Resuscitation

"You may go ahead and push the fentanyl.  Slowly, please."

I instructed the nurse at the neonatal intensive care unit to start administering the sedation medication to the baby as I started to arrange the sterile medical supplies and equipment for the procedure.  The patient was an infant girl with serious neurological deficits who needed supplemental tube feedings for nutritional support, and her attending neonatologist asked me to place in her a special feeding tube through the abdominal wall into the stomach.  It is a relatively simple but also painful procedure, and as a rule it is performed under sedation or anesthesia.  I have performed many of these procedures in infants without complications, and was optimistic that this one would also go well.

As the nurse started to give the medication intravenously, I spoke with the doctor and two nurses who were immediately assisting me, and reminded them that the first two minutes of the procedure, during which an endoscope (a small, thin, flexible tube with a camera) is inserted into the stomach, could be the most critical, and dangerous.  I explained that the sedated baby could potentially stop breathing as a reaction to the scope, and that it might be necessary to temporarily interrupt the procedure to resuscitate the baby by giving her supplemental oxygen.  I also reassured the team that nearly all my patients who previously experienced this temporary interruption was able to have the procedure completed without difficulty.  One of my nurses nodded in agreement, as she had previously assisted in the same procedure many times before.

The assisting doctor suddenly directed my attention to the baby's cardiorespiratory monitor, and appeared quite concerned.  The baby's oxygen saturation started to drop precipitously because she was not breathing.  I asked the nurse to give the baby oxygen by mask.  Still no improvement.  The baby's oxygen saturation, which normally should be about 100%, now dropped to about 70%.  I asked the nurse to start ventilating the baby with the bag-valve-mask assembly and 100% oxygen, while the other doctor repositioned her head to allow air entry into the lungs.  I looked at the monitor, and was dismayed to see that there was no evidence of chest movement.  We were trying to push air into the baby's lungs, but air was not getting inside her.  The oxygen saturation reading now dropped below 60%.  She might die soon if things didn't improve quickly.

The baby likely experienced what is known as "rigid chest syndrome", a rare but well-known potential adverse reaction to fentanyl, the sedation medication used for the procedure.  A patient with this condition develops severe tightness and spasms of the chest wall muscles that it becomes impossible to breathe, and sometimes the only thing that can be done is to medically induce muscle paralysis so that oxygen from a ventilator can move into the lungs to save the patient.  The other doctor and I were seriously considering the possible need for this, when suddenly a couple of faint chest movements were noted on the monitor.  I asked the nurse to keep resuscitating the baby, offering reassurance that the baby appeared to be recovering slowly by herself.  A few seconds later, the monitor showed that the oxygen saturation started to rise from 57% to 60%, and after a few more ventilation attempts with the bag-valve-mask assembly, oxygen finally started to move freely into the baby's lungs as the chest relaxed and started to rise and fall visibly with each delivered breath of air.  Within a couple of minutes, the oxygen saturation appeared stable, and we eventually felt confident enough to actually start and finish the procedure, with no further difficulty.  I appeared calm throughout the situation, but emerged from the procedure drenched in sweat, knowing that the baby could have died.  Thankfully, the baby did well after the procedure, had no trouble with tube feedings, and was being prepared for hospital discharge within a few days.

The only reason that the baby survived the ordeal was that she, for a lack of better words...stayed alive.  It would be impossible to resuscitate a dead person.  "Dead" is also the word that describes us before we become Christians:

"And you were dead in the trespasses and sins in which you once walked, following the course of this world, following the prince of the power of the air, the spirit that is now at work in the sons of disobedience - among whom we all once lived in the passions of our flesh, carrying out the desires of the body and the mind, and were by nature children of wrath, like the rest of mankind.  But God, being rich in mercy, because of the great love with which he loved us, even when we were dead in our trespasses, made us alive together with Christ - by grace you have been saved."  (Ephesians 2:1-5)

Unless God first breathes life into us spiritually and awakens us, we will remain spiritual corpses that will not respond to the most valiant effort by men and women who try to blow the air of the Gospel message into us.  May we who believe in Christ thank God for giving us life in the first place!

