High-tech Care with Old-Fashioned Values

I miss home

It is fall and I miss "home". Growing up in North Dakota not a weekend went by in the fall (and very few evenings during October) when we were not hunting birds. Today the air was really crisp for the first time in east TN and I missed pheasants. Before you jump down my throat about the whole hunting bit let me describe the scene.

The morning is clear, crisp with the huge bright blue Dakota sky pressing down all around on the browns and grays that are prairie and harvested fields. There are more shades of brown on the fall prairie than you can imagine. If you are lucky you will also be in "big country" which is the term we use for large tracts of land that are only broken by dry creek beds and car trails. The land rolls and falls and the wind is a constant causing the grass to move like waves.

It is still nearly dark as the car pulls up to the starting point for what will be a very vigorous walk. As you get out you begin to take old and trusted shotguns from their cases. Hunting weapons you have come to know through years of loving use. My double is an old Browning whose wood checkering pattern has long since been worn smooth by my hands that have doubled in size since I first fired it. It is a familiar friend that has waited another year to be carried into the field. Vests and hats, boots and coats all familiar through the years are put on and the dogs are released to run nervously around jumping up to greet everyone. Rooster pheasants have a particular early morning call and you start to hear them not so far from where you stand.

Someone takes charge and outlines how we will walk. I like the deep cover and the remote sites. Partly this is so no one else can shoot the birds I raise and partly because I am proud to be able to move still in the thick brush where the dogs sometimes rush by. The cold and stiffness quickly make way for a rhythm of walking and climbing. I always have a song on my lips as I begin to breath more deeply. Then someone says something like "watch her" meaning a dog is working a bird.

Pheasants love to run. They will run far before they will fly and they can outrun dogs in thick brush. But sometimes they stop and wait and the dog echos them freezing and shivering at the same time. Pheasant roosters are big gaudy birds all reds, greens, whites and browns. There is no way they can hide and yet they always do. You walk up to the dog spacing with others without words due to years of hunting together and....nothing happens. There is no bird. The dog is pointing at a bare patch of ground.

You are walking 10, 5 then 3 feet from the pointer. Just as you are about to say.."Nothing here" an bird larger than you remember thunders out of the bare ground. The colors catch in the sun and you take a half step back in fear of the noise, the motion and the surprise. After vaulting 8 feet into the air the bird levels and then flies away at amazing speed. Somehow in the middle of all this the older hunters again instinctively wait a bit to let the kid recover from surprise and take the first shot. If everything is perfect they take their first pheasant in front of their older colleagues who all grin and praise the shot, the dog and the day. The dog even grins as she brings the bird back, proud of her role in this ritual. You spread out and begin again. Man I miss home.

What He Wills biggest need. Most of you have gathered from the last few months that my blogging has been a fairly unvarnished look at an emotional and spiritual journey on which I am embarked. At this point I am just holding on. And l am learning patience.

A friend told of a writer who pictured life like a ride down a river. Sometimes there are calm pools and the shore just slips by peacefully. Other times we are in rapids and are just holding on for dear life knowing that our efforts to change things are minute compared to the power that is moving us. I would agree with one exception: those of us who know Christ at least have someone else in the boat with us to help us stay calm if we trust. This past week has been so emotionally draining for me I am just holding on.

It has been a good week of lessons. I finally received a fairly large check form Medicare about 1 day before I was completely drained of resources. It had been nearly 7 months without payment from our major payor and I was just hanging on. I was trembling when I opened the envelope and could not speak as I showed it to my staff. God had promised to supply what I need not what I want and He did so on the day I needed it. I was speechless both from relief and from a sense of awe that my God was watching, and knew my needs exactly. It was a faith stretching experience. He has drawn me firmly to White Pine over the past month and I am not sure why but given His track record, I am expectantly waiting for that answer.

I am reading an excellent J I Packer book on the Lord's prayer. One of the main theses is that God's ultimate end and the essence of His nature is relationship. Prayer is about extending and affirming that relationship and tuning our hearts to His will. I find that as I have been going through some personal and family stress that relationships are the thing that makes my life livable. Alone we are naked, wretched and cannot grow. Supported by relationship we can blossom, give and love.

