Folie (Madness)

One of the most bizarre and interesting psychiatric diagnoses that I learned about in medical school is called Folie a’ deux.   It was first described in the 19th century by two French psychiatrists, Charles Lasegue and Jean-Pierre Falret, and is also known as Lasegue-Falret Syndrome.  Unless you are a doctor I wouldn’t expect you to know this disorder.  Today I mentioned this to two psychotherapists who had never heard of it.   I only remember it because it is just so unusual.

Folie a’ deux literally means “madness for two” and is so rare that most physicians, indeed most psychiatrists, will never see a case.  In this condition two people share a delusional belief and sometimes even hallucinations.  It’s as if the delusions are transmitted from one individual to another like an infection.   Clearly we don’t go around sharing and catching delusions randomly or we would all be infected and there would be no rational thought.  The typical configuration for folie a’ deux is a mother/daughter pair.  Once the two are separated, one of the individuals (usually the daughter) reverts to rational thought but the primary person (usually the mother) continues in the delusional experience.  If the two are brought back together, the daughter again gets caught up in the shared delusion.

There is not enough information to learn in medicine (insert eyeroll here!) so the powers that be continuously change the names of every disease, bacteria, and drug.  The Diagnostic and Statistical Manual of Mental Disorders 4 (DSM-4) referred to this disorder as “shared psychotic disorder” and “induced delusional disorder”.  Most professionals however continue to refer to this by the original name, folie a’ deux.  It is so rare, however, that it is not even listed in the current DSM-5.

The diagnostic criteria in DSM-4 include the following:

  1. The affected individuals must have a delusion that develops in the context of a close relationship with an individual who already has an established delusion.
  2. The delusion must be very similar or even identical to the one already established in the primary case.
  3. The delusion cannot be better explained by any other psychological disorder, mood disorder with psychological features, a direct result of physiological effects of substance abuse or any general medical condition.

When I was in med school, I was taught that there was one documented case of folie a’ trois (madness for three).  It was a grandmother/daughter/granddaughter triad.  Wikipedia, however, reports that the name can be expanded i.e. folie a’ quatre, (four) folie en famille, (family madness) or even folie a’ plusieurs (madness of several).  I’d like to propose that our country is suffering from an even larger phenomenon:  folie a’ masses.  (Yes the English word ‘masses’ is translated into French as ‘masses’ but is pronounced with only one syllable as in Maaaaas.)

There is a mass delusion going on in America.  Nearly half the country is suffering from folie a’ masses.

Ask any Biden voter why they are voting for Joe Biden and they will give you a litany of things wrong with Donald Trump.  “Trump is a racist.”  “Quid pro Quo”.  “Trump called our fallen soldier ‘losers’.”  and who can forget “Russian Collusion”.  When asked to provide evidence of any Trump wrong doing, they rely on anonymous sources, anonymous whistleblowers, suppositions, fake dossiers, falsified FISA warrants, media reports that are just repetitions of all of the above.  Where is the evidence?

I won’t take the time to exhaustively refute every accusation made against the president because of Brandolini’s law:  “The amount of energy needed to refute bullshit is an order of magnitude bigger than to produce it.”  (For the scientifically challenged an ‘order of magnitude’ is 10 times.  Two orders of magnitude is X 102 or 100 times.)  I will, however, address a few of these as just examples of the mass delusion.

“Trump is a racist.”  The original argument was about The Wall, then the executive order limiting travel from 7 countries known to harbor terrorists, then Charlottesville.  All of these accusations have been proven false over and over.   In the meantime, Trump has made incredible progress in prison reform and presided over the lowest unemployment among African Americans in history.   His democratic opponent on the other hand was one of the authors of the 1994 Crime Bill that has created so much misery in the Black community.  Trump is a racist?  Um, no.

“Quid pro quo.”  An anonymous whistle blower reported that Trump tried to blackmail Ukraine by withholding aid if they did not investigate Biden.  The transcript of the phone call proved otherwise.  Then it came out that the “anonymous whistle blower” wasn’t so anonymous and is a democrat who hates Trump. The democratically controlled House of Representatives even impeached the president on this flimsiest of evidence! His democratic opponent on the other hand was in bed with a Ukraine gas company.  Quid pro quo?  Again, no.

“Trump called the fallen soldiers losers.”  This was an out and out lie published in The Atlantic and attributed to an anonymous source.  Numerous people who were present have come out and reported that it didn’t happen.  It was a fabricated lie made from whole cloth without a granule of evidence.

“Russian Collusion.”  This one was fed to the American public for three full years.  Hillary Clinton and the democrats paid money for a dossier that was falsified.  It was “leaked” to the news media who then reported that Trump was colluding with Putin.  The FBI then used news media reports (I use the term ‘news media’ very loosely) as evidence of collusion to obtain FISA warrants.  Worse, at the time that they obtained the FISA warrants the FBI had hard evidence that the dossier was fabricated.  Three years and 30+ million dollars later and we now have proof that it was all made up. Did you get that last part? Made up. A lie. Fabricated.

