Kids say the darndest things. I remember when my son was four years old, he brightly exclaimed one day while playing in the yard,
"Daddy, when I am really old, like when I'm a teenager, I want to...."
Whoa. Hold it right there, buddy. Did he say that teenagers are old? I guess to a child who's barely in preschool, anyone who has been around three or four times as long has to be pretty ancient. This conversation was going to get interesting.
"So, you think that teenagers are really old, huh?"
"Yes."
"So, how old do you think teenagers are?"
"Five."
Well, this new math was getting pretty complicated. To my four year old son, teenagers are old, and teenagers are five years old. It was too profound for adults to understand. I suspected that this had something to do with his learning at the Montessori preschool, because my son was inexplicably speaking with a Sri Lankan accent. His preschool teachers were from Sri Lanka. I had to pursue this just a little further.
"Do you think that Daddy is old too?"
"Yes."
"Even older than a teenager?"
"Yes. You're really, really old."
"How old do you think Daddy is?"
"Six."
Somehow I knew he was going to say that. I couldn't resist asking him one more question...
"How old do you think Mommy is?"
"[bleep]"
Unfortunately, I can't quote what he said without my wife's permission. Suffice to say that he knew how to recite a few numbers in ascending order.
It turned out that my son was not the only child with such a contracted perspective on time. I asked another four-year-old girl a similar question, and she thought that her mother was five.
As created, finite beings, our perspective is also limited when we ponder things that are beyond our earthly experience. When we consider our infinite God's character and promises, it is impossible for us to fully understand the enormity of scale compared to what we can see, hear, feel and think. When God promised Abraham, then childless, that he would be the father of many nations, He likened the number of his descendants to the stars in the sky or the sands on the seashore, if he could count them. Abraham believed, but did he truly appreciate the magnitude of the promise?
Likewise, when describing God's character, the psalmist wrote,
Your steadfast love, O LORD, extends to the heavens,
your faithfulness to the clouds.
Your righteousness is like the mountains of God;
your judgments are like the great deep;
man and beast you save, O LORD.
(Psalm 36:5-6)
The highest heavens, the tallest clouds, the mightiest mountains and the deepest oceans are not sufficient to characterize our infinite God. Our best efforts to picture Him are not much less contracted in perspective than those of a four year old child. May we glorify God by truly being in awe of Him.
Monday, October 1, 2012
Monday, September 24, 2012
Foreign Objects
Beep...beep...beep....
I sleepily rubbed my eyes, being rudely awakened by my pager's shrill tones. It was about 2:15 a.m., and prospects of a good night's rest was effectively ruined for the night. I managed to stumble out of bed without waking my wife, groped for my pager, and checked the message. It was the emergency room. As I picked up my phone, I made a quick mental list of why the ER would call a pediatric gastroenterologist at such an hour - maybe it was a child who was vomiting blood, or a teenage girl with a bad stomachache who refused to leave the emergency room without seeing a specialist (oh please, not that!), or...
"Hi, are you peds GI on call? This is Dr. Lee from the emergency department. We have a 15 month old girl who was found by her parents at home choking on something about an hour ago, and they thought she might have swallowed a coin or something like that. The kid's doing fine now, but we did chest and abdominal X-rays on her, and it looks like there's a coin stuck in the esophagus. It's about 2.4 centimeters in diameter, and it's about a couple of centimeters above the diaphragm...."
Translation - toddler was crawling around...toddler saw loose change on the carpet...toddler picked up shiny quarter...toddler played with shiny quarter...toddler put shiny quarter in mouth...toddler choked on shiny quarter...toddler swallowed shiny quarter...quarter got stuck in no-man's land in the esophagus, too big to fall into the stomach, but too far down the esophagus to vomit it back up. It's a fairly common scenario that I get called about a few times a month. The swallowed foreign objects (that's medical-speak for stuff that normally don't belong inside our bodies) may be different, but the stories tend to be similar. Besides quarters, I've removed pennies, dimes, nickels, various foreign currency (mostly Canadian and Mexican), marbles, hair clips, bobby pins, broken pieces of dental retainers, magnets, and a few batteries (getting a slippery AAA alkaline battery out of a 2 year old boy's stomach was particularly memorable).