I have found my skills in relationship are quite lacking. I often manipulate, become envious and controlling or revert to "fighting dirty" by withdrawing, deceiving and pouting. And at the core I am not patient....I want things the way I think I see them needing to be even in relationships with others. A friend of mine recently highlighted these flaws and then, in a display of Christ-like character, honestly challenged me while not throwing our friendship away. I glimpsed how Christ wants us to relate to our brothers and sisters: honest confrontation, love of the person and then firm hope in their ability to rise above their flaws with Christ's help. God has been so good to lead me to a church that embodies His spirit and to friends who embody Him in their daily lives. I can only hope I can learn from both groups to be a better man.

This brings me to the punch line. I am not sure what is happening in my life. I do not know what or who the future holds. I do know Him and upon that knowledge I will rest for there seems to be some reason to continue my practice in White Pine despite tremendous pressures financial, spiritual and emotional to just give up. I know He wants me here....I'm just not sure for whom or for what reason. I guess I'll just have to be patient!


My new church had a homecoming service today. I don't know all the details but they have been through a half-decade or so of hurt and turmoil that has caused the remaining members to be very open to change, open to the Spirit and open to the voice of their new pastor. I have felt a healing environment as I have attended and a "nakedness". By this I mean I feel they are welcoming all of me: my hurts, my flaws and my gifts. They seem to say "we almost died as a church so we now know EVERYTHING must be on the table for us to bear each others burdens and rejoice when you rejoice....join us." This is an amazing feeling in a church when you come with the pain and hurts, the shame and introspection that I did a few weeks ago. I am so grateful.

I have lived away from family and home since 1981. My family that remains in ND is quite interrelated doing a lot of things including church together. I have missed that opportunity and now feel a hunger to have a church family to love and from whom I can be loved. I have had such people and such churches in my past but I was the one not loving so that's the change.

The idea of homecoming is sweet. On the days I feel I cannot go on God seems to say "I don't want this earth to be too nice or you would not groan for heaven." Boy am I wanting heaven! For some reason He wants me here now so I can wait. Paul said to "live is Christ and to die is gain". I hope I can understand the first phrase better. I yearn to have that final homecoming when we get a new name and can finally meet the author of our salvation. Until then the homes we make in church here will have to remind us of what heaven ill be like. I hope all my patients can look forward to such a homecoming.

My Nickname

Two entries today as I will not have the computer for a while. I have been through a tremendous amount of stress recently and although my faith has not failed my emotions certainly have. I have spent a lot of time in prayer beating myself up with my own failures and my character flaws. These pop out when I think I am doing better and they almost always have at their core satan whispering to me about my worthlessness. Then I go out a prove him right with my actions hurting those closest to me. My prayers have been to ENDURE this time....get through it an move on intact or nearly so.

In our church on Wednesdays the women are studying with Beth Moore some of the Genesis stories. Last week she ended (as she is so good at doing) by recounting the story of Jacob wrestling with the angel and then getting a new name. His old name spoke of his scheming and the new of his overcoming. What a wonderful picture. She then took it to a new and wonderful place. In Revelation 2:17 we are told that "to those that overcome" will be given a new only God and that person will know. And that name will mean something to us both. It will be the nickname that defines us. Ancient peoples and Native peoples often had naming ceremonies at puberty with the choice of the name being sacred. It often described the person well in one or two words. My brother was good at nicknaming folks in our youth. They sometimes had something to do with physical or emotional traits and sometimes they seemed out of the blue. But, even if strange, they just seemed to fit the person.

Some day IF I OVERCOME (NOT JUST ENDURE) my trials, God will welcome me home and whisper to me a name. This name will speak of the trials, His grace and my triumph through His power. Then I imaging Him smiling and winking as we know that no one else knows. You see, no one else was there when we together walked through the fires triumphantly. The name will mean everything to me and will be out of the blue to everyone else who would hear it. Just think about it!

Rainbow Suprise

This is a bit scattered so stay with me. This week I was walking early in the morning around White Pine. I pray while I do this. Sometimes it's a bit like being on a cell phone while driving as I end the walk not really remembering the visual details. I have points in my route where I pray certain things. I start with God, His majesty and creative being and His grace and love for all and for me. Then I work on my desire for His will to be done in my life, the life of my church and my friends. Then I look inward at my sin and slowly developing Fruits of the Spirit then a time of thanks for forgiveness. Then I pray for others in my life both family and friends. Finally I pray for His help in getting through the day showing Christ in me to my patients and all I meet. I generally end up with the amen as I enter the office door.