Ripening a Buddha Head

Huge, succulent grapes.  Asian pears the size of grapefruits.  Melons with delicate yet distinctive fragrances wafting in the air.  Perfectly ripe papayas with deep orange flesh.  Juice oranges with paper-thin rind.  Crisp, sweet jujubes the size of hen's eggs.  Strange, exotic looking dragonfruit.  Wax apples (they're not apples and there's no wax, and I've never seen one in the United States), guava...I was in a fruit-lover's heaven, being virtually paralyzed by the immense choices at a large fruit market in Taiwan.  I happened to pass by the market a couple of winters ago while visiting my mother in Taoyuan, Taiwan.  Since I do not travel there much, I wanted to buy some of the local offerings that are rare in my present home near Los Angeles, California.  I picked several large jujubes, a few wax apples (not too many, as they were kind of expensive), a large dragonfruit, some of the local orange varieties, and a small papaya.  I could get more, but the collection was already feeling a bit heavy, and my mother's apartment was at least a ten-minute walk away.  It was time to complete the purchase.

As I brought the basket of fruit to the cash register, a cluster of odd looking artichoke-like lumps caught my eye.  Known locally as "Buddha head" fruit (or custard apple in English), they are about the size, shape, and color of large green avocados, with hard, coarse, paneled rind that resembles crocodile skin or a pangolin's plated armor.  I remembered eating them years ago, and recalled that they were really tasty.  I picked one up to inspect it, and was instantly disappointed by its hard texture.  They weren't edible.

At least not right away.

The man at the register told me that the Buddha heads were not ripe yet, but they were on sale, and that they would ripen in about two to three days if they were wrapped in newspaper and placed in a warm place, say, near the refrigerator vent or behind the computer monitor.  I was a bit skeptical that something as hard as a hand grenade would actually ripen that quickly, but since I was planning to stay a few more days in Taiwan, I took a chance and brought home two of the Buddha heads.

I spent the next couple of days enjoying as much fruit as my intestines would allow, and before long, I was down to the last couple of oranges and wax apples, and the two Buddha heads that I left behind the television. I removed one of the Buddha heads, and was immediately greeted with the intense aroma of ripe fruit.  I pushed one of the armor-like plates on the surface, and noted that it collapsed into the body of the fruit with very little pressure.  I peeled the loosened plate with the attached fruit, revealing creamy, succulent, sweet flesh.  The entire fruit was reduced within minutes to a pile of peel and seed.  The second fruit experienced the same fate the next day.  They were delicious, just like I remembered.

Like the Buddha head fruits, Christians also need ripening before the fruit of our conversion releases its sweet aroma.  Unbelievers tend to accuse Christians of being hypocrites because we often fail to demonstrate the love of Christ, joy, peace, patience, kindness, etc., that the world expects of us.  Instead of sweetness and fragrance, we come across as being hard, cold and bitter, because we still struggle with our old, sinful nature. Thankfully, we are promised that if we have been regenerated by the Holy Spirit, we will be ripened into good fruit.

And I am sure of this, that he who began a good work in you will bring it to completion at the day of Jesus Christ.  (Philippians 1:6)

Therefore, my beloved, as you have always obeyed, so now, not only as in my presence but much more in my absence, work out your own salvation with fear and trembling, for it is God who works in you, both to will and to work for his good pleasure.  (Philippians 2:12-13)

May each day in our lives be a day of ripening that leads us to become a sweet aroma before the Lord, in His time.

Fanatic Runner

There are generally two kinds of rookie marathon runners.  Many are of the "one and done" variety - once they cross the finish line (in various states of brain and muscle damage), they happily check "finishing a marathon" off their bucket lists, wear their finisher medals to school and/or work for the next month, and are unlikely to ever tackle the 26.21875 mile (or 42.195 km) distance again without wheels.  

I belonged to the other group.  After I completed the City of Los Angeles Marathon in 2004, finishing barely upright and a shade under 6 hours, I was bitten by the running bug, and running literally consumed me for the next several years.  I went to bed wearing my running clothes.  My watch alarm was set at 4:45 a.m.  I ran 10 miles, sometimes 12, before work.  I ran more than 100 miles a week for several months in a row.  I consumed huge amounts of food.  I subscribed to Runner's World magazine, and went to the local bookstore to read other running magazines and books that I didn't have.  I voraciously searched running-related web sites for tips, charts, and pace calculators.  I did tempo runs, progressive runs, quarter-mile repeats, Yasso 800's, medium long runs, recovery runs, and long runs.  Some Saturday mornings I would leave my home in Temple City, CA, for runs, and would end up spending over 4 hours leaving 27-mile long trails of footprints in nearby Arcadia, Monrovia, Irwindale, West Covina, Covina, Azusa, Baldwin Park and El Monte.  I participated in an online running discussion group.  I even joined the group's running mileage game one year...and won.  I ran 21 more marathons over 8 years.  I have a Boston Marathon finisher's medal somewhere in the bathroom.  I read running shoe catalogs in the bathroom.

