Inexorable Love

photo by Josh Scholten

“God has paid us the intolerable compliment of loving us, in the deepest, most tragic, most inexorable sense.”
C.S. Lewis

Relentless, unstoppable, inescapable, inevitable, unavoidable, irrevocable, unalterable, unceasing love.  It has always been, is now, and always will be.

It is a gift almost too much to bear knowing He bought it through suffering.  Nothing I have done warrants such loving grace.   Therefore I become inexorable too–nonstop and continuously–expressing gratitude, forgiveness, wonder.

The intolerable welcomed.
The inconceivable borne and born.
The incredible believed.

Obscurity in Medicine

photo by Josh Scholten

Be obscure clearly.
~E. B. White

As a family doctor, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation.  To begin with, there is much that is still unknown and difficult to understand about psychology, physiology and anatomy.  Then throw in a disease process or two or three to complicate what appears to be “normal”, and further consider the side effects and complications of various treatments — even evidence-based decision making isn’t equipped to reflect perfectly the best and only solution to a problem.  Sometimes the solution is very muddy, not at all pristine and clear.
Let’s face the lack of facts.  A physician’s clinical work is obscure even on the best of days when everything goes well.  We hope our patients can communicate their concerns as clearly as possible, reflecting accurately what is happening with their health.  In a typical clinic day we see things we’ve never seen before, must expect the unexpected, learn things we never thought we’d need to know, attempt to make the better choice between competing treatment alternatives, unlearn things we thought were gospel truth but have just been disproved by the latest double blind controlled study which may later be reversed by a newer study.   Our footing is quicksand much of the time even though our patients trust we are giving them rock-solid advice based on a foundation of truth learned over years of education and training.   Add in medical decision-making that is driven by cultural, political or financial outcomes rather than what works best for the individual, and our clinical clarity becomes even further obscured.

Over thirty years of doctoring in the midst of the mystery of medicine — learning, unlearning, listening, discerning, explaining, guessing, hoping,  along with a little silent praying — has taught me the humility that any good clinician must have when making decisions with and about patients.  What works well for one patient may not be at all appropriate for another despite what the evidence says or what an insurance company or the government is willing to pay for.  Each person we work with deserves the clarity of a fresh look and perspective, to be “known” and understood for their unique circumstances rather than treated by cook-book algorithm.  The complex reality of health care reform may dictate something quite different.

The future of medicine is dependent on finding clarifying solutions to help unmuddy the health care decisions our patients face. We have entered a time of information technology that is unparalleled in bringing improved communication between clinicians and patients because of more easily shared electronic records.  The pitfall of not knowing what work up was previously done will be a thing of the past.  The risk and cost of redundant procedures can be avoided.  The patient shares responsibility for maintenance of their medical records and assists the diagnostic process by providing online symptom and outcomes documentation.   The benefit of this shared record is not that all the muddiness in medicine is eliminated, but that an enhanced transparent partnership between clinician and patient develops,  reflecting a relationship able to transcend the unknowns.

So we can be obscure clearly.   Lives depend on it.

The Bridge of Grace

photo by Josh Scholten

The bridge of grace will bear your weight.
Charles Spurgeon

When considering the paradox of a holy infant born in a dingy barn, so weak and helpless, completely dependent on others for His care and safety, it seems impossible that such frailty was meant to hold the weight of a struggling drowning humanity in His hands.  No sin is too great and nothing too heavy a load for Him to bear.

Advent is a time to reflect on such mysteries,  deepening our understanding of the remarkable gift we were given the night God came to earth as one of us, to dwell among us, and now through the person of His Spirit, remains at home in our hearts.

The bridge built that night continues to bear the awful load that we alone could not manage without being lost forever.

A baby becomes our bridge to grace and we have been offered safe passage.

 

Edging Closer for Company

The trees are coming into their winter bareness, the only green is the lichen on their branches. Against the hemlocks, the rain is falling in dim, straight lines… This is the time of year when all the houses have come out of the woods, edging closer to the roads as if for company.
Verlyn Klinkenborg “The Rain It Raineth”

The deciduous trees in our part of the country have all been stripped bare, having come through two rain and wind storms in the last week.  It forces typically leaf-hidden homes out of camouflage and I’m once again startled at the actual proximity of our neighbors.  It isn’t as obvious in the summer given the tree buffer everyone has carefully planted.  Now we’re reminded once again we are not alone and actually never have been.

Even the mountains that surround us from the northwest to the southeast seem closer when the trees are bare and new snow has settled on their steep shoulders.

We think we have autonomy all wrapped up but it takes the storms of autumn to remind us we are unwrapped and vulnerable, stark naked, in desperate need of company when darkness comes early, the snow flies and the lights flicker.

Welcoming Heart

Keep a green tree in your heart and perhaps a singing bird will come–
Chinese Proverb

I need reminding that what I offer from my heart reflects what I will receive there.  If I’m grumbling and breaking like a dying vine instead of a green tree, my discouragement entangled by the cobwebs and mildew of worry, then no singing bird will come.

So much better to nurture the singers of joy and gladness with a heart budding green with gratitude, anticipating and expectant.

The welcome mat is out and waiting.

Any time now…

Longing for Longing

“It was when I was happiest that I longed most…
The sweetest thing in all my life has been the longing…
to find the place where all the beauty came from.”

~C.S. Lewis

Like children who long for Christmas,
anticipating for weeks
what that moment will be like
when they see gifts piled high under the tree–

we revel in our longing.

It is the sweetness
of “already but not yet”,
knowing with eager expectancy
there is more to come,
just a bit out of reach
but still intensely seen and felt,
something more wonderful,
a place more beautiful than we can ever imagine…