I instructed Dr. Lee at the emergency room to have the child hospitalized, and later during the day I made arrangements for the coin to be removed endoscopically under anesthesia. The quarter, no longer shiny, was eventually returned to the anxious parents in a small specimen jar. Hopefully it wouldn't end up in the kid's mouth again.
After years of picking shiny foreign bodies out of kids' innards, I have developed the habit of always warning parents and caretakers of young children about the little ones' propensity to find things on the floor and put them in their little mouths. Like most doctors, I assume that it is the adults' responsibility to make sure that their children don't sit around with a pocketful of loose change on the floor, and any suspicion of their failure to keep an eye on the kids would often result in prompt messages to the hospital social worker to investigate for possible child neglect. It is a toddler's nature to put little shiny things into his or her mouth, and disaster can easily result if such a nature is allowed to run its course unchecked.
Just as toddlers are prone to place themselves in potential harm, we humans in our natural state tend to take actions that lead to death and destruction. We were created to worship God and for His glory; however, the indictment on our sinful nature is:
For although they knew God, they did not honor him as God or give thanks to him, but they became futile in their thinking, and their foolish hearts were darkened. Claiming to be wise, they became fools, (Romans 1:21-22)
As a result, God allowed sinful mankind to succumb to its own nature:
Therefore God gave them up in the lusts of their hearts to impurity, to the dishonoring of their bodies among themselves, because they exchanged the truth about God for a lie and worshiped and served the creature rather than the Creator, who is blessed forever! Amen. (Romans 1:24-25)
In the end, such actions result in inevitable destruction:
Though they know God's righteous decree that those who practice such things deserve to die, they not only do them but give approval to those who practice them. (Romans 1:32)
May we perish the thought of rejecting God to do our own thing, because if God allows us to do so, it would be the most unthinkable punishment.
I sleepily rubbed my eyes, being rudely awakened by my pager's shrill tones. It was about 2:15 a.m., and prospects of a good night's rest was effectively ruined for the night. I managed to stumble out of bed without waking my wife, groped for my pager, and checked the message. It was the emergency room. As I picked up my phone, I made a quick mental list of why the ER would call a pediatric gastroenterologist at such an hour - maybe it was a child who was vomiting blood, or a teenage girl with a bad stomachache who refused to leave the emergency room without seeing a specialist (oh please, not that!), or...
"Hi, are you peds GI on call? This is Dr. Lee from the emergency department. We have a 15 month old girl who was found by her parents at home choking on something about an hour ago, and they thought she might have swallowed a coin or something like that. The kid's doing fine now, but we did chest and abdominal X-rays on her, and it looks like there's a coin stuck in the esophagus. It's about 2.4 centimeters in diameter, and it's about a couple of centimeters above the diaphragm...."
Translation - toddler was crawling around...toddler saw loose change on the carpet...toddler picked up shiny quarter...toddler played with shiny quarter...toddler put shiny quarter in mouth...toddler choked on shiny quarter...toddler swallowed shiny quarter...quarter got stuck in no-man's land in the esophagus, too big to fall into the stomach, but too far down the esophagus to vomit it back up. It's a fairly common scenario that I get called about a few times a month. The swallowed foreign objects (that's medical-speak for stuff that normally don't belong inside our bodies) may be different, but the stories tend to be similar. Besides quarters, I've removed pennies, dimes, nickels, various foreign currency (mostly Canadian and Mexican), marbles, hair clips, bobby pins, broken pieces of dental retainers, magnets, and a few batteries (getting a slippery AAA alkaline battery out of a 2 year old boy's stomach was particularly memorable).
I instructed Dr. Lee at the emergency room to have the child hospitalized, and later during the day I made arrangements for the coin to be removed endoscopically under anesthesia. The quarter, no longer shiny, was eventually returned to the anxious parents in a small specimen jar. Hopefully it wouldn't end up in the kid's mouth again.
After years of picking shiny foreign bodies out of kids' innards, I have developed the habit of always warning parents and caretakers of young children about the little ones' propensity to find things on the floor and put them in their little mouths. Like most doctors, I assume that it is the adults' responsibility to make sure that their children don't sit around with a pocketful of loose change on the floor, and any suspicion of their failure to keep an eye on the kids would often result in prompt messages to the hospital social worker to investigate for possible child neglect. It is a toddler's nature to put little shiny things into his or her mouth, and disaster can easily result if such a nature is allowed to run its course unchecked.