I was not a casual runner.  I was a running fanatic.  Life was simple and predictable, as I ate in order to run faster, I drank in order to run farther, and I slept and rested so that my muscles would recover in time for the next day's run.  This running thing, I ate it all up.

In the same way, there are two kinds of people who call themselves Christians.  Shortly after I received Jesus as my Lord and Savior, my well-meaning parents advised me to not get too crazy with my religion.  They didn't mind that I would receive certain benefits from going to church - I would learn how to be a good person, have the "right" kind of friends (and maybe even meeting the right girl), and have something to keep me busy on weekends.  They just did not want me to become a religious fanatic.

However, Jesus was not looking for casual, lukewarm Christians.  After he declared himself to be the bread of life, it was clear that Jesus was looking for hard-core followers:

"So Jesus said to them, “Truly, truly, I say to you, unless you eat the flesh of the Son of Man and drink his blood, you have no life in you. Whoever feeds on my flesh and drinks my blood has eternal life, and I will raise him up on the last day. For my flesh is true food, and my blood is true drink. Whoever feeds on my flesh and drinks my blood abides in me, and I in him. As the living Father sent me, and I live because of the Father, so whoever feeds on me, he also will live because of me."  (John 6:53-57)

Jesus was not looking for casual followers who just wanted a taste of what he had to offer, but those who would eat it all up.  Many of Jesus' followers turned back and left.  Those who remained were fanatics who eventually turned the word upside down.

Are we all in?

Sealing the Deal

There are certain seasonal rituals in which most American families participate - vacations during the summer, Thanksgiving dinner and holiday shopping during the fall, Christmas and watching the Super Bowl during the winter, and mailing in tax returns during the spring.  Taxes!  I wouldn't look forward to springtime if it weren't for warmer weather, flowers, and the celebration of Jesus' rising from the dead on Easter Sunday.  Paying taxes usually means collecting a folder that bulges with various receipts and tax-related documents, meeting with the accountant, writing a check to the accountant, receiving the prepared tax returns at the last minute, trying to explain to my wife why we pay so much in taxes, and finally mailing the tax returns.  

The final moments before I actually mail the returns tend to be painfully tedious.  I check the prepared forms, sign and date the forms, enter my Social Security number, and ask my wife to sign and date the forms.  I then enter my wife's Social Security number (I have done this so many times that I have memorized her number), pull out the checkbook, fill in the check amounts and double-check for errors (I rarely write such large checks, so it is a big deal), sign the checks, fill in other necessary details on the checks, find the mailing addresses for the returns, make sure that the forms and checks are in the proper envelopes, seal the envelopes, and hand carry the documents to the post office to have them sent by certified mail.  It is a meticulous process, and I insist on performing the task in a fixed order.

I did not always attend to such detail during my younger tax-paying years, and occasionally I would discover that either the check or a certain form was left out of the envelope after it was sealed.  If I caught my error in time, I would try to unseal the envelope as carefully as possible, and in most cases I would succeed in reopening the envelope without totally destroying it.  However, the reopening process would invariably leave small tears and wrinkles in the envelope flap, and it would have to eventually be resealed with additional glue and tape.

Mailing tax forms made me think about sex.

I'm not kidding.  When God established the institution of marriage, it was meant to bring a man and a woman to leave their parents and be joined in an irrevocable bond.  Sexual relations between the newly formed couple would consummate the marriage, so that they are bound as one and not to be separated in the relationship.  Sex is the glue that seals the deal, just as licking the envelope flap and pressing it down seals the envelope.  It is not meant to be undone, and attempts to sever the relationship, no matter how carefully, will cause irreparable tears and scars.

Flee from sexual immorality. Every other sin a person commits is outside the body, but the sexually immoral person sins against his own body. Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you were bought with a price. So glorify God in your body.  (1 Corinthians 6:18-20)

The apostle Paul did not specify in his letter the definition of "sexual immorality", but it is reasonable to say that any sex that is not between a husband and wife may qualify the definition.

