at the angle of her jaw when she was sitting upright.  (Don’t worry if you don’t know what JVP is, it doesn’t make much difference to the story!)  So I thought I’d give her some medicine to make her urinate to get rid of some of the extra fluid.  However, part of the investigation is finding out why the patient has CHF.

I did an EKG that showed remarkable ST depressions, which in the absence of chest pain, and a troponin (an enzyme we use to check for heart damage) of less than 0.01, pointed toward a heart that was starving for oxygen, and working very hard.  Alright, further down the rabbit hole, why did her EKG look like this?

The remainder of her blood work showed this woman to be a very sick individual.  She had only about 1/3 the amount of hemoglobin that she should have had normally, which was starving her heart of oxygen, which was in turn making her short of breath. 

This woman turned out to have bowel cancer.

The astounding thing was that she had been suffering for over a year with symptoms that no person should just accept as part of their life.  She had been unable to lie flat on her back for a year, due to the overwhelming shortness of breath, and to go along with that, something called Paroxysmal Nocturnal Dyspnea (PND).  Essentially, waking up in the middle of the night with the sensation of being unable to breathe, as if you were smothering.  So this delightful woman chose to sleep in a chair, upright, for a year, rather than visit her doctor.  Her bowels were also causing her grief, and instead of seeing a real doctor, she just consulted Dr. Google and Dr. Wikipedia.  (Neither of these “doctors” have a medical license, by the way.)  She diagnosed herself first with lactose intolerance, so she cut out milk from her diet.  Then when that didn’t help, thought maybe it was celiac disease, so she eliminated wheat products.  That didn’t work either, so she became a vegetarian.  Unfortunately, she combined all these things, and just made herself malnourished to go along with everything else.

I watched this woman cry, with tears in my own eyes, as she told me the story of her suffering over the past year.  It is a difficult enough story, without also knowing that her suffering was for the most part unnecessary.  When I asked her why she didn’t come to see somebody earlier than this, she simply sobbed, “I don’t know.”

God’s Saving Answer

Just like the stranded man who refused a rescue party, a boat and a helicopter in favor of his faith, some people refuse modern medicine in the same way.  This is not to say that God doesn’t perform miracles of healing, but more often than not, God refers us to the medical system that he has so graciously given us, just as he sent men on foot to rescue the stranded man. 

“While Jesus was having dinner at Matthew’s house, many tax collectors and “sinners” came and ate with him and his disciples.  When the Pharisees saw this, they asked his disciples, “Why does your teacher eat with tax collectors and ‘sinners’?”

On hearing this, Jesus said, "It is not the healthy who need a doctor, but the sick.  But go and learn what this means: ‘I desire mercy, not sacrifice.’  For I have not come to call the righteous, but sinners.””  (Matthew 9:10-13)

Jesus himself made it clear that sick individuals need a doctor, just as sinners need Him.  We live in a broken world, a world that unfortunately is plagued by so many diseases that most medical students at some point have to realize that despite the size of their textbooks, people actually do make it to adulthood. 

“There are different kinds of gifts, but the same Spirit. There are different kinds of service, but the same Lord. There are different kinds of working, but the same God works all of them in all men.

Now to each one the manifestation of the Spirit is given for the common good.  To one there is given through the Spirit the message of wisdom, to another the message of knowledge by means of the same Spirit, to another faith by the same Spirit, to another gifts of healing (emphasis mine) by that one Spirit, to another miraculous powers, to another prophecy, to another distinguishing between spirits, to another speaking in different kinds of tongues, and to still another the interpretation of tongues.  All these are the work of one and the same Spirit, and he gives them to each one, just as he determines.” (1 Corinthians 9:4-11)

The power of modern medicine is given to us by the Spirit, and the gift of healing does not need to look like Jesus’ healing, simply by laying hands on a person, or simpler yet, having the person touch Jesus’ robes.  We should try to be like Jesus, but we are not, and cannot be, Jesus.  We cannot all look at a crippled man and say, “Get up, take your mat and go home.” (Mark 2:11)  I’m not saying that this is impossible, but for the most part we work within the constraints of the physical world that God has created, and that means medicine.