Just as toddlers are prone to place themselves in potential harm, we humans in our natural state tend to take actions that lead to death and destruction. We were created to worship God and for His glory; however, the indictment on our sinful nature is:
For although they knew God, they did not honor him as God or give thanks to him, but they became futile in their thinking, and their foolish hearts were darkened. Claiming to be wise, they became fools, (Romans 1:21-22)
As a result, God allowed sinful mankind to succumb to its own nature:
Therefore God gave them up in the lusts of their hearts to impurity, to the dishonoring of their bodies among themselves, because they exchanged the truth about God for a lie and worshiped and served the creature rather than the Creator, who is blessed forever! Amen. (Romans 1:24-25)
In the end, such actions result in inevitable destruction:
Though they know God's righteous decree that those who practice such things deserve to die, they not only do them but give approval to those who practice them. (Romans 1:32)
May we perish the thought of rejecting God to do our own thing, because if God allows us to do so, it would be the most unthinkable punishment.
Wednesday, September 12, 2012
Fleeing From Sweetness
"Linda, tell me what you usually like to drink. You know, like soda, tea, coffee, juice, milk, sports drinks...stuff like that."
Linda was an obese teenager who was recently diagnosed with type 2 diabetes and a liver problem, and was seriously in need of losing weight. I asked the question to look for possible ways that she could improve her health.
"Well, I drink a lot of water..."
Linda spoke slowly and carefully, as if she was trying to give the "correct" answer. Her mother, who sat at her side, offered a more realistic assessment, and explained that Linda drank a lot of soda, as well as high-calorie, sugary blended coffee drinks (with extra whipped cream, of course), large cans of sweetened iced tea, and juice. I also discovered later that Linda ate a lot of snack chips while watching television, refused to eat vegetables, and consumed at least 2-3 times the normal portions of rice or tortillas during meals. She also detested exercise or anything that would cause her to break a sweat.
"Thank you, Linda for all this information. You know, I asked you all these questions to see what we can work on to help you lose some weight, and I think that cutting out sweet beverages from your diet will be a very good idea. You see, anytime you drink a can of soda, a glass of juice, a can or glass of iced tea with sugar, etc., you are taking in between 100 to 150 calories, and each time you do this, you literally have to walk about one mile just to burn off the extra sugar that you drank. So, if you just drink water instead, it's like you're walking extra miles every day. If you cut back by only one of those drinks a day, it will make a weight difference of about one pound a month, as long as you don't try to make up the difference by eating more the rest of the day."
That was my standard advice about soft drinks, calories and exercise. I call it "energy currency conversion". One can of soda a day equals one extra pound of body fat a month, and one needs to run one mile to burn off the sugar in one can of soda. It sounds simple enough for most of my patients and families to understand.
"What about diet sodas?" Linda asked nervously.
"Well, diet sodas are not as bad as regular sodas, in that they have almost no calorie. However, the problem with diet or low-calorie soft drinks is that they are as sweet as the sugar-containing stuff, so when you drink them, even though you are not taking in more sugar, you still crave sugar, so when the opportunity arises you will still go for the sugar whenever you can. Because of this, it's much better to just drink water and other unsweetened beverage whenever possible. I personally drink a lot of coffee and tea all day, but I usually don't put any sugar or other sweetener in them, and I don't feel the craving to do so."
Makes sense. A person who imbibes soft drinks with sugar substitutes to lose weight is sort of like a sex addict trying to overcome his perversion by watching pornography. It may not be the real thing, but rather than helping one to get the problem out of his system, it entices him closer to the real deal.
Linda would be much more likely to keep eating and drinking sweet stuff if she craves sweet stuff. Similarly, one is more likely to commit acts of sin or disobedience if the enticement of desire is planted in the mind.
But each person is tempted when he is lured and enticed by his own desire. Then desire when it has conceived gives birth to sin, and sin when it is fully grown brings forth death. (James 1:14-15)
It is better to separate oneself from the cravings. Don't compromise with them. Don't fight them. Run from them.
So flee youthful passions and pursue righteousness, faith, love, and peace, along with those who call on the Lord from a pure heart. Have nothing to do with foolish, ignorant controversies; you know that they breed quarrels. (2 Timothy 2:22-23)
Linda was an obese teenager who was recently diagnosed with type 2 diabetes and a liver problem, and was seriously in need of losing weight. I asked the question to look for possible ways that she could improve her health.
