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Are You Waiting In Line to Live Your Life?

Potluck meals generally work out well. Everyone brings something. Normally you end up with a lot of food and everyone leaves satisfied. 


 I remember a time when it did not work out well.

I was young and the potluck was for an event at school. My family had baked a large dish of homemade lasagna. When it was time to eat, the tables were released to go through the potluck line one at a time. As it turned out, we ended up being the last table to go through the potluck line. When we did there was no food left. 

It seems that all the other people that had gone before us must have taken larger amounts of food than what they had brought. Our lasagna dish was there, scraped completely clean along with all of the other dishes. We returned to our table with mostly empty plates. When the event was over, we went home hungry.

Potlucks are supposed to work out well and normally do. It seems that most of the time people tend to bring more food than they would normally eat. Everyone gets more than enough food, and we all get to enjoy the broad variety of what the others brought to the event. It usually doesn’t matter where you sit. Whether you are the 1st table or the last, you should get a nice meal. You can be calm, mature and orderly. You do not need to fight or jostle for position. When it is your turn, you are to be assured that there will be enough food for you. That is the rule.

Sometimes, like that one night, the rule doesn’t work.


Someone once described the process of medical education as a form of prolonged adolescence.

While others are going through the phases of life (marriage, kids, jobs, etc.) in their late teens and early 20s, those who aim to be physicians tend to be intensely focused. They put off a lot of life to focus on their goal. 

The entire process is like climbing a steep hill. You need to go to a good college, get good grades and do all the right things to get into medical school. Your college experience needs to be different than others. You need to be serious. You need to push to excel. If you do that you can get into a good medical school. 

That however is not the end. 

That is when the work really begins. Our tuition was based on 30 credit hours per semester based on the amount of work that was expected of us. You didn’t have the time to be doing a lot of things outside of your medical school course work. You needed to work hard to get good marks so that you could get the residency that you hoped for. 

That also is not the end.

Once you get to residency then the long work hours really start. For me it was overnight call every 3rd night. We rarely slept on call, spending most of the night caring for the steady stream of new patient admissions. I was getting great experience. All of that built me into a better physician and later allowed me to get into a cardiology fellowship.

When I went into practice, I rapidly became busy.  In my cardiology practice and as we started an LVAD (Left Ventricular Assist Device) and then a heart transplant program I poured my passion, heart and soul into it. I was proud of the fact that I could routinely live on about 5 hours of sleep per night. I would be up late working and would get up early to continue doing more. 

Why?  

Because it should work out…

There is an unspoken agreement: It is okay to do all of this. Of course you feel stressed and you push yourself very hard but the rewards at the end of it all will be worth it. 

You are climbing the hill and once you get to the top it will be wonderful.  

Others might stop along with way to rest or look at the flowers or enjoy the view. They are not as smart or as good as you are. You are focused. You keep pushing, knowing what it takes to reach the summit.

And don’t worry. There is plenty of time to enjoy things later. 

There will be plenty of food left when it is your time to go through the potluck line.

At least that is what the unspoken deal or unwritten contract promises. 


The 5-year survival odds were around 50%. That meant a 50/50 chance of dying within the next 5 years.

If you google adrenocortical carcinoma (ACC), for someone with locally advanced disease, that is what you will read.  I was 53 years old. Five years were not enough. That would mean not ever reaching retirement. It would mean that I had climbed so hard up the mountain only to be told that I was not going to be allowed to continue long enough to reach the summit. 

I had a lot of emotions.  One that surprised me was anger. 

I felt like the world was laughing at me. 

“Ha! You thought that you would work so hard, give up on hobbies and sports and things that other people do, and you would get the reward at the end. You fool! You were an idiot!”

I yelled back, “We had a deal!” 

There was silence.

I looked around to register my complaint. When I did, there was no one to complain to. 

“Hello? Is anyone there?”

Who made this agreement with me? Who forced me to do all of the sacrifices that I thought were so necessary? 