As the bible states, “Don’t you know that you yourselves are God’s temple and that God’s Spirit lives in you? If anyone destroys God’s temple, God will destroy him; for God’s temple is sacred, and you are that temple.” (1 Corinthians 3:16-17)  It also says, “Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your body.” (1 Corinthians 6:19-20) 

We should all follow God’s instructions, and do our best to take care of ourselves, to honor God with our bodies and recognize that our bodies are God’s house.  We should strive to follow medical advice, though there is nothing wrong with being critical of the evidence that is currently available.  That being said, it is reasonably clear that a healthy diet, exercise and a regular medical check-up are worth doing.  And of course, don’t smoke, follow the bible’s instructions on the consumption of alcohol, and stay away from random plants and chemicals that one might consume for recreation. 

One last thing – I have had patients whose families have blamed the patient for their own sickness.  One gentleman accused his wife of being sick because she didn’t pray enough.  If you agree with him, you need to read your bible more often.  As a starting point, go to the book of Job, and you’ll find that despite the fact that God himself said of Job “There is no one on earth like him; he is blameless and upright, a man who fears God and shuns evil,” (Job 1:8), he was still afflicted with terrible circumstances, including “painful sores from the soles of his feet to the top of his head.” (Job 2:7)  It is possible to be a follower of Jesus, or a biblical hero that God Himself praises for his conduct, and be afflicted by disease.  Pray, yes.  But don’t think that you or your loved one has become sick because the relationship they or you have with God is somehow not strong enough.  Since the Garden of Eden, the world is a broken place, and people become sick.  The last thing a sick person needs is an accusation like this from someone close to them. 

Treat your body like a temple of God; look after yourself, and seek medicine when you’re not well.  We are complex, multidimensional creatures, with physical, emotional, mental and spiritual needs.  None of us can afford to neglect any aspect of our overall well-being, and while it seems obvious to many, that includes the physical body God has created for us.  David Martin Lloyd Jones (who was a physician before becoming a preacher), when preaching about Psalm 42 said, “Does anyone hold the view that as long as you’re a Christian, it doesn’t matter what the condition of your body is?  You’ll soon be disillusioned if you believe that.  There are some in whose cases it is clear to me that the cause of their depression is mainly physical.  On the other hand, people who are physically weak are more prone to attacks of spiritual discouragement and depression.  But if you recognize that the physical may be partly responsible for the spiritual condition and make allowances for this, you’ll be better able to deal with the spiritual issues.”  (I actually got this quote from a sermon by Timothy Keller, entitled “Finding God.”)  Recognize that God has given us a body that needs taking care of, and realize that God has given us the gift of medical care.  When you pray for healing, modern medical care might just be the answer he’s given to your prayer. 

How Patients Harvest the Fruit of the Spirit

I’ve been participating in a class with my church, Spruce Hills Community Church, that we’ve simply titled Biblical Foundations.  In this class, we talk about the fundamentals to which all Christians should prescribe, using a resource called “The Purple Book.”  We were doing a lesson from Chapter 2, called “Lordship and Obedience,” in which one of the questions was “How can we tell who is a real follower of Jesus and who is not?”

The verse attached to this question was Matthew 7:16-18, which reads

“By their fruit you will recognize them.  Do people pick grapes from thornbushes, or figs from thistles?  Likewise every good tree bears good fruit, but a bad tree bears bad fruit.  A good tree cannot bear bad fruit, and a bad tree cannot bear good fruit.”

So our discussion centered around what the definition of ‘good fruit’ was.  We had a number of interesting answers, but there were two that really jumped out at me.  The first was that “fruit” referred to actions, much in line with what the bible says in James 2:14-17:

What good is it, my brothers, if a man claims to have faith but has no deeds?  Can such a faith save him?  Suppose a brother or sister is without clothes and daily food.  If one of you says to him “Go, I wish you well; keep warm and well fed,” but does nothing about his physical needs, what good is it?  In the same way, faith by itself, if not accompanied by actions, is dead.

The second reference that came out of our discussions was my own answer, which comes from Paul’s letter to the Galatians:

“But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness and self-control.” (Galatians 5:22, NIV)

With this verse I was compelled to share my experiences thus far in my residency (which I might add has only been 2 weeks) that I felt being a follower of Jesus has benefitted my patients in terms of their care.

An Alcoholic, or a Person who needs Jesus?

Admittedly, an individual can be both of these things at once.  The question is, as a doctor, which of these will I decide to focus on? 