"Well, I drink a lot of water..."
Linda spoke slowly and carefully, as if she was trying to give the "correct" answer. Her mother, who sat at her side, offered a more realistic assessment, and explained that Linda drank a lot of soda, as well as high-calorie, sugary blended coffee drinks (with extra whipped cream, of course), large cans of sweetened iced tea, and juice. I also discovered later that Linda ate a lot of snack chips while watching television, refused to eat vegetables, and consumed at least 2-3 times the normal portions of rice or tortillas during meals. She also detested exercise or anything that would cause her to break a sweat.
"Thank you, Linda for all this information. You know, I asked you all these questions to see what we can work on to help you lose some weight, and I think that cutting out sweet beverages from your diet will be a very good idea. You see, anytime you drink a can of soda, a glass of juice, a can or glass of iced tea with sugar, etc., you are taking in between 100 to 150 calories, and each time you do this, you literally have to walk about one mile just to burn off the extra sugar that you drank. So, if you just drink water instead, it's like you're walking extra miles every day. If you cut back by only one of those drinks a day, it will make a weight difference of about one pound a month, as long as you don't try to make up the difference by eating more the rest of the day."
That was my standard advice about soft drinks, calories and exercise. I call it "energy currency conversion". One can of soda a day equals one extra pound of body fat a month, and one needs to run one mile to burn off the sugar in one can of soda. It sounds simple enough for most of my patients and families to understand.
"What about diet sodas?" Linda asked nervously.
"Well, diet sodas are not as bad as regular sodas, in that they have almost no calorie. However, the problem with diet or low-calorie soft drinks is that they are as sweet as the sugar-containing stuff, so when you drink them, even though you are not taking in more sugar, you still crave sugar, so when the opportunity arises you will still go for the sugar whenever you can. Because of this, it's much better to just drink water and other unsweetened beverage whenever possible. I personally drink a lot of coffee and tea all day, but I usually don't put any sugar or other sweetener in them, and I don't feel the craving to do so."
Makes sense. A person who imbibes soft drinks with sugar substitutes to lose weight is sort of like a sex addict trying to overcome his perversion by watching pornography. It may not be the real thing, but rather than helping one to get the problem out of his system, it entices him closer to the real deal.
Linda would be much more likely to keep eating and drinking sweet stuff if she craves sweet stuff. Similarly, one is more likely to commit acts of sin or disobedience if the enticement of desire is planted in the mind.
But each person is tempted when he is lured and enticed by his own desire. Then desire when it has conceived gives birth to sin, and sin when it is fully grown brings forth death. (James 1:14-15)
It is better to separate oneself from the cravings. Don't compromise with them. Don't fight them. Run from them.
So flee youthful passions and pursue righteousness, faith, love, and peace, along with those who call on the Lord from a pure heart. Have nothing to do with foolish, ignorant controversies; you know that they breed quarrels. (2 Timothy 2:22-23)
Sunday, August 12, 2012
Traffic Control
I never knew that watching cars entering a parking lot could be so entertaining. There was nothing noteworthy at first glance that morning, as a crisply uniformed man directed very light traffic at the portal to a parking structure and adjacent open lots. However, as I observed from my own vehicle, I noticed that the man was not having much success in his traffic-directing endeavor. As a car approached the parking entry, he gently waved his lighted baton toward the open lot to the right, inviting the driver to steer in that direction. The driver paused the car momentarily, seeming to be considering her options.
She let go of the brakes, and turned left instead.
Ah, a rebel, I thought. I guess she had little regard for the man's directions. Appearing flustered, this uniformed man faced the next approaching vehicle, and pointed his baton to the lot on the left. His baton motion seemed tentative, and his arms showed little range of motion as he meekly smiled at the driver.
The driver turned to the right.
I was next in line as I drove toward this hapless uniformed security guard, smiled, and exchanged greetings with him. I wasn't sure whether he actually pointed me in any particular direction as I drove up the ramp to the parking structure.
I witnessed a different kind of parking lot drama in the spring of 2007. I was a direction-challenged traveler who was trying to find the registration and expo for the Boston Marathon, and somehow walked the wrong way and ended up near Fenway Park, just minutes before a sold-out Red Sox vs Angels game. The right-side lane of the street was lined bumper-to-bumper with cars heading toward the stadium parking lot as a uniformed person directed traffic. Receiving cue from the traffic signal, the uniformed man stretched out his hand, blew his whistle, and motioned the driver in the car beside him to stop.