May we heed King Solomon's advice:

I adjure you, O daughters of Jerusalem,

by the gazelles or the does of the field,

that you not stir up or awaken love

until it pleases.  (Song of Solomon 2:7)

Barks, Leaves and Fruit

Chuck and I became good friends while we attended medical school in the late 1980's.  Chuck had a somewhat distinctive appearance - tall, slender, wearing an easy smile, with brown hair, very light complexion and no freckles.  It turned out that he was part Cherokee Indian, and that his father, an aficionado of the great outdoors, taught him much about plant and animal life during his youth while growing up in Ohio.  Chuck once told me that his father taught him to recognize a variety of tree species by simply looking at the bark.  Needless to say, I was impressed by his professed skills of arbor identification, as I normally would only be able to identify a tree if there was a plaque or sign with the name of the tree species in front of it.  However, I eventually managed to improve my tree knowledge over the years, and now I can fairly confidently recognize an oak from a sycamore, or a mesquite from a palo verde.  It's not much to brag about, since most Cub Scouts probably can do the same.

On the other hand, I have no trouble identifying citrus plants.  Having lived nearly my entire life in Taiwan and Southern California, where warm weather and abundant sunshine provide fabulous citrus growing conditions, it is unusual for me to live for even a day without some citrus exposure.  We have navel oranges and lemons in the refrigerator, large, juicy pomelos (massive, grapefruit-like monstrosities with very thick rind) on the kitchen counter, a bag of mandarin oranges in a basket, a grapefruit tree in the backyard that is full of fruit, and a kumquat tree at my mother's house.  I can recognize Valencia oranges, Texas oranges, lemons, limes, tangerines, tangelos, and clementines.  If you show me a citrus tree, I'll immediately recognize the characteristic shape of the broad, dark green, waxy leaves, and know for certain that it is a citrus tree. 

Unfortunately, if the tree is not bearing fruit, I will not be able to tell whether it is a lemon tree, an orange tree, or a grapefruit tree, because their leaves are indistinguishable from one another.  It is by the fruit that the tree is recognized.

Just as it is impossible to discern a citrus tree without seeing its fruit, it is difficult to know a person without seeing his works and deeds.  A surgeon is good only if he has performed many surgeries successfully, and that his patients are happy with the results.  An honest looking person may simply be an expert in deception unless he also acts with integrity, even when it appears that no one is watching.  In the same way, one cannot claim to be a "born again" Christian without somehow demonstrating radical changes in thought, words and actions. We may fool others for a season, but our fruit will eventually betray our identity.

“Beware of false prophets, who come to you in sheep's clothing but inwardly are ravenous wolves. You will recognize them by their fruits. Are grapes gathered from thornbushes, or figs from thistles? So, every healthy tree bears good fruit, but the diseased tree bears bad fruit. A healthy tree cannot bear bad fruit, nor can a diseased tree bear good fruit. Every tree that does not bear good fruit is cut down and thrown into the fire. Thus you will recognize them by their fruits.  (Matthew 7:15-20)

You can't judge a fruit tree by its leaves alone.

Fussing Over A Blemish

Ronnie, a handsome looking eleven-year-old boy, is one of my "special" patients.  I have known Ronnie since he was five years old, some time after he developed sudden liver failure and required a liver transplant at a nearby hospital.  His surgery was quite successful; however, because a suitable sized organ was not available at the time, Ronnie received a liver that was much too large to fit properly in his abdominal cavity.  As a consequence, the surgeon had to to leave the abdominal muscles open, so that the liver, jutting prominently from his belly, was carefully covered only by his stretched-out skin and a small amount of underlying tissue.  I followed Ronnie for several years while he lived with a relatively unprotected liver, and was quite relieved when he was finally big enough to undergo additional surgery and have the defect corrected.  Needless to say, the extensive surgeries left Ronnie with quite a few abdominal scars, but Ronnie never appeared to be too concerned about them, as his belly was almost always concealed by clothing.

