"What did you find, Doctor?"
The mother was in her usual anxious self when I greeted her in the GI lab after her teen daughter's endoscopic procedures. Jenna had been complaining of stomaches for years, and recently the pain got to the point where she stopped going to school. She was getting depressed, not sleeping well, and also started to complain of headaches and pain all over the body. Her recent laboratory test results were largely normal, and physical examination findings did not suggest the presence of any serious disease. I was quite certain that Jenna had a "functional" disorder such as fibromyalgia. These conditions mostly present with various types of pain and discomfort that are not due to infections, obvious inflammation, cancer or any disease that requires surgery, and test results are almost always negative. I was quite reluctant to perform additional studies on her, but recently indicated that I would consider performing GI endoscopies on her if the results, which I expected to be normal, can provide the family reassurance that Jenna does not have any other serious disease. She ended up getting both an esophagogastroduodenoscopy (scoping from the mouth) and a colonoscopy (scoping from the rear end).
"Jenna handled the procedures pretty well. Here's a copy of the photographs that I took inside her." I handed the mother the endoscopy pictures, and did my best to explain the findings. "This picture is from the first part of the small intestine...this one from the stomach looking toward the intestine...from the stomach looking up toward the esophagus...from the lower part of the esophagus...from the area of the large intestine next to the appendix...the rest of the large intestine...rectum...." I paused for a moment.
"Basically all the parts of the digestive tract that were visible on endoscopy were completely normal. Jenna does not have ulcers, does not have infections inside her stomach, does not have bleeding, does not have polyps...does not have cancer. I hope that you take this as good news, and the negative findings were basically what I expected before going into the procedure."
"You're sure that the tests were negative?" Jenna's mother asked, staring blankly while her daughter, still under the influence of sedative medications, giggled unintelligibly in the gurney beside her.
"I've learned in medicine never to actually say 'never' or 'always', but I'm as certain about this as I possibly can be. I did take some biopsies during the procedures, and the results should be available next week to further confirm that Jenna does not have a serious organic disease."
My confidence in what I said was based on what I learned in medical school, in my residency training, in my pediatric gastroenterology fellowship, in my work experience, in books, in journals, in discussions with families, colleagues and mentors, and in attending numerous national medical conferences. The only thing that would further increase my confidence would be if God actually told me that it was so. Unfortunately, I wouldn't be surprised if the mother wanted a second opinion.
Is there anything in which I can have true confidence? Being one who has lived under God's grace as a Christian for many years, I have full assurance of my salvation. Jesus said,
"All that the Father gives me will come to me, and whoever comes to me I will never cast out. For I have come down from heaven, not to do my own will but the will of him who sent me. And this is the will of him who sent me, that I should lose nothing of all that he has given me, but raise it up on the last day. For it is my Father's will that all who see his Son and believe in him should have eternal life. I will raise them up at the last day." (John 6:37-40)
The first of two diagnostic questions that are taught in Evangelism Explosion training is, "Have you reached the point in your spiritual life where you know for certain that if you were to die tonight you would go to heaven?"
My answer is yes. I'm even more certain of it than I am of Jenna not having cancer.
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