I’ve been working since the start of my residency in the emergency rooms of the two local hospitals.  While they both get their share of people with substance abuse issues, one of them is located much closer to the downtown area of the city, which lends itself to a greater proportion of patients whose chief complaint is often listed as “ETOH” “Intoxication” or “IVDU.”  Etoh is medical shorthand for ethanol (alcohol), and IVDU is Intravenous Drug Use.  Then there are the patients that come to the ER from the penitentiary, almost always with a chief complaint of “chest pain.”  Then there are the patients that the ER staff refers to as “frequent flyers,” which means the person generally has multiple visits in a month, quite often more than one visit, between both hospitals, in a week. 

These patients wear down on the doctors, nurses and health care professionals that work in the ER.  Which is unfortunate, because from a social, psychological and spiritual point of view, they need us to be there for them more than the patient with a straightforward medical issue.  I find it challenging to see the level of “jadedness” among healthcare workers towards these various populations, and even more difficult is the fact that it is generally accepted as an inevitable change in your outlook as you work in an emergency room setting. 

So it has been that with the help of God, I have stood firm against the onslaught of jadedness.  So far, at least.  And I realize that the most obvious criticism against this statement is that it’s only been 2 weeks.  But I can feel a difference inside of me.  I can feel the presence of the fruit of the spirit, deep within me, like a great oak with roots that extend deep into my consciousness.  Sure, I’ve already had times that I’ve been irritated with patients for being “poor historians,” which just means I can’t get them to answer the questions I’m asking in a way that makes sense to me.  I had one patient in particular whose main complaint was “feeling unwell.”  Then she told me that she had passed out and was unconscious for six hours, and had passed out at about 3:20 in the afternoon.  I was interviewing her at 7:30.  She answered most of my questions with “I don’t know.” She complained about anything and everything, none of which seemed connected, and I felt myself getting frustrated.  Then I reminded myself that God loves both of us equally.  In human eyes, I’m the doctor, she is the alcoholic frequent flyer, but in God’s eyes I’m no better than she is.  Both of us are sinners, both of us need God’s grace in order to get anywhere in life.  And just like that love, joy, peace, patience, kindness, goodness, gentleness, faithfulness and self-control flow over me and out of me.  Oh, and in case you’re wondering, I admitted the patient to the hospital for an upper GI bleed.  That’s God working through me, because I could never have deciphered her complaints on my own.

A very similar story for a man from the penitentiary who was born the same year that I was.  It almost brought tears to my eyes to see this young man, who had been born full of potential, describing to me how he had lost his prescription medication in his jacket when the police had chased him down.  His last IV drug use was less than a week ago.  Now he was in the ER with chest pain.  It’s a complaint that inmates sometimes use just to get out of the penitentiary for a little while.  A stereotypical complaint from a stereotyped individual. I have to say though, the whole trick of reminding myself that we are equals in God’s eyes tends to work wonders.  I listened to his story, brought out the characteristics of the pain, what made it better, what made it worse, examined him thoroughly (even did an ultrasound of his heart), and came up with a diagnosis.  Pericarditis, which is an inflammation of the lining that surrounds the heart.  Another admission to hospital for a stereotypical complaint from a stereotyped individual.  And he thanked me for listening.  The only thing I wish I could have done more for the guy was given him a copy of the Gospel of John.

Sending Home the Intoxicated Patient

One of the things I’ve learned in my short time in the ER is that there have been no studies done regarding the discharge of intoxicated patients from the emergency room.  It’s not something drug companies can make money from, so they don’t fund the studies.  So as a doctor, I have no evidence based guidelines that tell me if it’s alright to send home a patient with a blood alcohol level of 59.8 (17 is the legal limit), or if I should keep the patient in the ER to let them sober up first.  If the person is having complications (such as seizures or a clinical entity known as Delirium Tremens aka DTs) as a result of their intoxication, that’s an easy decision, usually involving an admission to medicine.  One of the doctors I worked with suggested that the patient has to be able to walk sensibly in order to be discharged home.  Otherwise, they get a work up congruent with the reason they presented to the ER, then they get sent home.  No such thing as “sleeping it off” in a busy emergency room.

As I write this, the hamster wheel of my mind is turning, and I’m thinking that this would be a wonderful way for Christians to donate their money and make a difference.  If pharmaceutical companies won’t fund a study that clearly there is a need for, in a population that needs Jesus in a way that some of us may never experience, then maybe we should do it ourselves.  This would be an amazing way of helping God’s downcast and needy, by finding out if there is a difference in outcomes depending on whether you send a drunk person home, or keep an eye on him in the ER.  At the moment, we really don’t have an answer to that question.