Well one day this week the sky was dreary. It looked like rain but the type of clouds made it clear it was only dark but no rain. My mood was a chameleon to the day. I was dark, feeling alone. I was trying to advise God on the best way for Him to move a great burden out of my life....and I felt I was not being successful. I felt like David complaining that God's face was far from me. I was unsure where my life was going and I was very lonely. I walked a bit out of my usual route and was facing east. Just as I turned around to the west to head to the clinic the sun peeked through. As I turned, right in front of me, a rainbow suddenly appeared with one end in the middle of White Pine (about where my church is). I began to weep. In a flash I seemed to understand that God's promise to never abandon me and to always be with me was real. It was as if He was saying. "I'm right here behind you watching you walk through this dreary time. Do not fear. I am with you and will not see you come to harm." I am so grateful that scripture tells us that this is exactly His attitude toward His children. In Isaiah 40 we are told He will renew our strength....not that we will be removed from our trials. The passage before that is the lovely one that recounts the greatness and power of God. The trials are nothing compared to Him and He is with us. Thanks be to Him.

Flu Season

Every year about this time there is a mad rush. Patients and their families begin to call about the availability of flu shots. We start asking folks if they want them. We hear the same stories of past allergies and "it gave me the flu." The government starts to remind us of how important getting the shots are. And the business of influenza starts. Influenza is a public health issue and, although the health departments do provide some vaccine to providers and give some themselves, the vast majority of Americans now will get their shots from hundreds of sites: mega-stores, pharmacies, schools, senior centers etc.

This fragmented approach coupled with marketing from middle men who distribute vaccine for a profit is a great example of how the American system fails the public. Most influenza is spread and fomented by children and in the school systems. This source then spreads into the community eventually affecting the very young and the very old. For years the target audience was the one most likely to agree to vaccine (and pay)....the elderly. Never mind that the response to immunizations as we age is far less than in the young. Never mind that the young are spreading the disease. This was pure supply and demand and stores were there to help with the hype. And in the race to be first (to get the $$ from the anxious public) shots are given earlier and earlier each year. Never mind that the immunity from the shot wanes after several months so giving too early may still not ensure complete community coverage.

In the past few years there has been more emphasis on preschool and now finally school children. This will ultimately be a better use of the fixed dollars but we still have a fragmented system. I wish the profit was removed. I wish we had an immunization policy in this country that provided basic immunizations for contagious diseases and epidemic diseases free of charge to all. I wish that the policy would use the science to distribute the vaccine to those most likely to spread the disease and those most susceptible to it.. I wish my fax machine would stop spitting out "Flu vaccine special price" sheets from middle men.

But this is America. We eventually get to the right answer after exhausting all other possibilities first! By the way our shots will be available Oct 24th and 31st in the PM.

Fruit Tree

Many of you know the list of the Fruits of the Spirit or character traits that Christians are to have. I have been struggling with these for several months because I am quite good at seeing others flaws but quite blind to my own. My actions over time have caused me to have to daily face the aftermath of my lack of fruit and the lives I hurt.

Fruit ripen with time. They come into being by the branches merely doing each day what they are called to do while receiving sustaining life from the roots and main vine. The result, over time, is that they become more and more like Christ and less and less like the world.

Love, Joy, Peace, Patience: The first 4 are foundational and so hard for me. My love is not agape. It is more rooted in what I get not what I give. Christ's example of dying for us when we were in total conflict with Him seems too high a mark. I see the key to His love as the incredible forgiveness that it embraced. I have trouble even forgiving the small slights of my family and friends. Yet He asks me to forgive others because I understand the tremendous amount I have been forgiven by Him. Forgive as far as the East is from the West. And then He desires that we restore the relationship. Without His divine intervention I can never do this. And can never expect my brothers or sisters to do the same with me.

Joy, real joy that permeates our being with the perfect contentment God's Spirit can give also seems elusive. Happy at times but Joy in the chaos? Hard for me yet He commands it. When the joy comes I think the peace that passes our understanding and the resultant patience are easier.

My challenge to to learn love....sacrificial and forgiving love. Love that expects the best in others and is not so self-centered. Love that sees others' flaws as their challenges that God has placed before them to cause them to grow. The great mystery is this: God gives the fruit if we rest in Him. Problem is I want them now. He says "in time with trials". To learn to love he puts us in unloving situations and then watches. Each time I lash out He says "Do over" and we are back to square one. But each day we mature there is a bit more of Christ in us.