Pardon me if I don’t believe one word that I hear on the mainstream media.  They can howl when The Donald calls them Fake News but is there a better description?  They lie about their lies and the truth is not in them.  It has gotten to the point that when they report “Donald Trump called our fallen soldiers ‘losers’ for dying and not winning” that I literally laughed out loud at the radio.  It was clearly false.  If you believed it, then please call me.  I have a bridge in Brooklyn I’d like to sell.

Some would argue that I am the one who is deluded, but I do see his shortcomings. I don’t believe Trump is the second coming of Jesus.  I don’t think he’s perfect.  He has many flaws as do we all.  He’s rude.  He calls people names.  The names may not be polite, may not be nice, but to quote Ezra Pound “No capon priest was the Goodly Fere but a man o-men was he.”   Donald Trump is a man who champions America and average working Americans and is fighting against the people who cling to power at all costs.

Folie a’ masses?  The delusion is real, my friend.  It is a spiritual blindness and I pray the scales fall of in time for America to survive.

Self-Esteem

Steve Baskin wrote the following in an amazing article in Psychology Today:

The self-esteem movement has done an entire generation a deep disservice. It started with the best intentions. In 1969, Nathaniel Brandon wrote a paper entitled “The Psychology of Self-Esteem” that suggested that “feelings of self-esteem were the key to success in life”. Hearing this, many people started to find ways to confer confidence upon our children. This resulted in competitions where everyone gets a trophy and no one actually wins. “New games” attempted to engage children without any winners or losers.

(https://www.psychologytoday.com/us/blog/smores-and-more/201112/the-gift-failure)

What is self-esteem?  Psychologists define it as a person’s overall sense of self-worth or personal value.  Too little and you become depressed; too much and you are classified as narcissistic.  Where is the balance?  What is healthy?  How do we tell the difference between our own sense of self-worth and our own understanding of our abilities—good or bad?  Is it possible to think “I’m good at doing this one thing” but still hold the belief “I am worthless.”?  I posit that not only is it possible but extremely common.

I grew up with a drug problem.  I know it’s an old joke, but I was drug to church–dare I say–more than average.  Three times per week in a “normal week”–twice on Sunday and again on Wednesday night–was the minimum expectation.  During the summer I usually attended two or three different vacation bible schools (Harmony, High Hill, Westside, maybe even First Baptist Ashburn); and at least one week in the summer we went to Revival for six nights in a row.  (For those of you, who did not grow up Southern Baptist in the Deep South, think of Revival as a week of penitence along with hell-fire-and-damnation evangelistic preaching.  I dreaded it every year.)  We even attended “M Night” once a year.  (Don’t even ask.)  If Billy Graham had a campaign, we watched it nightly on our black and white television.  We had mandatory family devotions and were expected to have our own private time of scripture reading and prayer.  I point all that out to say that I was marinated in church and scripture growing up.

The Bible, however, is a really, really, big book with lots of amazing stories and lessons, men of faith and men of failure, the great redemption of mankind in the person of Jesus Christ.  It’s big.  There’s too much to absorb.  So when a troubling verse crossed my path as a young child, I didn’t know to stop and think “I wonder what that really means?” or “Is there an implication here that I’m just not getting?”  In other words, there was so much to learn, absorb, and process that I got into a habit of glossing over something I didn’t understand.  There was just so much information that was straightforward that I didn’t spend time on the complex.

Here’s a perfect example.  Matthew 22: 37-39 says:

And he said to him, “You shall love the Lord your God with all your heart and with all your soul and with all your mind.  This is the great and first commandment.  And a second is like it:  You shall love your neighbor as yourself.  (ESV)

I think I understand the first two verses:  And he said to him, “You shall love the Lord your God with all your heart and with all your soul and with all your mind.  This is the great and first commandment. That seems straightforward right?  Love God.  Love God a lot.  While we could debate what “love” means all day, the gist of the verse is easily understood.  In addition, it’s the first and great commandment.  In other words, DO IT!   It’s verse 39 (and a second is like it:  You shall love your neighbor as yourself.) that I didn’t understand.

I remember my second-grade school teacher, Mrs. Bacon teaching us the Golden Rule.  We’d pretend to be putting on gloves while we said, “Do unto others as you would have others do unto you.”  The pantomimed gloves were to somehow represent and imprint the message on our brains.  The first time I read Matthew 22, it reminded me of the Golden Rule; except there’s one BIG difference.  The Golden Rule says to treat others as you want them to treat you.  I get that.  I understand that.  The second most important commandment that Jesus mentions, “You shall love your neighbor as yourself.” is different in a HUGE way.  The huge implication, the part I didn’t understand and couldn’t get past is this:  Who loves themselves?

As an adult, I cognitively know that how I want to be treated and how I love myself are not the same; but how do I inculcate this love of myself without being prideful or boastful?  Pride and boastfulness were never allowed in my family of origin.  It is downright “unchristian” to be prideful or to boast and God forbid a parent should boast about their child or congratulate them for an accomplishment.  That would be too close to a parent bragging on themselves, which presumably was also “unchristian”.