The silence persisted.  There was no one there.

I had more questions.

“What was I working so hard to get to at the end?”  And why?” “Had I been a fool?”

Normally it works out. Normally there is plenty of food, but sometimes it doesn’t work out.


A few years before this I was sitting on an airplane. Once we had gotten up in the air, I pulled out my laptop and began pounding away on some work. The woman next to me glanced at my screen and then asked, “Are you a doctor?” 

“Yes, I am.”

“My husband was a doctor.” she said. “He was supposed to be with me now…”

She was quiet for a minute and then she continued, “We saved and planned and put things off thinking that once he retired, we would have time.  We were going to travel, to visit our children, and to do all the things that his busy practice had not allowed time for. But he died shortly after retirement.”

She paused again, looked at me, and then said, “I am trying to do the things that we had planned to do together, but instead I am doing them alone.”

We talked some more. As we talked, we realized that I knew her husband. He had been an attending physician when I was a resident. He was good at what he did. He was dedicated. I told her I was sorry for her loss. 

My PowerPoint suddenly didn’t seem quite so important.


It has now been more than 7 ½ years since my cancer diagnosis. I thank God that my cancer has not recurred. My health is good at the moment. In the days to weeks following my initial CT scan and diagnosis however I learned some things. Since then I have continued to grow and learn.  


Life is a journey – with a whole bunch of important and valuable stuff along with way – more than it is a destination. 

It is not just about “getting somewhere.” It is just as much about living and truly experiencing what each season of our life is all about.  

My perspective has really changed. I no longer think of life as starting at one point and then working to reach some pinnacle before I die. We live through life – all of it – and maybe we learn some things as we go along but it is not that any one phase of life is necessarily “better” than the others.  Each and every phase bring their own joys and challenges to be enjoyed and dealt with.

Even in my Christian life on this earth it is not as simple as starting out at one point and then working until I reach spiritual perfection. That is not it at all. The start is forgiveness and acceptance by God. That start, set free by my justification in Christ, is what enables me to enjoy and live the journey. We strive to grow and mature, surely. In that I would hope that I learn and grow as I go along in life (we call this process “sanctification”). But I no longer expect that in this life I will reach some spiritual pinnacle where I have it all figured out. That is a deception. I can never grow complacent in my faith. That is how people fail and fall. My spiritual journey is to discover the challenges and joys at each phase of my life. My role is to live what God has put in my path today and to seek to do that with faith and joy, empowered by the knowledge of my position in Christ.

Don’t just assume that you can “live your life tomorrow.” You must live today.

I say this again for emphasis. This is a complete change of perspective. 

If the family is going to do something, I now want to go along and be a part of it. We call this FOMO (Fear Of Missing Out) but maybe we all ought to live our lives with some degree of FOMO.  I don’t want to miss out because I am gone working all day and then exhausted after. I want to see and experience the things that life brings today rather than just waiting for what comes tomorrow.

I am going to take my vacation time. I am going to have margin in my life to be a part of things that are important to me and my family. I am no longer so willing to “play the martyr” and sacrifice the fun things in life. 

The “they” do not exist. 

There is no one there giving you the guarantee that if you sacrifice living your life today, you will have your life to live tomorrow.  Whoever you might have thought you were “making a deal with” they do not exist.

Please understand that this like everything is a balance.  

God exists. He gives us promises. 

In faith I know that I have a wonderful future hope in Christ. I have no worries or doubts about that. A key part of my life here is understanding that this life is only a shadow of the real and wonderful future that God has for us after this life.  To serve Christ in this life is a privilege and sacrifice is a natural part of that.

God however has never given us the promise that if we sacrifice and work hard that we will have rewards in this life. He has not given a warranty or guarantee that we will live to an old age or make it to a successful retirement. 

God is not the “they” and there is no other “they.”

Learn to practice the art of living in the spirit of “hebel.”