The car kept moving, and the driver seemed to not notice the uniformed man.
The car moved no more than two or three yards before the man sharply blew his whistle again, pointed at the driver, chased down the car, bellowed out angry words that are not fit for print, and ordered that the car be pulled over. The poor woman in the car had no choice but to comply, and parked behind a line of other vehicles that were similarly detained. Another uniformed person stood guard, standing beside a patrol vehicle with flashing lights.
Lesson for the day - you don't mess with the Boston Police Department if you're planning to watch a Red Sox game. Police officers are not private security guards. They have real authority, and they act with authority.
However, despite their formidable powers, police officers have only limited powers compared to Jesus, when he appeared on earth in human form. When he spoke the Sermon on the Mount, the people took notice:
And when Jesus finished these sayings, the crowds were astonished at his teaching, for he was teaching them as one who had authority, and not as their scribes. (Matthew 7:28-29)
Jesus' authority was not only affirmed by men, but also by the forces of nature when he calmed the storm that raged over the Sea of Galilee:
He said to them, “Where is your faith?” And they were afraid, and they marveled, saying to one another, “Who then is this, that he commands even winds and water, and they obey him?” (Luke 8:25)
Indeed, Jesus declared to his disciples after his resurrection that he holds authority over all the universe, and that believers are being sent under his authority:
"And Jesus came and said to them, “All authority in heaven and on earth has been given to me. Go therefore and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, teaching them to observe all that I have commanded you. And behold, I am with you always, to the end of the age.” (Matthew 28:18-20)
May we therefore be more than just polite, hapless Christians. Jesus has sent us by his ultimate authority to change the world.
She let go of the brakes, and turned left instead.
Ah, a rebel, I thought. I guess she had little regard for the man's directions. Appearing flustered, this uniformed man faced the next approaching vehicle, and pointed his baton to the lot on the left. His baton motion seemed tentative, and his arms showed little range of motion as he meekly smiled at the driver.
The driver turned to the right.
I was next in line as I drove toward this hapless uniformed security guard, smiled, and exchanged greetings with him. I wasn't sure whether he actually pointed me in any particular direction as I drove up the ramp to the parking structure.
I witnessed a different kind of parking lot drama in the spring of 2007. I was a direction-challenged traveler who was trying to find the registration and expo for the Boston Marathon, and somehow walked the wrong way and ended up near Fenway Park, just minutes before a sold-out Red Sox vs Angels game. The right-side lane of the street was lined bumper-to-bumper with cars heading toward the stadium parking lot as a uniformed person directed traffic. Receiving cue from the traffic signal, the uniformed man stretched out his hand, blew his whistle, and motioned the driver in the car beside him to stop.
The car kept moving, and the driver seemed to not notice the uniformed man.
The car moved no more than two or three yards before the man sharply blew his whistle again, pointed at the driver, chased down the car, bellowed out angry words that are not fit for print, and ordered that the car be pulled over. The poor woman in the car had no choice but to comply, and parked behind a line of other vehicles that were similarly detained. Another uniformed person stood guard, standing beside a patrol vehicle with flashing lights.
Lesson for the day - you don't mess with the Boston Police Department if you're planning to watch a Red Sox game. Police officers are not private security guards. They have real authority, and they act with authority.
However, despite their formidable powers, police officers have only limited powers compared to Jesus, when he appeared on earth in human form. When he spoke the Sermon on the Mount, the people took notice:
And when Jesus finished these sayings, the crowds were astonished at his teaching, for he was teaching them as one who had authority, and not as their scribes. (Matthew 7:28-29)
Jesus' authority was not only affirmed by men, but also by the forces of nature when he calmed the storm that raged over the Sea of Galilee:
He said to them, “Where is your faith?” And they were afraid, and they marveled, saying to one another, “Who then is this, that he commands even winds and water, and they obey him?” (Luke 8:25)
Indeed, Jesus declared to his disciples after his resurrection that he holds authority over all the universe, and that believers are being sent under his authority:
"And Jesus came and said to them, “All authority in heaven and on earth has been given to me. Go therefore and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, teaching them to observe all that I have commanded you. And behold, I am with you always, to the end of the age.” (Matthew 28:18-20)
May we therefore be more than just polite, hapless Christians. Jesus has sent us by his ultimate authority to change the world.