By the time I was applying to Emory College I was terrified that I would not get in.  I believed I was a country hick and might not make it with the fancy folk at the big university. Current high school students may laugh to hear that the University of Georgia was my “back-up” since it is nigh impossible to get in there now unless you have a 4.2 GPA and have started your own non-profit to save the planet or cure cancer.  After I arrived at Emory, however, I slowly began to realize that I was well qualified and well prepared for the academic expectations there.

How does one reconcile a realistic view of one’s abilities and an internal belief that you are of no value or worthless or unlovable or stupid or not a man or…..any host of other core lies that men believe about themselves?

It’s taken 55 years to discover the answer but I think I finally understand.  Jesus loves me, my past, my present, my future.  He’s not the big judge in the sky, hammering a gavel down every time I mess up.  He already knew/knows/will know everything I’ve done/did/do/will do.  (How do you reference time when you are writing about a God outside of time?)  In spite of His all-knowing, Christ died for me on the cross to redeem me.  Why would He do that?

He loves me.

Jesus Christ, the Son of the Most High loves me.  He loves me with all the radiance of a million galaxies and all the endurance of eternity.  He loves me to the core of my being.  He loves my brokenness and my glory.  He loves my struggles and my victories.  He loves……me.

Just a few years ago, I didn’t really, really, believe that Jesus loved me down in the depth of my heart.  I knew it in my head, but in my heart I still believed that God was sitting behind his judge’s bench, ready to wag his finger and punish me. If I had a stray thought, or was not 100% completely, brutally honest, I believed he would be angry.  Just to “shade the truth” was immoral and deserving of God’s judgment.

I know for a fact that I’m not the only one who believed this way.  While I was traveling and singing with the Hawpond Messengers in high school, another gospel group with which we frequently sang used to perform a song “God’s Gonna Gitcha for That”. (every wrong thing that you do, God’s gonna gitcha for that!) I can still hear the lady singing it.  It’s ridiculous, I know.  Even then I thought the song was ridiculous.  I knew in my head that Jesus loved me.  After all, he died for me, didn’t he?  In my heart of hearts, however, part of my core lie was I believed I was unworthy of love.  From that false belief, I lived a life of self-loathing.   When I asked the question “Who loves themselves?”, it was from this root of self-judgment and self-flagellation.

Once I began to believe that Jesus truly and without reservation loves me, I began to see myself as “lovable”.  How can I hold a higher judgment that the Almighty?  I can’t.  If Jesus loves me then I am by definition lovable.

So then does loving myself lead to arrogance? to narcissism? Does it violate the family values with which I grew up?  No.  There’s a simple reason that loving myself and seeing myself as lovable doesn’t lead to arrogance and boasting:  I did nothing to deserve that love.  I am loved by Jesus, not because of anything I have done, but because He is love and love is part of His very character.  I did nothing to earn his love and therefore there is no basis for boasting.

Ultimately, for me to have a healthy self-view, I had to accept Christ’s view of me.  I am lovable AND it has nothing to do with me, but everything to do with Jesus.

 

 

 

Abundant Life

I’ve been wondering recently about abundant life.  I mean, really, what is it? No one I know thinks it is material wealth, so we’ll just dismiss that out of hand. Is it happiness? Popularity? Beauty?  I’m pretty sure that’s a no, nope, and nada respectively.

I know a 96-year-old woman who is living in a nursing home and is physically too weak to get out of bed. She grins when you visit and tells you how glad she is to see you and what Jesus is teaching her.  When you leave, you feel—loved.

There’s a mother who used to come to my practice, a large African-American woman of strong opinions and the wife of a Baptist preacher.  Their children are all grown now. I miss her and think of her often. She always treated me like I was the most important person in the world—not because she needed my help and skill as a physician but because her life was full of Jesus and it spilled out of her.  One morning I saw three social disasters in a row and when I walked into room four and saw her there, I felt like I could release my burden for just a moment. I leaned back against the exam room door, closed my eyes and let out a long sigh.
“I’m so glad to see you.”
“Dr. Cooper, what’s the matter?”
“The world is broken and in need of redemption.”
She just smiled widely and said, “That’ll preach all day.”
I laughed and she hugged me before telling me about her kid.  

I think these ladies have abundant life.

As I was thinking about abundant life, I thought I’d go to the source.  “The thief comes only to steal and kill and destroy. I came that they may have life and have it abundantly.”  ‭‭John‬ ‭10:10‬ ‭ESV‬‬. There is a duality in this verse that I’m sure has been pointed out by others many times before.  Satan steals; Jesus gives. Satan kills; Jesus gives what? Life! Satan destroys; Jesus gives life how? Abundantly.

There’s another parallel that’s I’ve recently begun to see.  