Hebel is Hebrew term that while classically translated as “vanity” more accurately is about the brief or fleeting and transient nature of our lives. It reflects on the inevitability of death. Living in the spirit of “hebel” redirects our thinking.

Behold, what I have seen to be good and to be fitting is to eat and drink and find enjoyment in all the toil with which one toils under the sun the few days of his life which God has given him, for this is his lot. Every man also to whom God has given wealth and possessions and power to enjoy them, and to accept his lot and find enjoyment in his toil—this is the gift of God. For he will not much remember the days of his life because God keeps him occupied with joy in his heart.[1]

Life is “hebel” (a vapor, a mist, brief and fleeting).

We should not live our lives just waiting for a time when we can enjoy the things in this life that God has given us. This life is not perfect. It is a mix of good and bad. In that God wants us to enjoy the good He gives us now just as we must also endure the bad.  It naturally causes us to embrace simplicity and emphasize relationships over material gain. It causes us to live in a spirit of gratitude for what we have and a greater appreciation for the present.

Balance:

As a I reflect on all of this I must be careful. I have been incredibly blessed with amazing experiences, opportunities, family and friends. I have had a great life. I am not saying that if I had a chance to go back and do it all over again that I would change a lot.  But my philosophy of life, in the spirit of hebel, has changed. 

This does not mean living a life devoid of sacrifices.  I can choose to make sacrifices for things that are important. But I no longer assume just because I do so that I am promised something for it (at least not in this life).

There is a much more mature and healthy understanding. 

  • Do I take on doing something? I weigh it out. Is it important? If yes – then I am willing to make sacrifices and give up comfort, free time, or rest.  I make this choice for the sake of what I am trying to achieve (or what God calls me to achieve) rather than some elusive promise of great times to come. I do so with the understanding that if I die tomorrow, I would still be okay with the choice to do this thing.
  • Are there things that I want to do in my personal life? I am no longer willing to put off or delay these things. I am under no delusion that there is a promise that we will have tomorrow to do “the thing” in this life.  We might not.
  • This does not mean just pursuing leisure or pleasure. It is much deeper than that. It is about setting priorities and living and seeking to cherish every moment. It is clear in Ecclesiastes that “toil” is a gift from God and is a part of really enjoying and living this life.  Sometimes the most meaningful things – the things that really are what it means to live – are not fun or easy. But they are what it means to “fill up my lungs and run!”[2]

The potluck table is open. We each will get a turn, but I am not willing to let others take more than their share and just assume there will be something left for the rest of us. I will insist that we all get our share. 

That isn’t selfish. That is just being authentic and fair. It is a real understanding of this life in that none of us is really promised with certainty anything tomorrow. The calculus of decision-making shifts once we truly grasp this. 

Let me state some extremes so that you better understand what I am or am not saying:

  • Does this mean you just spend all of your money and don’t save or plan for the future? Of course not. Is it worth it to save now so that if I am here, I can retire comfortably and even if I am not so that my wife will be okay? Yes. Of course.
  • Do you quit your job today so that you can do all the things that you want to do? Some might say that. But for me, no. Not necessarily. There is value in work. “Toil” is one of the gifts that God gives us in this life. There are good things that I can do. There is value in using my training and skills. Is this important enough to me or valuable enough to miss out on some other experiences? Yes. In this moment or season this is what it means for me to “really live.”
  • Isn’t this selfish? Is this just saying it is all about me? Am I saying that I am going to insist on bullying my way ahead of everyone else in the potluck line? Nope. It is about reasonable respect for each other. It is also recognizing that the “they” who we think are promising a full plate may not actually exist. It is about a respect and appreciation for the life that God has given us. It is such a thankfulness and appreciation for that life that we are unwilling to squander or waste it.

David Letterman asked the musician Warren Zevon this, “From your perspective now is there something that you know about life and death that maybe I don’t know?”