We Should Tear Our Robes

In 2 Kings 5:1-7, the bible tells a story of a man with leprosy looking for healing:

“Now Naaman was commander of the army of the king of Aram. He was a great man in the sight of his master and highly regarded, because through him the Lord had given victory to Aram. He was a valiant soldier, but he had leprosy.  Now bands from Aram had gone out and had taken captive a young girl from Israel, and she served Naaman’s wife. She said to her mistress, “If only my master would see the prophet who is in Samaria! He would cure him of his leprosy.”

Naaman went to his master and told him what the girl from Israel had said. “By all means, go,” the king of Aram replied. “I will send a letter to the king of Israel.” So Naaman left, taking with him ten talents of silver, six thousand shekels of gold and ten sets of clothing. The letter that he took to the king of Israel read: “With this letter I am sending my servant Naaman to you so that you may cure him of his leprosy.”

As soon as the king of Israel read the letter, he tore his robes and said, “Am I God? Can I kill and bring back to life? Why does this fellow send someone to me to be cured of his leprosy? See how he is trying to pick a quarrel with me!””

In one of his sermons, titled “Reconciliation,” Timothy Keller talks about this passage in the following way:

“The king of Israel is saying: “I’m a king, there’s a lot of things I can do, but the deepest needs that you have can only be met in God. Do not come to me for what only God can do. Do not ask me to do what only God can do.” Culturally, every therapist, every politician, every doctor, every teacher, every minister, we’re trying help people.  And we write our books, and we say we have the program, we have the theory, we have the way.  Every one of us, at some point, ought to be saying, “Look, we can help you somewhat, because all human problems have psychological, sociological, educational, physical, emotional components.  But at some point we need to tear our clothes and say ‘Don’t look to us for what only God can do.’” Ultimately, your deepest needs can only be met, and your deepest problems can only be solved in God.”    

Every healthcare worker available, all doctors, nurses and support staff cannot be the ones that patients look to for healing.  Alcoholism, substance use, dependence and abuse can only be solved with the help of God.  As a result, our secular society has hamstrung medicine by attempting to remove God from the equation.

There is a phrase that is sometimes heard in medicine that goes something like this:

“There is nothing more we can do for you.”

I’m planning on never using that phrase.  It’s true, there will come a time that the treatments available to a patient will no longer prevent the patient from starting on a downward spiral in terms of their health.  Modern day medicine cannot prevent death, or bring the dead back among the living.  But there is always something more we can do for our patients. 

Every shift I’ve worked so far, I try to find time to pray for each person who comes through the hospital doors to see the new doctor in the emergency room.  I’ve already seen patients live who seem to have survived against all odds, like people with large blood clots in both lungs, and I’ve seen people die whom I thought should have lived, like a man who showed up with “fatigue” but refused admission to hospital for further investigation and died two days later.  So remember, it is always up to God, and so if you ever become a patient, remember to pray.  God is the only hope you have for the solution to your deepest problems and to meet your deepest needs.

For myself, I pray that God will continue to bless me with the fruit of the Spirit, so that my patients may harvest the benefits of having a doctor that knows in his heart that his patients need God above all else.

Book List

Hey all,

A friend asked me if I'd read any good books lately, and I figured I'd post it to the group so that everyone can check them out if they feel like it. 

I've read several books by Timothy Keller now, and they've all been fantastic.  My favourite so far is probably "The Meaning of Marriage" which he wrote with his wife as co-author.  Others include "The Prodigal God" and "King's Cross."  I'll also mention here that Timothy Keller has a podcast series simply titled "Timothy Keller Podcast" which has been amazing.  There are 64 episodes, all around 40 minutes long, and I've listened to them all, some of them multiple times.  Great sermons for all sorts of issues within Christianity.

I've also read three of Francis Chan's books, the first of which was "Erasing Hell."  It's an interesting read, but I suggest that you listen to Timothy Keller's podcast and the episode titled "Hell: Isn't the God of Christianity an Angry Judge?" before reading this one.  Helps to put things into perspective.  If you're really interested, Erasing Hell was a book that Francis Chan wrote in response to another book called "Love Wins" by Rob Bell.  If you love to read, I'd suggest reading Rob Bell's book first, and then read Erasing Hell right after.  It helps to compare and contrast good theology with not-so-good theology, and helps you to identify the features of a book that is likely to be trustworthy.  (At least, that's what it did for me.  However, absolutely do not read only Rob Bell's book.  It will lead you down a path that is not biblically supported.)

