Stressed in the Little Things

Romans 8:26-28: (The Message): Meanwhile, the moment we get tired in the waiting, God’s Spirit is right alongside helping us along. If we don’t know how or what to pray, it doesn’t matter. He does our praying in and for us, making prayer out of our wordless sighs, our aching groans. He knows us far better than we know ourselves, knows our pregnant condition, and keeps us present before God. That’s why we can be so sure that every detail in our lives of love for God is worked into something good.

This week, for me, has been a test of my groaning.  Monday started with a pot hole and a flat tire on the way into an already short-staffed holiday.  Tuesday led to the mechanic finding a few more problems in my not-that-old car that would eventually take four days to fix, find rides from gracious friends & coworkers, and cost a lot of money.  Additionally, as I'm rounding out my third year, I get the joys of applying (and paying) for state licenses and board certification exams (they don't tell you that the process of becoming a doctor doesn't end with your diploma or your residency!).  And it all needs to be done--and paid for--within a few months.  It's a little stressful to say the least!  Just when I started feeling comfortable in my role as a senior resident, I have started stressing about the multitude of "little" things I must do to keep my career moving forward.

This week I've been reading through & soaking up Romans 8.  These verses are so poignant to my life right now.  It doesn't matter if I'm having a great week or a bad one--God knows it, and His Spirit is interceding for us.  In great detail.  Down to the penny of every cost, the second of every procedure, the mg/kg of every medication I order (yes, I'm in pediatrics!).  As I strive to continue to live for Him, I can trust that He is with me every step of the way.  He will make a way where there seems to be no way.  He will work it all out for good--His good and mine.  

Feedback

If you've been in medical or dental training for any length of time, you are likely very familiar with the term "feedback."  If you're an upper-level resident, fellow, or attending, you've probably attended seminars on how to give feedback, with silly examples like "Feedback Fridays" and, my personal favorite, "The Feedback Sandwich", with a little bit of negative surrounded by fluffy positivity to cushion the criticism.  The word feedback itself makes my skin crawl, to be honest.  It implies that I've done something wrong, that something needs to be done differently, usually in the way or to the preference of the one giving the feedback.  Feedback can be positive, but when someone says, "I have some feedback for you," I've realized this is a nice way of saying, "Let's talk about what you did wrong."

Feedback is also a physiologic phenomenon.  Remember the positive and negative feedback loops in physiology class?  How hormones act on organs and the organ sends a signal back to make a change indicating it's received the signal?  How positive feedback increases the target's function and negative feedback inhibits it?  At least that's how I remember it...

And then it comes to the matter of our hearts.  From where do we, as Christians, get spiritual feedback?  There's no such thing as Feedback Fridays (at least in my theology...), but it is a continual, instantaneous process.  The Holy Spirit brings conviction through times of prayer, worship, reading the Bible, and even through other Believers.  That prick in your heart...Was that the right thing to do or say, the right way to react?  Was that conversation necessary?  Why didn't you pray for that patient or coworker?  Let's readjust your focus.  It's--thankfully--not a feedback sandwich--the hope and gentleness offered in our salvation is a long-standing, permanent offer, no fluff or pretense about it, no having to second-guess my position or status or role as a child of God.  We've got God's love in the form of a Savior sacrificed the cross, no matter what.  But we need to stay sensitive to His feedback (as much as I'd prefer a different word such as 'conviction' or 'discipline'), and change our lives accordingly, knowing there may be eternal value (for me and others) as I respond to the Holy Spirit's prompting.

I Timothy 4:8, 15-16: For physical training is of some value, but godliness has value for all things, holding promise for both the present life and the life to come...Be diligent in these matters; give yourself wholly to them, so that everyone may see your progress.  Watch your life and doctrine closely. Persevere in them, because if you do, you will save both yourself and your hearers.

When I Don't Know

CMDA Resident Life Devotional March 29, 2013

Isaiah 48:17--

This is what the Lord says--

your Redeemer, the Holy One of Israel:

"I am the Lord your God, 

who teaches you what is best for you, 

who directs you in the way you should go."

I don't know about you, but life in medicine--especially the training years--is somewhat of a certain, well-defined, generalized trajectory.  Making a decision about where to go for undergrad--even what I'd major in--seems like child's play compared to the decisions before me today.  What am I going to do after residency?!?  The plan to this point has been straightforward:  MCAT, Medical School, COMLEX/USMLE, Step 1, Step 2, Residency, Step 3, finish Residency, take specialty boards, go on vacation.  If you're still alive and vigorous, there's this fork in the road...Fellowship, Missions, Real Doctor Job, Research, Work at Starbucks, Never Return From Vacation.  Some days, the opportunities before me are overwhelming.  After all, this is the rest of my life we're talking about here! 