I am reading a book about learning to find "Safe People" to be in our lives and identifying the Unsafe People that help to keep us in interpersonal and spiritual chaos. Safe people believe in us, confront us with our sin, empathize with us, bring out the best in us, forgive us in love, move us spiritually in a positive way and unconditionally love us (not what we do but who we are and who we are becoming). The Unsafe ones blur boundaries, use us, abuse us, cause our baser nature to emerge and center the relationship around their needs. Often they do these destructive things in very deceptive ways causes us to feel we are the cause of the chaos they create. I know I can see patterns for me where I have been unable to identify Unsafe people in my life until they have turned me inside out and my world upside down. The book emphasized the Christ is the ultimate example of a Safe person. As a friend He was loving, loyal, able to confront in love and empathetic. Those around Him were positively changed.

So if Christ perfectly embodies the fruits of the Spirit AND is the ultimate Safe person, we should look to Him as our model. We should look for friends, partners and churches that show the Fruit and His character in their lives. Then we will find the safety we need to be in healthy and real relationships. This seems basic but has been a good revelation for me. I must bear the fruit if I am to be a safe friend and I must seek out others of like purpose. It is only in that collection of "branches" that my fruit will have the best chance to ripen to maturity.

Lessons to learn

I know that much of this blog has been non-medical but I feel lessons learned in all areas of life (not just science) is what makes up a physician. When I was teaching I had the opportunity to interview potential medical student or potential residents. I wanted to hear all about their non-science life and I always asked: "Tell me about a failure in your life that you caused and how it affected you." The answers were illuminating. I recall one young woman who was at an Ivy League undergraduate program. She was ALREADY IN CHARGE OF A FEDERALLY SPONSORED RESEARCH LAB. Not just a project but her own folks working under her! She was brilliant and attractive and accomplished in some non-science areas. In response to the question she thought long and hard and then said..."well, one time a boyfriend dumped me before I had a chance to dump him." I said something like "I'm sorry for you because in your training or your practice you will make an error that will hurt or possibly hasten the death of someone. If all you have to use as prior experience is being dumped once in your life I don't know if you will come through all right." I saw young doctors faced with their first failure (not just a wrong answer on a test) do one of three general things: they could fold up and be crushed (some even dropped out), they could ignore or deny their responsibility (those are the dangerous doctors ) or they could study the pain and failure and learn.

Like many of them I have been blessed almost my whole life with successes. Luckily I played competitive sports where an air ball or a fumble can ruin a game or a season. Still I have had a relatively pain-free life. These past months have been very different. I have been challenged again and again with not only my interpersonal and character shortcomings but also my failures in my profession. Recently I saw a Beth Moore tape that stressed that God will keep allowing tests in our life until we "get an A". She said that if we were having the same test again and again we must not be learning the lesson. She also said that our greatest tests will involve our greatest loves and will also have the greatest impact for change in us and our world. Very true.

My current test is the same as previous ones: to learn patience and trust in God that He will sustain me if I am doing what He calls me to do. Sure, I know this but I still advise God. I make alternative plans, try to speed up the process all the while showing very little of the faith I claim to possess. I have come to understand that I have 3 cores ways of responding to issues: feeling, thinking and acting. I am sure that too often I feel first. When I do this (especially when I am tempted by Satan to use the emotions of guilt, despair, anger or shame) I then rivet my thoughts to those emotions driving me deeper in sin. My actions then follow my thoughts. I have decided that this lesson for me is learn to see when my emotions react to a situation in such a way as to take away my joy, my peace and lessen my faith. When I see that I can ask God to help me calm the emotion and allow me to recast the situation in His eyes. This is bringing me peace that I have only hoped for in the past. The poems I have on the site for today reflect this struggle and capture what I am trying to say. I hope that I finally understand the test and have a way to get that "A".

Growing Pains

Over the past few months I have been under quite a bit of strain due to a delay in a large amount of Medicare nearly 6 months worth! My devotional life has been leading me to understand that trials in our lives are pretty specific and allowed by God to bring out the fruits of the Spirit in a believer. Joy, Peace, Patience and Kindness are my hardest and, boy, have the lessons come fast and furious! The problem is (as Beth Moore says) "God's into A's"....not C's! He doesn't just want me to survive a trial. He wants me to really ace the lesson. This is why the same lessons keep coming up for us, I believe. We have not really got the concept mastered and He say's..."OK, one more time". During this financial crunch I have had to really step out on faith in several areas and it has been very hard. My prayers have been that my patients and my staff would see Christ in me each day. I fear that most days they see more Peter (before the open tomb) than Christ. Emotional, reacting, anxious, triangulating and very other words quite the opposite of our Lord.