Francis Chan also has a couple of other books that I really enjoyed, one called "The Forgotten God" and the other called "Crazy Love."  I found Crazy Love to be a very challenging (in terms of living out a Christian lifestyle) book, and so I bought the study guide to go with it and plan to read it a second time.  

Another prolific writer that I've discovered is C.S. Lewis, and I've read several of his books so far.  The first one I read was called "Mere Christianity," and is probably a great one for all of us to read while we're doing Biblical Foundations.  On that note, I think I'll go back and read that one now.  :)

I've also read "The Screwtape Letters" and "Screwtape Proposes a Toast" which are fascinating reads, but take your mind for a bit of a twisted ride.  Wonderfully educational though. 

And that leads us to the book I'm currently reading... well two books actually.  I'm reading a book called "Scaling the Secular City: A Defense of Christianity" by J.P. Moreland.  Some of the ideas about evolution and creation that I talked about in the first week of Biblical Foundations came from this book.  It's a book that you've really got to push through the first little bit to get into, and then there's so much information that it's taking me a while to digest and get through it.  It is, however, a great way to strengthen your faith, and to defend it against others should you really get into the material.

The other book I'm reading right now is called "Radical" by David Platt, which is a book that Anna gave me for my birthday.  The author does a good job with it, but he tends to take a long time to make a relatively simple point.  Still, a good book, but it has made me feel that I could really simply discover most of what he says by reading the bible on my own and taking to heart the things that Jesus says and putting them into practice in my life.

Anyway, now that I've written a book of my own, I'll stop here.  If anyone else has a good read to recommend, send it my way.  I'd love to add to my reading list!

David

Miracles

Hello again!

Alright, so don't expect me to post something like this every day.  It's just not going to happen.  This essay that you'll find below is something that I began writing in the month of February, and then it sat on my harddrive for a couple of months, almost finished but with nowhere to go once it was done.  But now, I have an audience!

So, a couple of disclaimers.  I wrote this in response to a strong emotional and intellectual reaction to something that one of my friends from LifeGroup said during one of our bible studies.  I have NO seminary training, and what you'll see is based solely on my own readings.  So, if you've got questions, comments, or really feel that I've stated something that is not biblical, then please, please let me know.  I did my best to write and research both with humility and diligence, but I am human after all.

So it is with some nervousness that I post this, the first of my Christian reflections intended for a broader audience.

Miracles: Always Happening Where I’m Not

            A group of like-minded Christians were discussing the role of the Holy Spirit in church today, whether the gifts of the spirit as outlined in 1 Corinthians 12 are still present in Christians today, and if miracles continue to happen today or if they were limited to the early Christian church.  One of the group members admitted that he believed in the possibility of miracles, but that he wished he could see one or have proof of one occurring in the present day.  He expressed his frustration when he declared, “I believe in miracles, but they’re always happening where I’m not!”

           

            As I thought about that statement, I wondered about the seemingly apparent accuracy of his lamentation.  We, as Christians, certainly believe in the power of God to enact miracles at any time, anywhere – but when we read about the awesome miracles of the old and new testaments, there is certainly nothing similar happening like those miracles in present day North America.  So why might that be?

            My first thought was that all miracles are to accomplish a purpose.  That purpose depends on whether it was an Old Testament or a New Testament miracle. 

The Purpose of Miracles

Old Testament

The Old Testament describes things such as the parting of the Red Sea, “Then Moses stretched out his hand over the sea, and all that night the Lord drove the sea back with a strong east wind and turned it into dry land.  The waters were divided and the Israelites went through the sea on dry ground, with a wall of water on their right and on their left.” (Exodus 14:21-22)  Only verses before this however, God tells us in His Word the reasons He enacts this incredible display of His power.  “But I will gain glory for myself through Pharaoh and all his army, and the Egyptians will know that I am the Lord.” (Exodus 14:4) So it was to teach the people of earth that God is the one and only Lord, with the power to deliver his chosen people from all odds, and to glorify the name of the Lord.  “And when the Israelites saw the great power the Lord displayed against the Egyptians, the people feared the Lord and put their trust in him and Moses his servant.” (Exodus 14:31)  It is relatively obvious that God used his miracles to bring glory to Himself, to make it undoubtedly clear that He is the Lord and that His people need only trust in Him for deliverance.  To emphasize this point, consider the following verses: “When the poor and needy search for water and there is none, and their tongues are parched from thirst, then I, the Lord, will answer them. I, the God of Israel, will never abandon them.  I will open up rivers for them on the high plateaus.  I will give them fountains of water in the valleys.  I will fill the desert with pools of water.  Rivers fed by springs will flow across the parched ground.  I will plant trees in the barren desert – cedar, acacia, myrtle, olive, cypress, fir, and pine.  I am doing this so all who see this miracle will understand what it means – that it is the Lord who has done this, the Holy One of Israel who created it.” (Isaiah 41:17-20, emphasis added)