And then I read the above verse...the Lord is going to teach me what is best for me and direct me in the way I should go.  There is incredible comfort in this verse!  We all have Proverbs 3:5-6 memorized--"Trust in the Lord with all your heart, and lean not on your own understanding.  In all your ways acknowledge him, and he will make your paths straight."  There's a lot that I have to do in those verses...trust, lean not, acknowledge.  And I do try to do those things.  But then I have to remember that I'm not here for my glory/satisfaction/self-discovery, but God's.  So in the end, it has to be the Lord who instructs me in what is best and shows me where I should go, and it's up to me to be willing to follow.  

As you celebrate Resurrection Sunday this weekend, I encourage you to take time to rest in the work that has been completed for you through Jesus.  Christ is Risen Indeed!

Be Strong & Courageous

CMDA Resident Life Facebook Posting, February 16, 2013:

Yesterday in clinic I had that moment when I thought, "Wait, that's just not right."  I'm halfway through year two of residency, and I'm starting to pick up on that sick/not sick feeling.  In the US, I have a lot of options...tests to run, specialists to call, attendings to consult if I have questions, concerns, etc.  But I'm not in the US this month--I'm in Honduras on a one month international elective.  The 9-month old boy sitting in front of me weighs 5.5kg (11 pounds) and the mom isn't concerned about his weight.  He's always been small.  What brought him in today--his first doctor visit ever--was that he's

started turning purple and passing out when he gets angry.  I spent a long time--with an interpreter--clarifying the story.  Clarifying what he eats and drinks.  Trying to figure out why a 9 month old can't even sit up on his own.

Thankfully here, I'm not alone (of course...the ACGME RRC wouldn't like that!).  I'm here with my chief resident from last year who is serving for 2 years with World Medical Mission.  Together we're reading a ton and emailing specialists in the US our pictures and EKGs and 'heart ultrasound' pictures (not exactly a formal ECHO because we don't know how to do those).  We have limited labs available, but the ones we have available we've done, just to rule out as much as we can.  Bottom line, this kiddo needs a specialist!  The cool thing is that we are that specialist here.  We're following & monitoring him and will refer him to the right people in the big cities when we figure out who that is.

Deuteronomy 31 chronicles some of Moses' last words before Joshua began leading the Hebrews.  They hadn't yet reached the promised land. Verse 6 says, "Be strong and courageous. Do not be afraid or terrified..., for the Lord your God goes with you; he will never leave you nor forsake you.”

Wherever we are, we aren't alone.  I love Psalm 139:7-10: "Where can I go from your Spirit?  Where can I flee from your presence? If I go up to the heavens, you are there; if I make my bed in the depths, you are there. If I rise on the wings of the dawn, if I settle on the far side of the sea, even there your hand will guide me, your right hand will hold me fast."  No matter what you're facing today--be it a puzzling

patient, a difficult family situation, or just struggling to make it through the week, remember Who calls you also walks beside you.

I Bet God is Laughing Too...

CMDA Resident Life Facebook Posting, January 2, 2013:

Matthew 6:25-26--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?

Happy New Year!!  I hope it’s been a good start so far!  A funny thing happened to me this week.  God provided something that was little.  Something He really didn’t have to.  Contacts.  Like the kind I wear in my eyes.  Let me explain.  

A few weeks ago, I realized I was running low on contacts and would need a new prescription before ordering more.  I had just signed up for the Vision plan on my insurance during open enrollment this fall, specifically to get the contacts covered as a benefit.  I made an appointment, went to the optometrist, and left with a prescription.  For glasses.  They couldn’t fit me for contacts because my plan didn’t kick in until January 1.  And I had one pair of contacts left!!  So naturally, I panicked, thinking, “I better not have to wear my glasses...”  (which I rarely ever wear!).  I had a little bit of a tantrum, never even thinking to ask God to provide them for me.  I figured I could stretch my new pair to the new year, had an appointment set up, and thought I was good to go.  But if they had to order them...if I couldn’t get them before I leave for a month-long overseas elective...I’d have to resort to glasses.  And I didn’t like that option!

I came home halfway across the US for holiday vacation, opened my bathroom cabinet, and found two boxes of contacts just sitting there, waiting for me to be surprised by them.  Immediately I laughed and thought God must be laughing too.  Somehow, in His sovereignty, He had me keep two whole boxes--a 3 month supply of contacts--at home.  I put them there--more than a year ago--and had forgotten all about them, but my God hadn’t!!  It was such a little lesson to me that God cares for the small stuff I forget to pray about because, well, it’s small stuff.  And how much more will he take care of the BIG stuff--relationships, fellowship applications/interviewing/matching, family, hopes/questions/fears/doubts about the future, etc.  

As we face a new calendar year, I hope you’ll remember with me that our Father loves us, will provide and take care of us, and He can be trusted with all our worries.  No matter how big or small they may be!