Warren was giving his final interview as he was facing almost certain death from malignant mesothelioma. His answer has become famous, “Not unless I know how much you are supposed to enjoy every sandwich.”[3]

Would you please have the audacity to live?  Would you be so bold as to do it today? Can you embrace the spirit of “hebel?” 

Can you be so blatant as to refuse to passively sit back and just let life pass you by? Can you insist that you too enjoy the meal and not just let everyone else go through the buffet line?


[1] Ecclesiastes 5:18-20, Revised Standard Version

[2] A reference to the Sara Bareilles song, “Chasing the Sun.” 

[3] https://www.youtube.com/shorts/IF8Kh55pOAQ

Categories
Reflections on Life, Being Human, and Medicine

The Parable, The Pioneer and the Power of Returning

I can still picture the place and remember the moment.

We were in a hotel and conference center in Pendik which is on the Asian side of Istanbul Turkey. I had been invited to give a couple of talks in a cardiovascular symposium. It was exciting and an honor to be a part of this meeting. 

We walked on a break between sessions. I was with Luis. Many in my community will instantly know who I am referring to but for a broader audience, Luis was a pioneer and a visionary cardiac surgeon for our region. By now he was advanced in years and carried himself with a profound dignity that evoked respect. I was careful when I was with him to treat him with the honor that I knew he deserved.  I also knew that he had the benefit of years of passion in his work and with that came wisdom.

As we walked, he focused his attention on me. He was sincere in his concern for me which flattered me. On his part, he truly wanted to know how I was doing and how our programs were doing. 

I now joke about how leadership seems to be confronted with, “the crisis of the day, the crisis of the week and the crisis of the month.” His question came amid one of the many political struggles and challenges that come naturally whenever you work to bring change to an organization. I poured out my concerns and sketched out some of the details of the current struggle. 

He listened politely and then put his arm around my shoulders and leaned in with sage advice. I have carried that advice with me ever since.

But to understand it better, let me first take a little detour into a proverb from the Bible. This is Jesus teaching:

He said: “In a certain town there was a judge who neither feared God nor cared what people thought. And there was a widow in that town who kept coming to him with the plea, ‘Grant me justice against my adversary.’

“For some time he refused. But finally he said to himself, ‘Even though I don’t fear God or care what people think, yet because this widow keeps bothering me, I will see that she gets justice, so that she won’t eventually come and attack me!’” [1]

I think this is a puzzling proverb. When I was young it did not make sense to me. Jesus was teaching his disciples about prayer and faith and yet the scriptures record that Jesus also said:

“Truly I tell you, if you have faith as small as a mustard seed, you can say to this mountain, ‘Move from here to there,’ and it will move. Nothing will be impossible for you.” [2]

Now this I understand. If I have faith, Jesus taught, then God will answer my prayer. Doesn’t this mean then that if I want my prayers to be answered I should go in confidence to God in prayer and just ask for what I need? And having laid out that request, shouldn’t I similarly have the confidence to know that God has heard me and will answer my prayer?  If I were to return time and time again, would that not be a sign of a lack of faith?

Certainly, I used to think, to ask time and time again would be an assured way to show that you do not trust God and therefore do not have the faith necessary for God to grant your request.

And yet, Jesus told them about the persistent widow. In fact he closes the parable by asking, “However, when the Son of Man comes, will he find faith on the earth?”

Now wait a minute. The context means that he was saying that if you have faith, you will pray and pray and pray again.

This means that perhaps my thinking was off.

Let me put it more simply:

Prayer 101: If you have a need or concern, put in a prayer, sort of like putting in a work order or ticket at the help desk. Once that is submitted there is nothing more you need to do. You just wait for the answer. You do not need to pay attention to the issue anymore and can go on with the rest of your life.

But Jesus was taking the disciples to another level.

Prayer 201: If you have a need or concern, you should repeatedly and continually lay it out before God in prayer. Jesus said, “And will not God bring about justice for his chosen ones, who cry out to him day and night?”  He was telling them to pray in faith but was also telling them to not cease in praying. Like the persistent widow he taught them to come back again and again and again and again before the almighty God in faith and to lay out their needs and the needs of others. 