Despite all that the desire to have the practice grow and flourish has been another prayer. Over the past couple of weeks that has happened dramatically. As it has done so it is clear that it has very little to do with me or my skill. God is just good. I have been blessed with patients who put up with my quirks and still tell people to check out our practice. Their word of mouth has been quite humbling.

In Mary and Holly I have two people that fit their rolls quite well. Most of my patients have never seen or spoken to Mary as she works when patients are not in the clinic. Mary came on board in the middle of this financial crunch and (I must admit) I was worried that she might not be of help. Within a few hours, however, she had changed my bias about electronic billing, calmed my fears about the Medicare and outlined a way to proceed that I would have never dreamt up in, well in forever. She is stabilizing the ship and putting forward more ideas of how to change some of my bad habits regarding billing. All my patients know Holly and appreciate her ability to bring smiles to faces, calm to people anxious about referrals and relief to those worried about having blood drawn or shots given. She juggles phones and office while remembering names and details I could never bring to mind about each patient. During the sudden increase in volume both of these women have kept the practice going even when I seem to be rowing in a different direction.

We have others that have been helpful. I cannot mention names but I have one dear friend who is a remarkable manager and who has supported and suggested changes to me all the while encouraging the type of personal practice I am trying to achieve. Others have been crucial in encouraging by sending cards or even suggesting marketing. We have one patient who even keeps us well stocked in jam! And today a proud grandmother brought an essay her granddaughter had made about our practice!

My father was a dentist in a small town where he was raised and I saw first hand what that type of practice was like. My brothers both have professional practices where their patients seem to adore them. I had not really experienced this (or was not open to it) until recently. I am so grateful that my eyes are now seeing how interrelated patient and practice are. I am smiling when I think of folks I saw or met for the first time today....they are now part of that fabric. I am more excited about medicine than I have been in a long time and it is not because of the science. It is simply that I have started to understand what a wonderful gift God has given me to be involved in helping people when they are in need AND receiving what they give to me in return.

Screening Scares

When I was a resident the rise of HMO type health plans heralded the idea of "paying to keep people healthy". Debates occurred about how much money preventive care would save and just when in the timeline of the patient would the payoff occur. Most research suggested that there was some positive gain from using certain preventive strategies (immunizations and prenatal care) but there was an ongoing debate about mass screening for cancer and heart disease. This was just as HIV was becoming a national scare. With that scare was the first modern disease to become a political topic. Advocacy groups quite vocal in their options, regardless of the research, pushed for all kinds of (in my opinion) harmful strategies. We initially could not even know as a physician what our patient's test results were. Patients were issued a private random identifier and would then call in using their number not their name to get results. It was a crazy approach to a public health problem.

Because of the success both financially and politically of the HIV issue other diseases and their advocates began to push the envelope. We taught women breast self exams without fully knowing the impact such training would have (myriad untold women finding benign lumps early in their exams prompting biopsies and anxiety). We pushed for "yearly" PAP smears when the research showed that certain high risk groups needed that (and maybe more) but low risk groups could get away with much less frequent exams. Then we began to screen for heart disease and diabetes. Civic groups, pharmacies, health fairs sprung up with folks getting "free screening tests" and then no followup or risk stratification. Certainly folks with disease were found adding to our certainty of our approach but many others were left scared, confused and without guidance. While all this was going on we blindly ignored issues like the nutritional damage that was being done at our public schools with poor lunch choice and sweet drink machines.

So what's the answer? Ideally you should screen for a disease that, if caught early (before major symptoms bring it to the patient's or doctor's attention) can be cured, delayed dramatically or modified in some way that will make a major impact on the patient or society. In other words if you can catch it early, cheaply AND IT MAKES A DIFFERENCE TO THE PATIENT OR SOCIETY. The test should be relatively inexpensive, easy to administer AND THE TREATMENT SHOULD BE COST EFFECTIVE.

All tests have 2 main statistical issues that influence their effectiveness. Sensitivity is the ability of a test to identify people with the disease. If a test is 95% sensitive (pretty good) it would identify 95 of 100 people WHO HAVE THE DISEASE correctly. This means 5% will think they are ok but the test would be wrong (THIS IS A FALSE NEGATIVE). Specificity is the ability of the test to exclude those who do not have the disease. If a test is 95% specific (again pretty good) for every 100 people who are without the disease 95 would be correctly identified as disease-free. BUT 5% WOULD TEST POSITIVE INCORRECTLY...a false positive. Every screening test has both false negatives and false positives.