New Testament

           

            The New Testament shows a different kind of miracle being performed, miracles that serve a different purpose than they did in the Old Testament.  Now, God has sent His only Son, our Lord Jesus Christ to earth to save us from our sins for all eternity.  Only, if Jesus did not perform any miracles, would any have believed that He was (and is) truly the Son of God?  My heart wishes that this would have been the case, but my brain tells me that people found it hard enough to follow Jesus, even with his miraculous powers of healing, the feeding of five thousand, and turning water into wine.  After Jesus had performed many miracles, He taught that He is the Son of God, to which the Jews “began to grumble about him because he said ‘I am the bread that came down from heaven.’ They said, ‘Is this not Jesus, the son of Joseph, whose father and mother we know? How can he now say, ‘I came down from Heaven’?’” (John 6:41-42) So difficult was this teaching that Jesus even asked his disciples, “‘You do not want to leave too, do you?’ Jesus asked the Twelve.” (John 6:67) Perhaps their answer would have been different if they had not seen the power of the Son of God at work, if Jesus had the appearance of being ‘just a teacher.’  So it seems that the miracles that Jesus performed were a mark of the authority that Jesus possessed as the only Son of God.  His power spoke to the Jewish people as well as the gentiles during the time of His life on earth, and continues to speak to us through the Scriptures of the New Testament.  The purpose of His miracles was to inform us of His identity, that we might listen and obey the remainder of His teachings.  John 5:31-36 says, “If I were to testify on my own behalf, my testimony would not be valid. But someone else is also testifying about me, and I assure you that everything he says about me is true. In fact, you sent investigators to listen to John the Baptist, and his testimony about me was true. Of course, I have no need of human witnesses, but I say these things so you might be saved. John was like a burning and shining lamp, and you were excited for a while about his message. But I have a greater witness than John–my teachings and my miracles. The Father gave me these works to accomplish, and they prove that he sent me.”  The miracles of Jesus serve to prove that God sent him, His only Son.

After the Resurrection of Jesus

           

            After the death and resurrection of Jesus, the apostles were charged with the great commission when Jesus said to His disciples, “Go into all the world and preach the good news to all creation.  Whoever believes and is baptized will be saved, but whoever does not believe will be condemned.  And these signs will accompany those who believe: In my name they will drive out demons; they will speak in new tongues; they will pick up snakes with their hands; and when they drink deadly poison, it will not hurt them at all; they will place their hands on sick people, and they will get well.” (Mark 16:15-18)

Here we can see that after the death, resurrection and ascension of Jesus, Peter, Paul and the apostles, in addition to many named and unnamed disciples, were given the gift of performing miracles from the Holy Spirit.  This was with the purpose of spreading the Gospel throughout the nations, and as we read through the remainder of the New Testament, we see evidence that each one of the miracles listed by Jesus was performed at some point. 

The Man Doing the Miracles

            So, we’ve looked at the purpose of miracles, both from the Old Testament and the New Testament.  Now we’ll look at the person who performed the miracle. In both the Old and New Testaments, the person through whom God enacts his miracle defers all glory and honour to God the Father.  Immediately after the crossing of the red sea in the Old Testament, we find the Song of Moses, recorded in

Exodus 15:1-18, which opens with the first verse “I will sing to the Lord, for he is highly exalted.  The horse and its rider he has hurled into the sea.”  Interesting, that Moses quite plainly states who it was that achieved victory for Israel that day, even if it was Moses who “stretched his hand over the sea.”  When Jesus performed one of his many miraculous signs, He tells us that a man was born blind, not because of some sin of his or his parents, but so that through him, the glory of God could be revealed.  “As he went along, he was a man blind from birth.  His disciples asked him, ‘Rabbi, who sinned, this man or his parents, that he was born blind?’ ‘Neither this man nor his parents sinned’ said Jesus, ‘but this happened so that the work of God might be displayed in his life.” (John 9:1-3)  Jesus summarized His work here on earth when He prayed for Himself in the Garden of Gethsemane. “ ‘Father, the time has come. Glorify your Son, that your Son may glorify you.  For you granted him authority over all people that he might give eternal life to all those you have given him.  Now this is eternal life: that they may know you, the only true God, and Jesus Christ, whom you have sent.  I have brought you glory on earth by completing the work you sent me to do.  And now, Father, glorify me in your presence with the glory I had with you before the world began.’” (John 17:1-5)  All of Jesus’ work, the work God the Father had sent Jesus to earth to complete, was to bring glory to God.  All of Jesus’ work, right to the pinnacle of all miracles, the death and resurrection of Christ, by which the entire world may be saved, brings glory to God. 