Wednesday, July 4, 2012
A Bronchoscope, a Cotton Swab and a "Shamu" Needle
"Doctor, we have a problem."
Those were words from my nurse while I was fully gowned, masked, gloved and ready to start the procedure on the sedated infant. The premature baby was unable to feed by mouth due to multiple medical concerns, and needed to have a feeding tube placed through the abdominal wall into the stomach. Unfortunately, the most important piece of equipment for the procedure, a neonatal gastroscope, somehow became malfunctioned at the last moment, and a replacement scope was not available. The only gastroscopes that we had were too large to go through the baby's throat without potentially causing damage and/or interfering with the baby's breathing. It seemed for the moment that I had no choice but to postpone the procedure. Better to play it safe than risk a serious complication, I thought. However, my nurse wasn't quite ready to quit, and she asked whether I might consider using a bronchoscope instead. A bronchoscope is designed to go down into the lungs, and is much smaller than the neonatal gastroscope that is used to go down the baby's stomach. However, because of its small size, it does not have some of the features of gastroscopes, and would require some creative manipulation to be used properly in the stomach. The idea seemed a bit unorthodox, but workable, so I agreed to give it a try. The procedure was successfully completed after several minutes as the bronchoscope was put to good use. The baby did well.
I received an urgent message from the father of another baby who also required tube feedings. It was about 4:30 p.m. on Friday. He frantically explained that the tube somehow got plugged up, and that the baby could not be fed. The father was ready to bring the child to the emergency room, as the clinic was already closed for the week. After considering various options, I asked him to find a single tipped cotton swab (or to cut a double-tipped swab in half), and to insert about an inch of the stick into the tube to try and unplug the tube. The father managed to pull off the trick within a couple of minutes, and thanked me for sparing him the trip to the emergency room.
Sometimes the technical difficulty in placing a stomach feeding tube is not because a child is too small, but too big. I once tried to place such a tube in a morbidly obese teenage boy who had a brain tumor, and discovered that the special needle for the procedure was too short to puncture the stomach through all of his belly fat. Hearing my dilemma, the nurse anesthetist offered me the "Shamu" (i.e., referring to the killer whale at San Diego's Sea World) needle, and handed me an extra long spinal needle that she uses to perform epidural anesthesia for obese women. The needle reached the stomach easily, and the tube was successfully placed without further difficulty.
A bronchoscope, a cotton swab, and an extra-long spinal needle each serves very specific and essential functions, just as in the body of Christ, each believer has unique sets of gifts and abilities that God has given us to serve and build up each other. Knowing our gifts and abilities will certainly help us to serve more effectively; however, we also must not refuse to let God use us in more "creative" ways within the body, and we need to be available to be used by Him when called upon to do so. God can and will use us in any way that He pleases.
But now, O LORD, you are our Father;
we are the clay, you are our potter;
we are all the work of your hand. (Isaiah 64:8)
As each has received a gift, use it to serve one another, as good stewards of God's varied grace:
(1 Peter 4:10)
Those were words from my nurse while I was fully gowned, masked, gloved and ready to start the procedure on the sedated infant. The premature baby was unable to feed by mouth due to multiple medical concerns, and needed to have a feeding tube placed through the abdominal wall into the stomach. Unfortunately, the most important piece of equipment for the procedure, a neonatal gastroscope, somehow became malfunctioned at the last moment, and a replacement scope was not available. The only gastroscopes that we had were too large to go through the baby's throat without potentially causing damage and/or interfering with the baby's breathing. It seemed for the moment that I had no choice but to postpone the procedure. Better to play it safe than risk a serious complication, I thought. However, my nurse wasn't quite ready to quit, and she asked whether I might consider using a bronchoscope instead. A bronchoscope is designed to go down into the lungs, and is much smaller than the neonatal gastroscope that is used to go down the baby's stomach. However, because of its small size, it does not have some of the features of gastroscopes, and would require some creative manipulation to be used properly in the stomach. The idea seemed a bit unorthodox, but workable, so I agreed to give it a try. The procedure was successfully completed after several minutes as the bronchoscope was put to good use. The baby did well.