Let's take a PSA test. It tests for prostate cancer right? Well, actually it tests for the level of a protein found to be elevated in most men with prostate cancer. It can be elevated in other instances as well and LIKE MOST BIOLOGICAL tests that actually measure a level (not merely a + or - by being found present) there is a Bell Curve of results. Currently the cut off for worry on a PSA is 4.0. This number was chosen to make the false negatives low and the false positives fairly low. So you go to your doctor and test're OK right? Well, actually, a study a couple of years ago showed that nearly 28% of a group of men tested with PSA and then undergoing biopsy had PSA AROUND 2.0 AND WERE FOUND TO HAVE ABNORMAL CELLS THAT LOOKED LIKE CANCER. There are also men who have PSA's in excess of 4.0 who have negative biopsies and no cancer.

All I can tell men who want PSA's for screening is that when we get the result we can talk more about what it might mean. I also try to find out if they would want treatment if a cancer was found. It can get very confusing. Add to this that we often screen EVERYONE of a certain age and sex for a disorder. This is like sitting at the soda counter looking for the next undiscovered star to walk might be their a while. A better approach would be to identify family, social, nutritional and symptom histories that would develop groups of higher risk patients who could be screened. This approach generally will lower your false positives when you screen.

USA TODAY recently published yet another report that Routine Physicals had little value and wasted large amounts of health care dollars. It is at these exams that batteries of screening tests are often performed. Makes me $$ but is not worth the cost.

The upshot? Be selective in your requests for screening. Know your risk factors. Talk with your doctor about the effectiveness of the testing approach her or she is using and find out if better tests are out there. ALWAYS BE AN ACTIVE PARTICIPANT IN YOUR CARE EVEN WHEN WE SEEM TO BE SURE WE KNOW WHAT WE ARE DOING!!

More random thoughts.

I wonder why, when faced with unhappiness in life is it so important to find a reason or someone to blame? I am always amazed at the capacity of humans, including myself, to downplay our own weakness. Daily I see people who, despite being overweight or unfit, blame the lack of time or other people as the cause of their illness. In fact many seem genuinely disappointed when all lab and x-ray come back without disease. They "know I've got something bad wrong". Stress, poor family life, poor nutrition and tobacco are often the root problem. When shown the truth of this and the need for change they say that they cannot or that they "have tried" in the past and failed.

We all do this. It is in our nature. In the garden Adam blamed Eve for his complicity in sin. Eve pointed to the snake. We all desire to be our own god and therefore our compass has to be right and error must come from the outside. This is why Paul's statement that temptation and sin arise within our own minds first is so stunning. Maybe I would not be such a good god after all.

I have been spending a season taking a long and hard look inside myself with the help of some books, a few wise friends and prayer. What I have found is not too pretty. My world far too often revolves around me not Christ. I am quick to be hurt and offended but miss the hurts I inflict. I want others to have infinite patience with me but I have none for them. Basically given a list of the fruits of the Spirit (love, joy, peace, patience, kindness, goodness, gentleness, faithfulness and self-control) I am the poster boy for the "before" photo.

The puzzle about bearing fruit is that the branch bears by "abiding" rather than doing anything itself. It needs to be intimately connected to the vine and receptive to what the vine offers. In other words to get better I need to abide in Christ more fully and more unreservedly. Not more church, more giving, more work rather more communion and more trust. This is very hard for someone who likes to act to fix a problem. I want to be the actor (and receive the accolades).

Christ's approach was different. His miracles and His power arose out of the very intimate communion He had with God the Father. He was the ultimate expression of the fruit of the Spirit. I have decided that in order to be a good man I must be able to give it all up...all my selfish desires, all my self-centered goals and all my private gods.

Paul's image of us as a "living sacrifice"...actually placing ourselves on the alter alive (like Isaac) is the model. To do that I must just live each moment fully for His glory and die to self daily. He promises strength to help us do just that. It is a freeing vision of now for Him nothing else has priority. This burns away a lot of the stress of life and helps avoid blaming others for the past or the future. Maybe that's the approach we need with patients: Do right by your body NOW. Past is past and future is not here but NOW you can help yourself. I wonder....