friends

Facebook did not invent this problem but it does illustrate it quite well: having many friends can be a way of not having any friends.

Stateless Patients

A 30 y/o woman presented to a rural clinic for prenatal follow up: G2P1 at 25 weeks. As I used the ultrasound to check dates, look for anomalies, and measure amnionic fluid, I thought of the patient’s lack of sufficient identification in this country to allow her access to complex OB care. Instead, a volunteer internist was doing her ultrasound. The baby appeared healthy, but I later noted that she had not gained weight for several visits and that she was on prednisone. She had started having joint pains when she first got pregnant, was diagnosed with rheumatoid arthritis, started on steroids, and the labs that she could afford were sent off.

Through translators, the patient reported oral ulcers that were now healed, but no rash. Exam confirmed persistent pain and limited range of motion in the elbows, knees, wrists, MCP and PIP joints. Anemia down to a hemoglobin of 5 had improved to 8.5 with iron and steroids, but the WBC was still low at 2.7. She had negative rheumatoid factor, positive ANA and dsDNA, and negative anti-Smith. The creatinine was normal and urine protein was 3+. She met criteria for lupus.

I explained to the patient how a lupus diagnosis put her and her baby at risk, and the medications had risks as well. I increased the prednisone and asked her to come back in a week, hoping I could get some advice via email as to what to do. Thankfully, rheumatology friends overseas emailed back. We then developed a plan including medications that we could obtain and that were considered relatively safe during pregnancy, hoping to reduce the steroids at some point.

Three weeks after I first saw her, the patient had gained some weight and her joints were nearly normal, though she still had proteinuria. I outlined an ongoing plan for the staff as I left and prayed for her and the baby.

One wonders when helping people who are outside the “system” and its resources for whatever reason, at home or abroad: am I doing the right thing? Am I practicing beyond my scope if no one else will see them? How can I get better at doing this when medical progress seems to require more and more sub-specialization? And how can I protect these people’s privacy and security and still advocate for improved access to care?

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The Power of the News

The newspaper press is a great power, but just as an unchained torrent of water submerges whole countrysides and devastates crops, even so an uncontrolled pen serves but to destroy. If the control is from without, it proves more poisonous than want of control. It can be profitable only when exercised from within.
                                                         -Gandhi (autobiography Beacon, 1993 p. 287)
 

A Problem of Diagnosis

Efforts at cultural diagnosis are hampered if they are pursued from within the same framework of fundamental assumptions that brought into being the disorders they hope to cure.
                                                                                           -Ken Myers

Unchanging and Changing

• Biblical Truth does not change. Humankind’s understanding of God, the universe, and personal human experience before God does change. God is an absolute truth while humankind’s statements about God are in the form of theological presuppositions. 
•  
•                                                -From C.W. Brister, Pastoral Care in the Church
  

Death

Everyone knows they're going to die...but nobody believes it.

                                                                                   -Mitch Albom

Why Follow?

The people did not follow Moses because they thought he had a good idea. The people followed Moses because they sensed that God truly sent him, that his mission was God inspired. They believd that God was behind the mission, and so they followed the one who articulated God's call.
                                                              - George Cladis, Leading the Team-Based Church (p51)

Mastery

Success is not a matter of mastering subtle, sophisticated theory, but rather of embracing common sense with uncommon levels of discipline and persistence.

                                                                             - Patrick Lencioni, The Five Dysfunctions of a Team

The Very Best Cell Phone Plan for your Child

I found this awesome new cell phone plan for kids! I wanted to just let

people know what a great investment it is! This is only a partial list of its benefits:

1. No monthly fee (one time charge only)

2. No hidden fees, late fees, or any other fee!

3. It rings when you want it to (just press one of the buttons). It does

 not ring when you don't press the button so you have complete control!

4. It is really easy to resist texting while driving

5. It is very colorful

6. The screen won't break if you drop it (so you won't need a screen

 protector, or a case)

7. No crank calls

8. No one can use this to steal your identity

9. The NSA cannot track you

10. It blocks sexting, 100%

11. Your kid can't ask you for money using this phone

12. No Youtube in bed

13. Prevents screen addiction

14. Encourages outside activities

15. Doctor recommended (I'm a doctor and I recommend it)

16. Can be used by any age child! 

17. Blocks access to extremist web sites of all flavors (though there is

 a one-eyed monster as you can see; you have to deal with that one)

I am sure you can add to this list (please do!). I highly encourage the

dollar store cell phone plan for your child!

to whom?

If you write, unless you write to someone, you write to no one.

Art

To reduce works of art to their ideational content is to rob them of their power, distort their true nature, and make them finally unnecessary.

                                                                              -Leland Ryken, Liberated Imagination, 128

Love and Respect Message

This is a message I shared at the Olympia Chinese Christian Church on June 23, 2019.  Some people asked for some of the slides for reference so here they are. Much of the material is obviously from Dr Eggerich's book and seminar, Love and Respect I highly encourage reading the book or getting in on on of his seminars.

A few of the slides:

Click HERE to download the entire power point file.