I received an urgent message from the father of another baby who also required tube feedings. It was about 4:30 p.m. on Friday. He frantically explained that the tube somehow got plugged up, and that the baby could not be fed. The father was ready to bring the child to the emergency room, as the clinic was already closed for the week. After considering various options, I asked him to find a single tipped cotton swab (or to cut a double-tipped swab in half), and to insert about an inch of the stick into the tube to try and unplug the tube. The father managed to pull off the trick within a couple of minutes, and thanked me for sparing him the trip to the emergency room.
Sometimes the technical difficulty in placing a stomach feeding tube is not because a child is too small, but too big. I once tried to place such a tube in a morbidly obese teenage boy who had a brain tumor, and discovered that the special needle for the procedure was too short to puncture the stomach through all of his belly fat. Hearing my dilemma, the nurse anesthetist offered me the "Shamu" (i.e., referring to the killer whale at San Diego's Sea World) needle, and handed me an extra long spinal needle that she uses to perform epidural anesthesia for obese women. The needle reached the stomach easily, and the tube was successfully placed without further difficulty.
A bronchoscope, a cotton swab, and an extra-long spinal needle each serves very specific and essential functions, just as in the body of Christ, each believer has unique sets of gifts and abilities that God has given us to serve and build up each other. Knowing our gifts and abilities will certainly help us to serve more effectively; however, we also must not refuse to let God use us in more "creative" ways within the body, and we need to be available to be used by Him when called upon to do so. God can and will use us in any way that He pleases.
But now, O LORD, you are our Father;
we are the clay, you are our potter;
we are all the work of your hand. (Isaiah 64:8)
As each has received a gift, use it to serve one another, as good stewards of God's varied grace:
(1 Peter 4:10)
Monday, June 11, 2012
What Would Warren Do?
Mr. Warren Buffet is a rock star in the investment world. He is well-known for his time-tested investment practices, and his company, Berkshire Hathaway Inc., is one of the most consistently profitable worldwide. A single share of Berkshire Hathaway common stock (A-share), which was sold for less than $10,000 in the early 1990's, is currently worth more than $120,000. Nearly every major investment decision that he makes is immediately broadcast worldwide in minutes, if not seconds. When Warren Buffet speaks, people listen. He is known as the "Oracle of Omaha", and writings about him, his investment methods, and his words of wisdom abound in books, magazines, newspapers, and on the Internet.
I am not Warren Buffet. I have neither Mr. Buffet's financial insight, nor monetary wisdom, and I have made poor investment decisions that he likely would not make under similar circumstances. It therefore stands to reason to believe that I will be a better steward of God's material resources if I try to think like Mr. Buffet when I make major financial decisions. Would Mr. Buffet buy or sell? Would he build cash reserves or purchase investment property? Would he leave his estate to his offspring or donate it to charity? Would he buy gold, stock, or bonds? Would he collect art or antique cars? WWWD (What would Warren do)?
Unfortunately, I can ask all the WWWD questions, and never arrive at a proper answer. The problem is that while I have heard about Mr. Buffet, occasionally read about Mr. Buffet, and even own an infinitesimal fraction of his company in the form of Berkshire Hathaway B share common stocks, I have never actually read any book about him or by him, have never listened to his speeches or interviews, and have never studied his company's financial statements. WWWD? I have not the faintest idea.
While "WWWD?" has not yet become a popular expression, "WWJD?", or "What would Jesus do?" has become a fashionable statement among Christians. Someone just cut me off on the road - WWJD? A friend owes me money but will not repay me - WWJD? I need to buy a car...new or used - WWJD? "WWJD?" became a fad expression on posters, billboards, bracelets and bumper stickers. It sounds cool, as if you say it often enough, it makes you seem to know Jesus.
Sadly, just as I do not know much about Mr. Warren Buffet, many who glibly ask "WWJD?" do not truly know Jesus. They may know something about Jesus, and have seen drawings of a gentle Jesus holding a young child, healing the sick, and speaking to gatherings of thousands by the sea or the hillside words of wisdom about doing good deeds and being kind. However, do they remember that Jesus is God, who willingly became man and suffered utter humiliation and death for our sins, who rose from the dead and is in the place of highest glory? For it was written about Jesus,
"who, though he was in the form of God, did not count equality with God a thing to be grasped, but emptied himself, by taking the form of a servant, being born in the likeness of men. And being found in human form, he humbled himself by becoming obedient to the point of death, even death on a cross. Therefore God has highly exalted him and bestowed on him the name that is above every name, so that at the name of Jesus every knee should bow, in heaven and on earth and under the earth, and every tongue confess that Jesus Christ is Lord, to the glory of God the Father." (Philippians 2:6-11)
When we ask "WWJD?", do we know the Jesus in the book of Revelation, who not only encouraged, but also corrected and rebuked the seven churches?