I come face to face with immense tragedy on a daily basis—clear evidence of the enemy coming to steal, kill, and destroy lives.  This is not exaggeration. In the past week, I’ve had a very handsome 15-year-old teenage boy sneaking out at night to meet an adult man at Waffle House.  He looked stunned when I mentioned that Atlanta was the center for child sex trafficking. I had a 17-year old whose first cousin and best friend committed suicide.  He wept in my arms. I talked to another young man, a former-sort-of-still patient, who told me about the day his father left the family years before. He fought to hold back tears. There was the college student who is daily numbing the metaphorical gunshot wound to his chest with marijuana and the high school senior, six weeks from graduation, who is expecting to be kicked out of school on Monday.  A family came into my practice Friday for their very first visit with no idea that their five-year-old daughter almost certainly has autism. I had to tell them the news and change the course of their imagined future. An hour later, a newborn came in for his first visit and I found Developmental Dysplasia of the Hip.  Another was sexually molested.  There’s always ‘another’.  It is my immense privilege to help these people, to love them.

I’m beginning to believe that abundant life is a life of walking with Jesus such that His life spills out of you and into the lives of others, but that’s not all it is.  It’s also painful. It costs us something to walk with Jesus. It costs us something to help another human soul. In order to feel the joy of making a difference in someone else’s life, you must also feel their pain.  Holding pain and joy simultaneously in your heart is not easy. It is difficult and it hurts and you wish it would go away; but in order to heal their hurts and pains, to rescue the perishing and care for the dying, we as Christians are called upon to dive into their wounds with them and show them that they are loved unconditionally. Yeah, it costs us something, but it’s necessary to pay that price in order to reap the reward of seeing Jesus change lives, to know that you were a tiny part of healing another’s heart-wound.  It’s also beautiful and rewarding and abundant.  

I don’t claim to know all the answers and there are certainly more aspects to the abundant life than this, but at least part of it is loving another human soul with the love of Jesus because it is spilling out of you.  That is the abundance of Christ’s love overflowing. 

Jesus, did the same for us, didn’t he?  He feels our pain and sees our brokenness.  When we go to him, he just holds us and loves us–abundantly.

Jesus, I feel sad today and I’m not sure why except for the overwhelming losses I’ve seen this week.  How do I hold it all?

You don’t.  You were never meant to hold it.  Just like my life flows through you to them.  Their griefs are to flow through you to me. Their pain and wounds are not for you to hold onto but to absorb and pass to me.  It is too much for the human heart to bear.
“casting all your care upon Him, for He cares for you.”
I Peter 5:7 NKJV

You can’t know the joy of loving others without Jesus; you also can’t bear their pain without Jesus.

 

Sadness

I’m not given to strong emotions.  Actually, I have difficulty feeling sad.  I just hate it.  Sometime in my childhood, I learned that sadness wasn’t “appropriate”.

I idolized Mr. Spock from ST:TOS, (For the syfy naïve that’s “Star Trek: The Original Series”.) I knew as a fourth grader that Mr. Spock was half human and half Vulcan.  Vulcan’s are known for being logical.  They aren’t devoid of emotion; they just refuse to be ruled by their emotions.  Mr. Spock, as half-human, desperately wanted to be seen as Vulcan and struggled to keep his all too human emotions under control.  I wanted to be him.  Learning the “Vulcan Salute” was a given, but I went so far as to sit cross-legged on the bathroom counter, looking in the mirror, and trying to raise one eyebrow while saying “Fascinating”.

Two women that I love are in failing health.  My mother has had numerous medical procedures, pulmonary embolus, pacemaker placement, shoulder surgery, medication reactions, etc.  You name it and she’s probably had it along with all the exceptions to the rules.  She was a vigorous woman when I was growing up, loving and jovial, bossy and in charge.  She could always tell what needed to be done and had probably already done it.  I’ve joked that you could call her at 5:00pm and tell her that you were bringing 20 people for dinner and she would welcome them with open arms and a hearty meal.  That’s all changed now.  She really can’t do for others like she used to and in fact, needs help herself most days.

Similarly, my mother-in-law has always had a smile for everybody and a servant’s heart for everyone in need.  She loves her daughters, sons-in-law, and grandchildren and greets us all with a hug and a kiss.  My MIL can cook a turkey better than any I’ve ever tasted (and she has fortunately taught my wife!)  She’s never been the gale-force wind that my own mom can be, but she is always accepting and loving and kind.  Her health is failing.

Sunday morning, I picked my MIL up to take her to church and she wasn’t doing well.  She is well aware of her decline and was feeling a bit emotional as a result.  It was tearing me up to see her in her sadness.  I held it together until church.

Right before we went into the worship center, a woman who stands near me in the choir, a woman who I have known tangentially for many years, told me that she has just been diagnosed with stage three ovarian cancer.  The damn dam broke.

Oh, I didn’t openly weep!  That would have been against the “Cooper Family Values” that sadness is bad; but I was sad.   I felt it deeply.  I could hardly hold it together to sing.  “Our God Saves”?, “Jesus Messiah”?  “How Marvelous”?  Really Jesus?  I usually worship with my whole heart and sing with abandon, but not Sunday.  I was grieving.

We lost so much at The Fall.  Life.  Freedom.  Wholeness. Everything.

Revelation 1:18 says Jesus holds the keys to death and Hell.

Come quickly, Lord Jesus.  Maranatha.  Come quickly.

