High-tech Care with Old-Fashioned Values

Gas Prices and Other Thoughts

Gas is approaching $4 per gallon here and filling my truck is over $70 a pop now. One becomes a conservationist in a hurry when the wallet is hurt that badly each time you fill up. I certainly don't recall the gas rationing of the 70's very vividly but I wonder how far away from that we may now be. As a consuming nation we have always "lived large". America more than any other definition is one of excess to the rest of the world. Excess violence, excess consuming, excess waste, excess pop culture. Maybe this looming economic change for us will force some type of maturity on those types of patterns. Then again, maybe not. I know that Satan certainly uses our consumerism to aid our tendency toward greed and idolatry. Not that we need much encouragement.

I find that the more I have, the more I want and the more I want the less I seem to have. That is far from the contented life that Christ advocated. We were not to even worry about things of material nature both because God will supply what we need when it is needed and because looking to the future with worry or convoluted plans robs God of our attention now. By diverting our attention to something that does not exist (the temporal future) to something that does (our eternal security through Christ's grace) Satan achieves a goal of weakening our perception of eternity. We are "amphibious" as C.S. Leis wrote....both temporal and eternal beings. The more we concentrated on one part of our nature, the less we will concentrate on the other. God desires that we look to the Eternal and Satan desires we think only on the temporal. If we could see from God's view we would be able to be as Paul was "content" in all circumstances.

The other thoughts I have had recently are about milestones. Certainly, with school ending we see our children and friends marking, often publicly, a transition in their lives. Other milestones pass uncelebrated but not unknown. These may be special days in the lives of those whom we care about or those who have left us for eternity. Memorial Day is a time to not only remember those who have died in the line of duty to our country but also those who have served or are serving honorably. My thanks for those of you who have done so and my prayers for those whose milestones happen this month.

Me and Pat

Just a short blurb on another event this week. I was asked to speak to a women's luncheon about weight loss and exercise. I was prepared for a group of a bout 50 or so. When I got to the event there were around 400. That's 400 women and 4 men (the pastor of the church, one husband, a guy who may have wandered in and myself). That is kind of the definition of intimidating!

Luckily, one of my first slides said that "Talking to a group of women about diet and weight loss is like trying to tell Pat Summitt how to coach!!"

The talk went well and I think I am learning as I go about this whole diet issue. One interesting fact from my preparation: the LUMEN of the intestine appears to monitor its contents and sends signals to the brain and other body parts depending on what is found. Let me say that again....our gut tests not only what is being absorbed into its bloodstream during digestion but MONITORS WHAT IS PASSING THROUGH as it attempts to tell our brain how much and what to eat.

We are fearfully and wonderfully made.

Water and Blood

My middle son was baptized today. There were several others at the church that went through the ceremony. I was very happy and proud of his decision to publicly show what was a spiritual commitment that he had made. I has me thinking about the sign of baptism. I do not believe that there is anything in the ordinance that makes or breaks someone's eternal security. That being said I know that Christ was baptized in order to "do all right things".

The symbolism is undeniable. We are nurtured in the womb in a bath from which we emerge to face the world as a new creature. Everything is changed and yet we are prepared for it physically. Much will be hard. There will be times of sickness, pain and loneliness, yet the journey begins as we come out of the water. Christ told Niccodemus that he would need to be "born again" in order to inherit eternal life in paradise. By using water the ancients re-inacted the physical birth. By using some words (Christ's suggestion to baptize "in the name of the Father and of the Son and of the Holy Spirit." the ceremony is raised to a different and more meaningful level.

We are submerged and dead, lost and unformed. We emerge with this new life in Christ sinless, alive and growing toward His likeness. The old is passed and the new has started. We also identify with Christ's own baptism and life and say to the world "I am a follower of the Christ." These are deep spiritual truths that all lie behind the act of baptism. We do this in front of witnesses (even if only the pastor) in order to make that proclamation public and real.

Here is east TN baptism can be a real social event. Some churches wait for months and do mass baptisms. Others baptize new believers immediately. Many still will "go to the river". I attended one such baptism about a year ago that brought the simplicity and beauty of the act fully into view. With nature all around and the flowing water of the river as a background, it was hard not to imagine Christ standing there, smiling and nodding.

I am glad that God has chosen to ask us to do public things to align ourselves with His cause. It is far too easy to do what the crowd wants these days and my son's decision to run counter to that makes me proud.

Stories and Connections: Ramblings

I guess one of the things that entices me about medicine in general and primary care specifically is the diversity of stories and the way they are told. I try to use the "pattern recognition" that seems to aid all of us in primary care because common things are common.

In this day and age we have medicalized everything that used to be the realm of others: nutrition, exercise, aging, spiritual pain, emotional upheaval as well as routine birthing. The small step from childhood immunization for polio and smallpox has become an lucrative industry of well child visits. These paternalistic encounters presupposed that parents cannot think about safety and diet and development is far too complex. Sure, I have detected developmental delays, abuse and neglect and the occasional congenital condition but these largely were self-evident or brought to me by a parent. And, yes, I have seen my share of unfit parents who were clueless about feeding a 2 month old solid food or other basic issues.

Yet I feel this reflects familial and social failings that would best be addressed elsewhere. When I was in Houston we had an early model of RN's doing well-child visits largely because the MD's were too busy in an overloaded public healthcare system to perform the evaluations well. The nurses did the screening as well as most of the doctors would have done BUT we found that the questions they were asked and the confidences shared were quite different. They began to function as the wise aunt or grand-dame of the family who knows child-rearing from years of experience and observation. The nurses also had a more culturally appropriate point of view as they often lived or grew up in the communities our clinics served (not the case with our doctors).

Back to my point. I feel that primary care is about stories, listening to those stories and then responding both with expertise and inquisitiveness while being a caring human. What I find daily is that the stories are fascinating...even the ones that are "made up" for the doctor to hear. These are the convoluted histories that hide abuse or addiction or loneliness. The stories make the day fun.

The connections make the day stressful. The child who is not quite right but you are not sure why and the parent (a friend ) puts their trust in you when you have no clue what is wrong....just some vague hunch. The treatment that does not seem to work that keeps you awake at night wondering if you missed something in the story or the lab. The patient who is sent to a specialist who, also a human, misses the story's point and dismisses symptoms I feel are urgent. These are the things that terrify me.

It is the same with other jobs, I am sure. Other people worry about the construction of a home for a friend or working on a car that doesn't quite seem to be right. They too feel the pressure that is more than just a craftsman's care. It is the connection with another whom you are serving with your chosen profession. I am glad of the feelings because I have seen and taught folks who did not have them....and I would not send patients to them.


If you look at the menu you now see a "Forum" area. This is a fledgling bulletin board of sorts. Forum are places where folks can leave thoughts in more connected ways and develop community with other visitors. I will moderate this area and pull off postings or people that prove offensive. I have started a few discussion areas and can post more. I would like to leave this up for a while and see how people respond to it. The general category is for questions and advice on what should be on the forum. The other areas are self-explanatory. I would like you to be creative and give some input. If it works we will keep it up otherwise it will die.