When we ask "WWJD?", do we realize that Jesus' twelve disciples, after spending considerable numbers of days and nights with him, still knew little about him when he calmed the storm? For it was written:
And the men marveled, saying, “What sort of man is this, that even winds and sea obey him?” (Matthew 8:27)
Do we know the full picture of Jesus that is in the Bible? Many who claim to be Christians have never read much of the Bible, and the Jesus in their minds is only the Jesus of their imaginations. Before we ask "WWJD?", we need to make sure that we do not violate the first commandment,
“You shall have no other gods before me. (Exodus 20:3)
Hmm, I wonder if Warren Buffet would put money on this pizza franchise....
I am not Warren Buffet. I have neither Mr. Buffet's financial insight, nor monetary wisdom, and I have made poor investment decisions that he likely would not make under similar circumstances. It therefore stands to reason to believe that I will be a better steward of God's material resources if I try to think like Mr. Buffet when I make major financial decisions. Would Mr. Buffet buy or sell? Would he build cash reserves or purchase investment property? Would he leave his estate to his offspring or donate it to charity? Would he buy gold, stock, or bonds? Would he collect art or antique cars? WWWD (What would Warren do)?
Unfortunately, I can ask all the WWWD questions, and never arrive at a proper answer. The problem is that while I have heard about Mr. Buffet, occasionally read about Mr. Buffet, and even own an infinitesimal fraction of his company in the form of Berkshire Hathaway B share common stocks, I have never actually read any book about him or by him, have never listened to his speeches or interviews, and have never studied his company's financial statements. WWWD? I have not the faintest idea.
While "WWWD?" has not yet become a popular expression, "WWJD?", or "What would Jesus do?" has become a fashionable statement among Christians. Someone just cut me off on the road - WWJD? A friend owes me money but will not repay me - WWJD? I need to buy a car...new or used - WWJD? "WWJD?" became a fad expression on posters, billboards, bracelets and bumper stickers. It sounds cool, as if you say it often enough, it makes you seem to know Jesus.
Sadly, just as I do not know much about Mr. Warren Buffet, many who glibly ask "WWJD?" do not truly know Jesus. They may know something about Jesus, and have seen drawings of a gentle Jesus holding a young child, healing the sick, and speaking to gatherings of thousands by the sea or the hillside words of wisdom about doing good deeds and being kind. However, do they remember that Jesus is God, who willingly became man and suffered utter humiliation and death for our sins, who rose from the dead and is in the place of highest glory? For it was written about Jesus,
"who, though he was in the form of God, did not count equality with God a thing to be grasped, but emptied himself, by taking the form of a servant, being born in the likeness of men. And being found in human form, he humbled himself by becoming obedient to the point of death, even death on a cross. Therefore God has highly exalted him and bestowed on him the name that is above every name, so that at the name of Jesus every knee should bow, in heaven and on earth and under the earth, and every tongue confess that Jesus Christ is Lord, to the glory of God the Father." (Philippians 2:6-11)
When we ask "WWJD?", do we know the Jesus in the book of Revelation, who not only encouraged, but also corrected and rebuked the seven churches?
When we ask "WWJD?", do we realize that Jesus' twelve disciples, after spending considerable numbers of days and nights with him, still knew little about him when he calmed the storm? For it was written:
And the men marveled, saying, “What sort of man is this, that even winds and sea obey him?” (Matthew 8:27)
Do we know the full picture of Jesus that is in the Bible? Many who claim to be Christians have never read much of the Bible, and the Jesus in their minds is only the Jesus of their imaginations. Before we ask "WWJD?", we need to make sure that we do not violate the first commandment,
“You shall have no other gods before me. (Exodus 20:3)
Hmm, I wonder if Warren Buffet would put money on this pizza franchise....
Sunday, June 10, 2012
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!
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!
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