 

 

Forty Years Ago

Forty Years Ago

I must be getting old.  Fifty-six doesn’t seem that old but I’m constantly amazed at how long I’ve known people.   In Ashburn, Georgia in the early sixties, few people moved. The kids with whom I attended kindergarten also graduated with me.  I could probably list fifty people on my Facebook friend list who were classmates. That’s 52 years of friendship with each one. Wild!

In spite of knowing everyone at Turner County High School, I started my sophomore year in a constant state of loneliness.  I didn’t realize it at first. My best friend of five years, a guy I’d spent hours and hours with both in and out of school, began making life choices that took him in a different direction than my life choices.  He partied; I worked (and sometimes studied). We never had a falling out. He and I simply drifted apart as our lives went in different directions. Even though the separation happened in a passive manner, it was still separation and for the first time in my life, I found myself without a close friend.  I still think about him often and wonder where he is and how he’s doing.

Oh, there were other friendship options and I was truly friends with many many people but no one really knew me, knew my heart.  I was friendly, polite, jovial even, but I was lonely. It was from this loneliness, that I began to pray for a friend, a genuine friend, a friend who would like me in spite of my foibles, failures, and flaws.  What were my options? It wasn’t like a new kid was going to appear out of the blue in this tiny town.

But God… (I think that’s my father’s favorite phrase.)

In spring 1978, First Baptist Ashburn, a church I didn’t attend, called a new pastor, Bob Zbinden.  Rev. And Mrs. Zbinden, affectionately and forever called Mr. and Mrs. Z, moved to town. They had four kids, a daughter in nursing school, twin boys in tenth grade, and a daughter in eighth grade.  Zack and Kelly and I quickly became inseparable. We didn’t even have a single class together that first quarter, but somehow began to eat lunch together.

We hung out at youth group.  We talked long into the night.  We prayed together. Mostly we sang together.  I earned my musical bona fides singing with Zack, Kelly, and Mark Mercer.  The twins inhaled bowls of fresh vegetables at my mom’s table. For two summers, Mrs. Z fed me lunch almost every day.  Our lives became intertwined.

Zack and I drove Kelly to Shorter College and helped him move in.  (I swear to this day an angel repaired our car on the way.) I’ve had dinner with Kelly in Chang Mai, Thailand where he works.  We’ve been in each other’s weddings. We’ve watched each other’s kids grow up, marry, and start their own families.

My wife and I have developed a close friendship with Melanie Zbinden and love spending time with her.  She’s full of love and joy and spreads it to those who have the privilege of knowing her.

Zack attended Georgia Tech while I went to Emory but we both went to First Baptist Atlanta where we continued to sing together.  One Sunday about 35 years ago, Dr. Charles Stanley asked us to remember our most desperate prayer and how God answered it. After the early service, we were in Sunday School assembly in the college department and I pulled Zack aside and told him how lonely I had been and that I had been praying for a friend when he and Kelly moved to Ashburn.  I told him for the first time that he had been a direct answer to my most desperate prayer. We both were tearing up. Mary Beth, the youngest Zbinden saw us and had a look of shock on her face. I remember asking her what was wrong and she said, “Well, it’s not every day I see my brother and his best friend crying!” We just laughed and didn’t offer an explanation.  (So, Mary Beth, here’s why.)

March 18, 2013                                                December 28, 2018

In short, in my most desperate hour, God answered my most desperate prayer with a family that helped shape the direction of my life.  Thank you Zbindens for your love, your care, your influence. May God continue to bless and multiply your family.

 

“So is Satan an agent of God?”

“So is Satan an agent of God?”

There is a knee-jerk response, “Of course not.” But is that response correct? The question had been asked by an incredibly intelligent man, a lawyer no less, trained in logic, argument, and debate. His question was valid and a direct result of our conversation that morning in small group. His question came from a position of humility; he was not trying to prove a point but genuinely trying to learn more about Christ. So how do we explain our temptations?

Our temptations come from a number of sources.  The world (or our culture and values we absorb from our culture) is a common source of temptation. (Romans 12:2) Our fallen nature produces plenty all by itself, but God tempts no one. (James 1:13-14). The devil tempts us, as we know from Jesus’ battle in the wilderness. He is also allowed from time to time and in order to accomplish God’s purposes in our lives, to “sift us like wheat,” (Luke 22:31). But that is not the same as being God’s agent. Satan, it appears, is always looking for ways, and has to ask permission, to do evil things in order to break our faith.   As Paul says, Satan is allowed to poke us with various pains in order to help us maintain humility

Why must we endure, like Paul, our “thorn in the flesh”? (2 Corinthians 12:7-10). There have been many times in my life that I have prayed for Christ to deliver me from sin, to take away the temptations. “Jesus answered them, “Truly, truly, I say to you, everyone who practices sin is a slave to sin. The slave does not remain in the house forever; the son remains forever. So if the Son sets you free, you will be free indeed.” John 8:34-36 ESV.  If Christ came that I might be free and free indeed, then why don’t I feel free? Why doesn’t the almighty, omniscient, creator of the universe, release me from this pain and suffering? Is he just sadistic? May it never be. Jesus loves us beyond our comprehension. His motivation in all things is first and foremost love for us. If this is true and he desires the very best for us, then why must we suffer our particular “thorns”? Paul wrote, “So to keep me from becoming conceited because of the surpassing greatness of the revelations, a thorn was given me in the flesh, a messenger of Satan to harass me, to keep me from becoming conceited. Three times I pleaded with the Lord about this, that it should leave me. But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me. For the sake of Christ, then, I am content with weaknesses, insults, hardships, persecutions, and calamities. For when I am weak, then I am strong.” 2 Corinthians 12:7-10 ESV