            What does all this have to do with miracles in our time?  It all outlines the possible reasons that we do not see miracles (like those we think of as miracles) in our own lifetime, but rather that we hear about them occurring in other places.  Western culture, and indeed western Christianity, has moved away from giving glory to God.  Sure, we worship God in Sunday services.  We give Him thanks and praise in the privacy of our own homes.  Sadly though, many Christians attend church every Sunday because it’s just what they’re supposed to do.  God doesn’t make it into their lives the other six days of the week.  We’re supposed to rest from work one day a week, not rest from God six days a week!

            To whom does all the glory go for the food that is placed on our tables?  To whom does the glory go for the financial prosperity that all North Americans, compared to the regions of the world truly stricken by poverty, enjoy?  To whom does all the glory go for the fact that our hearts keep beating, and that the sun continues to come up every morning?  The parting of the red sea was not just so that believers would know the power of God.  An entire Egyptian army was drowned so that believers and unbelievers alike would know that God was the only God, and that they would all know and believe in His almighty power, mercy and judgment!  Jesus died on the cross so that the entire world, believers and unbelievers alike, would have the Way to salvation made available to them, revealing the ultimate glory, power and love of God.  So how can we expect, that when we find it difficult, intimidating, terrifying even, to declare God’s glory in the little things, that he will enable us to be conduits for His power and perform miracles like those of the bible?  Or even witness another human being acting as such a conduit?  Let us start by proclaiming once again the glory of God at work in our everyday lives.  The food on our tables?  It didn’t come from a farmer, or a grocery store, or from our ‘hard earned’ dollars.  It came from God.  The money we earn?  It didn’t come from intelligence, multiple degrees or trades, an ability to work with your hands, the working of hands to the bone, or managerial skills.  It came from God.  The fact that a person’s heart has to beat an average of 103680 times per day just to keep you alive might go unnoticed by us, but God is responsible for each and every contraction, just as He keeps the earth spinning on its axis unbeknownst to those walking on its surface every day.  And it all has a purpose of bringing glory to Him, if we’d just shout out His praises each and every day.  “Give thanks to him who alone does mighty miracles.  His faithful love endures forever.” (Psalm 136:4)

            What about bringing our secular society back to Jesus?  Miracles, some would say, would go a long way to bringing about a revival in our culture, and rekindle Christianity in a land that seems to be trending toward the atheism and agnosticism.  But Christianity is well known, and there are few, if any, that can say they have no access to a bible.  God has told us everything we need to know in His Word.  Consider what Jesus teaches in the parable of the rich man and Lazarus:

“Then the rich man said, ‘Please, Father Abraham, at least send him to my father’s home. For I have five brothers, and I want him to warn them so they don’t end up in this place of torment.’

“But Abraham said, ‘Moses and the prophets have warned them. Your brothers can read what they wrote.’

“The rich man replied, ‘No, Father Abraham! But if someone is sent to them from the dead, then they will repent of their sins and turn to God.’

“But Abraham said, ‘If they won’t listen to Moses and the prophets, they won’t listen even if someone rises from the dead.’” (Luke 16:27-31)

            Here we can see that Jesus tells us that turning our hearts to God cannot be accomplished by miracles alone, not even by something as astonishing and wonderful as somebody rising from the dead.  It is not hard to see the saddening truth of this in our world today, since we have not only Moses and the prophets, but also Jesus’ disciples and Jesus himself – who actually did rise from the dead.  Again, we see evidence that miracles are not enough to make mankind turn from sin and embrace God the way He asks us to in the book of Hebrews:

That is why the Holy Spirit says, “Today when you hear his voice, don’t harden your hearts as Israel did when they rebelled, when they tested me in the wilderness.  There your ancestors tested and tried my patience, even though they saw my miracles for forty years…” (Hebrews 3:7-9)

Some of these Israelites saw first hand the parting of the Red Sea and the provision of manna when they had nothing to eat.  At Mount Sinai, when Moses was given the Ten Commandments, he returned down the mountain to see Israel worshipping idols in the form of golden calves.  Oh, how they tested the Lord!  It is wondrous that God, as many of us humans would do, did not throw His jars of clay away and start all over.  So hardened are human hearts that miracles simply do not have the power in and of themselves to center our lives around God, and to make ourselves living sacrifices to Him.