During the office visit, I discussed with Ronnie and his mother his recent health, his medication prescription, results of his recent appointment with the transplant surgeon, his family, his friends, and how he was doing at school.  All seemed to be well.  The physical examination was also quite satisfactory.  As I filled out some paperwork for the family, the mother casually asked me about "this small whitehead under Ronnie's left eye that wouldn't go away".  I admitted that I did not notice it before, and examined his face more carefully.  Indeed, about an inch under his left eye, there was a very small, pearly bump that was no more than 1-2 mm, or about one-sixteenth of an inch in size.  There was no redness, bleeding, scratches, or discoloration of the surrounding skin.  Having seen the same kind of lesion many times before, I smiled, and did my best to provide reassurance:

"Ronnie, that little bump under your eye is a very common thing called "molluscum contagiosum".  A lot of kids have them, and I probably had them at some point.  It's caused by a virus, and usually they will go away completely after a few months without any treatment.  You don't want to scratch or pick at it though, because it sometimes may spread to other parts of the skin.  Just leave it alone, and you'll be fine."

I got on the computer and showed Ronnie and his mother drawings and pictures of the lesion, and the mother knowingly recalled that she once had several of those on her chin before that was treated with either chemicals or liquid nitrogen, and that it left a scar for a while.  The mother seemed content to leave the lesion alone, since any treatment of the lesion may actually make it look worse.

Unfortunately, Ronnie suddenly became tearful and upset, and demanded that something be done to get rid of that "ugly" thing, which actually was barely perceptible to the casual eye.  He didn't care that treatment might leave him with a worse looking scar, or that it might be very painful.  He wanted it gone, and he wanted it gone IMMEDIATELY.  I had no choice but to go ahead and refer him to a dermatologist, and felt a bit embarrassed that I couldn't handle such a simple, harmless skin problem.

Overreaction?  Definitely.  On the other hand, when it comes to hearing God's word, we are commanded to pay attention to the slightest detail:

But be doers of the word, and not hearers only, deceiving yourselves. For if anyone is a hearer of the word and not a doer, he is like a man who looks intently at his natural face in a mirror. For he looks at himself and goes away and at once forgets what he was like. But the one who looks into the perfect law, the law of liberty, and perseveres, being no hearer who forgets but a doer who acts, he will be blessed in his doing.  (James 1:22-25)


God's word reveals His perfect character, exposes our iniquity, and defines his direction and will for our lives.  If we are "doers of the word", it compels us to respond, and what we see will be much more than a tiny spot under the left eye.

A Matter of Consumption

"Diego, I'm going to do a little test on you in order to get to know some of your habits.  We'll start with a game just to get you warmed up.  OK?"

"Uh, OK."

Diego came with his mother to have his stomachaches checked out.  After a couple of minutes of casual conversation, I learned that he likes to play basketball, but eats way too much fast food.

"You like to watch NBA basketball on TV?"

"Yeah."

"Great.  For the warm-up exercise, I'll give you 30 seconds, and I want you to name for me as many NBA basketball teams as you can come up with.  Ready?  Go!"

I noted the time on my watch, and within a couple of seconds, Diego started to rattle off a list of team names:

"Lakers, Clippers, Knicks, Mavericks, Heat, Cavaliers...Hornets, Thunder, Magic...."

"Good job.  Now, the fun part.  I'll give you 30 seconds again, but this time I want you to name for me as many vegetables as you can possibly think of.  Go!"

"Uh, carrots, broccoli..."

He was off to a good start, but stalled considerably after the first two vegetables, and eventually only added spinach and tomatoes to the list.  He later confided that he hated spinach.  Diego seemed to consume NBA basketball on TV much more than he consumed vegetables.

I was teaching Sunday school to the eighth graders at church a few days later, and decided to play the same game with the students, with a twist.  I asked them to list for me all the Bible verses that they were familiar with.  Sadly, most could not come up with more than one or two verses, and half the class mentioned John 3:16.  It was evident that their consumption of God's word was woefully deficient.


"Hear, O Israel: The LORD our God, the LORD is one.  You shall love the LORD your God with all your heart and with all your soul and with all your might.  And these words that I command you today shall be on your heart.  You shall teach them diligently to your children, and shall talk of them when you sit in your house, and when you walk by the way, and when you lie down, and when you rise.  You shall bind them as a sign on your hand, and they shall be as frontlets between your eyes.  You shall write them on the doorposts of your house and on your gates.  (Deuteronomy 6:4-9)

If we truly love God, we will have no trouble loving His words and commands, and will know many of them as if they are on the back of our hands.  Meanwhile, turn off the TV, and pass the vegetables, please.