What exactly was Paul’s thorn?  We aren’t really sure.  Some theologians believe it was a chronic eye infection; in which case, a physical weakness could not be construed as a temptation.  On the other hand, it seems Paul, a gifted and well-educated speaker and writer, was intentionally ambiguous and vague in the description of his thorn.

First Paul says he has a thorn in order that he might not become conceited. Paul had been given great revelation by God in order that the saints through the ages might know Christ through His inspired word. That had to be a very heady experience for the apostle, yet he was humbled in order that he might not be puffed up. Paul prayed that the thorn would be removed but it wasn’t. Christ accepts our prayers even if He doesn’t remove our thorns. Christ gives us Grace in a sufficient and equal measure to our thorn. Why? So that our strength is made perfect in our weakness. If we had no weakness, what would there be to overcome? If we were never tempted, how would we rely on Christ’s strength to work in us?

Is it indeed possible that Christ Jesus, who loves us more than his own life (Greater love has no man than this, than he lay down his life for his friends.), is it possible that He has a plan for our good that outsmarts our enemy, that uses our temptations, a plan to train us into warriors for his Kingdom? I knew two different friends in high school who had their own thorns and just gave in or gave up. I knew them both as children and believe that they met Jesus but they succumbed to their thorns. One died of AIDS. The other has disappeared and even his family doesn’t know where he is. He is either living under a bridge somewhere, or in jail, or in a grave. Nevertheless, if they truly did meet Jesus, they will be in heaven and at the great feast.

What then is the benefit to fighting and struggling and suffering? When someone gives up and succumbs to their battle, there are no works that survive. They can be saved “as through fire”, but what is the long-term eternal consequence? Their experience of Jesus and his salvation is limited to an eternity of mild gratitude. An overcomer, however, gets to know Jesus now and their works will be proven on the day of judgment. Only the works of gold, silver, and precious stones will survive. (1 Corinthians 3:12-15). Ultimately the most important reward may be a much deeper intimacy with Jesus Christ for all of eternity.

So, is Satan an agent of God? I don’t believe that God’s original plan was that we suffer so, but I also believe that our God is so far greater than our adversary, that He uses Satan’s plans against us and turns them on their head so that we might gain a greater reward because of our perseverance.

Thank you, Jesus, for my infirmities, my thorns, my weaknesses, that I might know you and your redemption and dwell with you in a growing intimate relationship for all eternity.

Let the Little Children Come

I’ve said it before.  I love my job.  It is intellectually stimulating, emotionally rewarding, and even spiritually healing.  I think I was born to be a pediatrician and was lucky enough to find my calling in life.

This week I had a little one, 9 years old, come in with moderate to severe pain in the left upper quadrant of her abdomen.  Her abdomen was not “board-like” and she didn’t have rebound tenderness, but still, there was something that wasn’t right about this scenario.  It didn’t fit the algorithms and paradigms in my head.  Her mother thought she was having a kidney stone. Even though kidney stones are increasingly found in children and while not impossible in this child, it just didn’t fit.  The pain was too high and anterior.  I was concerned enough to order a CT scan—something I seldom have to do as a primary care pediatrician.  She had a congenital malrotation of the intestines and a ruptured appendix up where her spleen ought to be.  I don’t rejoice in her suffering, but there is something immensely satisfying to know that you found a potentially life-threatening condition that was not otherwise suspected.  That’s what I mean when I say it’s intellectually stimulating and rewarding.

I also see Medicaid patients.  Many of my colleagues, especially here in the city of Atlanta, refuse to see kids on Medicaid.  I can barely wrap my head around this concept.  I am politically conservative and would defend the rights of my colleagues to see whoever they choose to see, but just because they have a legal right to do so doesn’t make it morally right.

I know a family, who will remain nameless, who has been going to a big name, long established, practically famous, pediatric practice, which will also remain nameless, for THREE generations.  Three generations of the same family going to the same practice!  That’s great!  I love that families trust their doctor and stay where they are comfortable.  One of the second generation families, however, decided to take in some foster kids.  Foster children by definition are wards of the state.  As wards of the state, children in the custody of Child Protective Services are automatically enrolled in Medicaid.  The state, as their guardian, provides the insurance for the children.  Also, when a child is taken into CPS custody, they must be examined by a pediatrician in the first few days.  Why in the name of all that is holy would a physician who has taken care of three generations of the same family refuse to see two foster kids for their intake evaluation and well visit?  Hell, I would have done it for free!