Everyday Miracles

            So it is safe to state that in North America, most churchgoers will admit that they’ve never seen a miracle like those of the stories from the bible.  Some will say with absolute certainty that they’ve never seen a miracle.  Not one.  But maybe, what we really need to do is change our definition of what constitutes a miracle.  Consider this passage from the book of Job:

 “Pay attention to this, Job.

Stop and consider the wonderful miracles of God!

Do you know how God controls the storm

and causes the lightning to flash from his clouds?

Do you understand how he moves the clouds

with wonderful perfection and skill?

When you are sweltering in your clothes

and the south wind dies down and everything is still,

he makes the skies reflect the heat like a bronze mirror.

Can you do that?” (Job 34:14-18 NLT)

This passage is a description of miracles that God performs every day, which indeed gives us pause for thought.  Is the reason we don’t see any miracles today because we have a warped sense of what is defined as a miracle?  People on earth have no basis for believing that it will ever rain on earth again, but put their faith in the water cycle because that’s the way it worked yesterday, so why not tomorrow?  Truly, it is a miracle each and every time it rains.  God planned for it to rain, exactly that much, at exactly that time, for a reason He determined at the beginning of creation.  We can’t plan our week with that kind of precision, and it is an exercise in humility to meditate upon the miraculous power of God.

The bible also teaches us that God performs miracles in response to our needs:

“The day after the Passover, that very day, they ate some of the produce of the land: unleavened bread and roasted grain.  The manna stopped the day after they ate this food from the land; there was no longer any manna for the Israelites, but that year they ate the produce of Canaan.” (Joshua 5:11-12)

God provided a miraculous source of food for His people while they were wandering in the desert.  As soon as they no longer needed manna, but could eat of the produce from the promised land, the supply of manna ceased.  Much the same for us, God provides us with what we need.  He gave the Israelites manna, and then gave them the food from the land of Canaan, but He never stopped providing for them.  His methods simply went from one that was overtly miraculous to one that is so ‘commonplace’ that we don’t always consider food from cultivated crops to be a miracle at all. 

Today, we all have God’s Word to guide us.  Those who have hardened their hearts toward God cannot be won over by miracles alone.  They need those of us who are Christians to love them into the family of God, by living out the lives that Jesus Christ commanded of us.  For those of us who already follow Jesus, our hearts are a little softer, and so God performs miracles in order to give us what He alone knows that we need. 

Or what of the following verse:

“Who can proclaim the mighty acts of the Lord, or fully declare his praise?” (Psalm 106:2 NIV)

This verse, according to the NIV Life Application Study Bible commentary, says that “If we ever stopped to list all the mighty acts or miracles in the Bible, we would be astounded.  They cover every aspect of life.  The more we think about what God has done, the more we can appreciate the miracles he has done for us individually – birth, personality development, loving friends and family, specific guidance, healing, salvation – the list goes on and on.  If you think you have never seen a miracle, look closer – you will see God’s power and loving intervention on your behalf.  God still performs great miracles!” 

Perhaps many of us are like Gideon, who declared: ““Sir,” Gideon replied, “if the Lord is with us, why has all this happened to us? And where are all the miracles our ancestors told us about? Didn’t they say, ‘The Lord brought us up out of Egypt’? But now the Lord has abandoned us and handed us over to the Midianites.”” (Judges 6:13 NLT )  Perhaps we are more like Gideon than we realize.  Sometimes we feel abandoned by God because we don’t see miracles like those performed in the day of Moses.  “Where are all the miracles?” we ask.

The only recourse we have if we cannot on a regular basis see God’s hand at work in our everyday lives is to pray to Him.  Pray that the Holy Spirit would fill us, and endow us with the fruit of the Holy Spirit and to open our eyes in this secular world that we find ourselves in.  May we all be given the eyes with which to see that God is everywhere, working all around us, and the hearts to know that every day we’ve ever lived has been filled with God’s miraculous power, glory, mercy and grace.