Philippians 4:19--And my God will meet all your needs according to his glorious riches in Christ Jesus. 

Insight from Sarah Coors, National Resident Council Leader

Spiritual Care

CMDA Resident Devotional  October 10, 2012

Matthew 5:14-16: “You are the light of the world.  A city on a hill cannot be hidden.  Neither do people light a lamp and put it under a bowl.  Instead, they put it on its stand, and it gives light to everyone in the house.  In the same way, let your light shine before men, that they may see your good deeds and praise your Father in heaven.”

Sometimes I get so busy that I forget to pay attention to the subtleties of my patients’ needs.  Like their spiritual needs, for example.  I’m working in the ER this month.  A Spanish-speaking family hadn’t required much, but was so appreciative.  As I said goodbye, the grandmother said, “God bless you, Doctor.”  I was caught off guard.  It is a rare occasion to hear such a comment in my hospital!  I didn’t know how to respond but later chastised myself for being too busy to stop and pray with them.

Another family came in with matching T-shirts—they were headed to a church convention.  Lo and behold their child had a contagious disease, and when asked if she could be in the nursery, I advised against it.  This time I shared a little more, asking where they go to church and telling them where I go.  But again, with more patients waiting and nurses requesting orders, I was too hurried to take the time to pray with them.   And today, in clinic, the opposite happened!  I tried to pick up on the clues I’ve been missing.  Some parents brought in their newborn, and both mom and dad were wearing rosaries.  I asked if they were Catholic, and the mom said, “No.”  I guess it was just a piece of jewelry to them—but it made me laugh that at least I was trying! 

If you haven’t read Dr. David Levy’s book, “Gray Matter”, I strongly recommend it.  He shares how his own faith was tested as he—a renowned neurosurgeon—learned to pray with patients.  Eventually they came to expect it from him, and even nurses and others around him looked forward to his prayers.  There have been times when I’ve felt the urge to pray for patients.  Parents have broken down in tears and started confessing sins to me—not at all what I expected from a simple, “Lord, heal this child” type of prayer.  I have seen prayer make a big difference in patients and their families.

One way we can let our light shine is by addressing our patients’ spiritual needs.  No matter what they believe about salvation or Christianity, illness is a vulnerable time where patients and their families may be more receptive to the hope we have within us.  Whether it is depression or a new diagnosis or end of life care, they’re looking to us as physicians for answers.  While we don’t always have all the medical answers (especially as residents!), you have Christ—a hope within you that is greater than any physical diagnosis or treatment.  Don’t be afraid to let your light shine!

Insufficient Memory

CMDA Devotional August 29, 2012

Please visit CMDA's Resident Life Facebook Page for more devotionals.

Psalm 39:12: “Hear my prayer, O Lord, listen to my cry for help; be not deaf to my weeping.  For I dwell with you as an alien, a stranger, as all my fathers were.”

As a resident, do you ever feel like you don’t know what you’re doing?  For me, it’s a daily occurrence!  I feel inadequate and unprepared, regardless how much I thought I prepared.  Our computer charting system occasionally pops up with an “insufficient memory” window; quite often I wish I could claim that phrase as mine!  As a Christian, there are also times where I feel inadequate.  I’m supposed to have all the hope in the world, but I’m exhausted, stressed out, and haven’t eaten in what seems like days—all for my calling to share Christ’s love with the hurting.  I try to quote verses I memorized growing up, reminding myself, “I can do all things through Christ who strengthens me” (Philippians 4:13), but sometimes fatigue overwhelms me, and I wonder how I can possibly continue.  I daily (often hourly!) have to remind myself who I am serving, and that “The one who called [me] is faithful, and He will do it” (I Thessalonians 5:24).

When I read the Psalm above, it really hit me.  Yes.  This world isn’t my home, this isn’t my final destination.  We live and work in a world surrounded by disease, hurt, disappointment, and pain.  It is our job as residents to discover what is wrong and how to treat it, yet we often come up short.  It is encouraging to me that even David, a man after God’s own heart, the king of Israel, felt like he didn’t fit in at times.  Hebrews 11 talks about Abel, Enoch, Noah, and Abraham (among others) who “admitted that they were aliens and strangers on earth.”  Verse 16 says, “Instead, they were longing for a better country—a heavenly one.”  It is my desire that on my longest, most difficult days, I would keep in mind a heavenly perspective including why I chose to become a doctor.  Revelation 21:4 reminds us that, for believers in Jesus, “He will wipe every tear from their eyes.  There will be no more death or mourning or crying or pain, for the old order of things has passed away.”  It is my prayer that—even when I’m exhausted—to live in such a way that I look forward to Heaven rather than being burdened by the stresses of my daily workload, trusting that the Lord will see me through and give me insight to care for my patients while we eagerly await the hope of Eternity.