I have one foster mom, a single lady, who routinely takes foster children that are difficult to place.  She has a large house with several bedrooms and several beds so she is on the list to take family groups.  Yesterday, she brought in five children who had just been placed with her.  Their story is almost too tragic to write about and might even be a HIPPA violation, so suffice it to say, these children are as shell-shocked as a Vietnam Vet in a wheelchair.  Tragedy upon tragedy.  When I entered the room, the children were sitting all in a row.  A nine-year-old boy and three little sisters all sat quietly while the foster mom held the 8-month-old.  When I asked who wanted to go first the oldest girl shot her hand up in the air and was followed almost immediately by the 9yo boy, both yelling “Me. Me. Me.”  Starving for attention.

“Well, buddy.  I think its Lady’s First.” I said.

“But I’m the man and I have to show them that it’s OK.”

I almost cried.  I thought I was going to have to leave the room but managed to hold my emotions in check.  I’d never met a nine-year-old MAN, but MAN he was.  He wanted to protect his sisters.  How long has he had to protect them?  I may have told him 12 times how proud I was of him.  During the course of the visit, he helped one sister climb onto the exam table.  He fed the infant a bottle while the foster mom was talking on the phone with CPS about an important piece of the history.  A child was forced to protect.  A child was forced to provide.  Who will protect and provide for him?  A Man Indeed.

I methodically went through each child’s exam, vaccines records, problem list, social history, medical history, medication list.  During the visit with the 6-year-old girl, who was precociously verbal, the 4-year-old girl walked over and just leaned against me, literally laying her head on my arm.  The 2-year-old sat in my lap while I documented her information into her chart.  She refused to get out of my lap while I talked to the foster mom about the infant, only getting down when I told her she had to in order for me to exam the baby.  When I finished the exam of the baby, the 2-year-old wanted back in my lap.  I held her and hugged her.  My heart was breaking for these babies and their wounds.  These children wanted, needed, couldn’t live without love and attention.  Can any of us?

Let the little children come to me and do not hinder them, for the Kingdom of God belongs to such as these, Luke 18:16

Some of my colleagues refuse to care for patients on Medicaid.  Why?  I cannot come to any conclusion other than greed.  I have a friend who is fond of saying “Where there is no margin, there is no mission.”  This is true and we cannot see patients for free for there would quickly be no mission.  Medicaid, however, does pay and it pays quickly, it just pays a little less than commercial insurance plans.  Unfortunately, the physicians who refuse to see Medicaid patients over a few dollars are poorer for it.

God’s Faithfulness

 

IMG_0264

 

To say it’s been a rough two weeks is an understatement. There’s nothing quite like a little work stress to drive you to pray and talk to Jesus.

This morning during my prayer time, I decided to reread the last two weeks of my journal.  When I pray, I write it down.  I used to send telegrams to heaven, but as I’ve learned to have a conversational walk with Jesus over the last 15 years, I write it all down.  I write down my worship, my requests, my needs and I record anything Jesus has to say to me in response.  This morning as I read through just two weeks of prayers, I was struck by how faithful Jesus is and how he answers prayer in ways you may not have anticipated.  Here’s this morning’s first paragraph.

Jesus, as I read back over your words from the past two weeks, I am struck by your utter and complete faithfulness.  It is truly your nature to love me and to be true in all that you do and are.  It strikes me that in the original language—your language of creation—that “do” and “are” are the same concept.  When one is outside time and space then there is no separation between “doing” which implies the passage of time and “being” which does not imply the passage of time.  Jesus, now I am thinking like a Syfy writer!

OK, I may have laughed out loud when I wrote that last line!  Maybe I read too much Syfy and too many physics articles but the fact remains God is faithful.  Is faithfulness a character quality?  In other words is faithfulness something God is?  Absolutely, but faithfulness is also something God does.  So God is faithful because he does faithful or maybe he does faithful because he is faithful.  Both are true.  Being and Doing are inseparable for the Almighty.

A bush burns (does) but is not consumed (is).

I am who I am.

God, being outside time, never changes.

 

Reminders

It’s been a hectic summer.  My family has traveled some and we spent a week at the beach.  Between the two vacations, though, my office was busy–very busy.  For years we have striven to do more checkups during the summer but recently The Children’s Care Network (TCCN) has gotten in on the act in an effort to increase wellness visits, immunizations, and appropriate screenings, especially among adolescents.  I like working hard and being busy.  It makes the day go by quickly and gives you a “good” tired at the end of the day—fatigue accompanied by a sense of accomplishment.

Healthcare is always changing; however, recently it feels like the changes are accelerating. In the past couple of years we’ve had to change electronic medical records with all the myriad details that required, adopted ICD-10, completed all the work for PCMH certification (awaiting my government overlord’s gold stamp of approval), accomplished several quality improvement initiatives from TCCN, preparing to start electronic virtual visits for medication management, and applied for a yellow fever certificate in order to start a travel clinic.  Whew!  It’s been exhausting.