This used to puzzle me. Why did Jesus teach this concept of repetitive prayer?

Like many things in Scripture, age and life experiences have helped and made this to begin to make sense to me:

  1. It takes more faith to keep asking. To return each day in prayer and lay out the request repeatedly, still seeing the problem and not yet seeing the answer takes an enduring faith. The repeated prayers are actually an exercise in faith. Faith is not then a “one and done” thing. Rather having faith and growing in faith is like exercising a muscle. With each prayer, the muscle is exercised, maintained and even strengthened. It is though you are saying, “Lord God I know that you are there, that you hear my request, and that you want me to continually bring the request. I know and trust in your answer whatever and whenever that answer will come.”
  2. There is something to the process that we need. God is not a vending machine that we go to get what we want and then leave. God is our loving father that desires to bring us with him through the process of His intervention, including his redemption and healing of our world. Like a parent training their child, he wants us to go through the process with Him, enduring over time (often even many many years) in faith as He works with us and through us to deliver the answer. The one and done prayer is a cop out. It allows us to wash our hands of the situation rather than dwelling in the concerns that we or others have. Our prayers for the concerns of those around us are a gift that allows us to carry their concerns with them and in partnership with a loving and redemptive God.
  3. We need to not tire of doing good. “When the Son of Man comes will He find faith?[3]” It is hard to persist in doing any good work especially if there are barriers or in times when it seems like there is no progress. We can muster enthusiasm and strength at first, but then can we go on to do what is harder? Can we sustain the desire or the drive to seek after the good that we want to do or that we want to see? That persistence in whatever we do – in this case in prayer – is what I think the persistent widow can teach us.

———-

Luis wrapped his arms around my shoulder and leaned in to speak to me. He smiled a bit as he began.  His Argentinian accent added a deep solemnity to his words:

“Mike, I will tell you exactly what you are to do.”

“Go to the hospital, see your patients and do your work. Ask for what you need to make things better and do so with a smile on your face.  When the hospital tells you “no” do not get upset.  Go home in peace. Get up the next morning and with a smile on your face come back to the hospital. Take care of your patients and do your work. Ask for the thing that you need all over again. They will likely tell you “no”. Do not get distressed. Get up the next morning and with a smile on your face, do the same thing over and over and over again. I will promise you that eventually they will give you what you want. This works. Whether they want to or not, whether they think it is feasible or not, eventually they will meet your request.”

I have been very fortunate to work in a progressive health care system. My leadership has generally been responsive to the changes and demands that we have seen necessary to improve patient care in our region. 

But not always. 

I have had plenty of times when I have heard a “no” or a “not yet.”  In those moments I do not despair. I think of Luis and that time walking between sessions in the hotel in Istanbul, Turkey. I can see the twinkle in his eye and can with fondness still feel his arm around my shoulder. I can hear his voice speak my name as he says, “Mike, do not tire in doing good.  The clinicians always outlast the administrators. If you are seeking what is right and good and best, patiently persist. The change will eventually come.”

Do not tire in doing good.

I smile now as I think of the parable of the persistent widow. I marvel at all of the programs and changes and growth and development of the past 20 years in our health system. 

I hope that maybe someone might read this blog, and in it find the courage to doggedly persist and continue to seek what is good and right and best.

Be a persistent widow. 

I will tell you what to do:

Do not tire in doing good. Keep your idealism. Do not settle for what is present today. Dream of what could be. Seek after it with a smile on your face. When (not if) you face opposition or are told “no” do not despair. Go home in peace. Come back the next day with a smile on your face, with your dreams yet alive and seek after it again, and again, and again.


[1] New International Version, Luke 18:1-8

[2] New International Version, Matthew 17:20

[3] New International Version, Luke 18:8