There is a lot of talk about physician burnout.  There are articles in the literature, letters to medical editors, talks at medical meetings, etc about physicians just quitting and walking away.  Physician suicide is a real concern among my colleagues.  I’ve always thought I’m immune to that but it has occurred to me, with all of this striving and long hours of work, that I was exhausted physically, mentally, emotionally.  That’s why I was so looking forward to a week at the beach.  Sun, surf, walking on the beach, reading all day, seafood for dinner.  Could life get any better?  It was pretty much everything I needed to rest and recover.

When the week came to an end, I spent the last few hours just contemplating and praying.  I started with just thanking Jesus for the time to rest but found myself asking about the coming week.  It’s both a blessing and a curse that I am always planning.  What do I need to do next?  What are the steps to that goal?  How can I improve?

At the end of the last day on the beach, I gathered my paraphernalia and headed up to the condo.  After rinsing all the sand off, I decided to do a few laps in the pool.  I was alone in a large indoor pool and did just enough laps to get a little fatigue in my chest when I stopped to rest.  A young family was getting in.  Dad was holding a beautiful nine month old.  The parents sat in the shallow end and passed the infant back and forth.  She was smiling, laughing, and generally having a great time.   It was a joy to see.  I found myself smiling at them and remembering why I love my job.

It had been nine days since I had had an office visit with a kid.  This little event, watching the parents and child in the pool just loving and enjoying each other was a vivid reminder of how much I love the fundamentals of my job.  The whole scene felt like a gift from Jesus and a reminder that I have the greatest job and earth.  Thank you Jesus for this.

 

Florinzi

I was so proud of my daughter.

We recently took a Disney Cruise out of Italy.  It was a Magic trip.  We started in Rome and made several stops along the coast.

My family thinks I’m a Nervous Nelly when it comes to boarding times, but the cruise staff makes way too many jokes about leaving people who don’t show up on time.  The benefit of taking an “official” excursion is you are never late for boarding and someone else is responsible for planning the entire event.  The excursions usually involve chartered buses and tour guides.  Most of these kinds of tours are well-oiled machines, running like precision clockwork.

About ten years ago, we were on a “Disney Official” excursion that actually did run late.  When we got back to the dock, there were cruise workers at the far end of the dock standing and waving for us to run to get on the boat.  I don’t know how much they pay in fines for being docked past their allotted time, but it must be a hefty price for the number of discussions and threats of being left that go into each announcement of the all aboard time.

That’s why I was anxious about our plans one particular day.  We were on our own!  If we missed the boat, we had no one to blame except ourselves.  I have to point out that there was not an excursion that did both of the things we wanted to do.  Maybe because to normal human beings, there really wasn’t enough time!  We were docked in Livorno, Italy but this was the closest we would get to Florence and of course my daughter has always wanted to see the Leaning Tower of Pisa sooooooo, we left early on a shuttle to downtown Livorno, had to figure out how to buy a bus ticket to the train station, ride the bus, figure out how to operate the kiosk to buy a train ticket to Florence, find the dang train, ride 1.5 hours to Florence, take a taxi to the museum, take a tour to see Michelangelo’s David, take another taxi, another train, change trains, another taxi to the Leaning Tower and finally a taxi back to Livorno.  We did all that with three hours to spare.  My anxiety was low for most of the day.  My daughter planned it all.  She had every train time, costs, schedules, and tour time (purchased in advance online by my wife).  Her scheduling was a thing of beauty.

In spite of all the landmarks, my favorite thing I saw that day was the Hospital of the Innocents in Florence.  I walked several blocks to find it.  It wasn’t actually far from the museum housing David, but let’s just say I didn’t take the shortest route.  The Hospital of the Innocents is the world’s oldest orphanage dating from the early 1400s.

I got a little choked up just seeing the orphanage.  I’ve seen David and while he is an amazing piece of art, the Hospital of the Innocents meant something else to me.  The Hospital was founded by The Silk Guild in Florence to care for the foundlings of Florence. It had a “wheel of secret refuge”, a special door where a desperate and destitute mother could place a baby and rotate the wheel so that the child was inside the safety of the hospital and the mother could remain anonymous.

Over the arches of the hospital are a series of “Tondi”.  These are ceramic ovals with stunning carvings of infants wrapped in swaddling clothes.  One of these is used as the logo for the American Academy of Pediatrics.  I don’t always see eye to eye with the AAP but I love that this is our logo.  By choosing an infant tondo from the facade of The Hospital for the Innocents, we pediatricians have honored the first recorded group and facility whose mission was to rescue babies.

HoI Tondo1

All ideas, great or small, must start with a single thought by a single person.  In this case, somebody, a single person, a good person, originally had the idea to rescue babies.  That person had a heart for children.  I have no idea if he/she had any medical training but this person had the heart of Christ and cared for the Innocents.  It is a beautiful legacy that this man or woman cared for the ones that Jesus loved.  “Let the little children come to me and do not hinder them, for to such belongs the kingdom of heaven.” Matthew 19:14 ESV.

The founder of The Hospital of the Innocents had the heart of Christ and the heart of a pediatrician.  I was deeply moved to be there.  What I had anticipated being a stressful day ended up being a gift from heaven.

Thank you Olivia.