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Being human Reflections on Life, Being Human, and Medicine Reflections on the Christian Life Updates on my health

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
Being human Reflections on Life, Being Human, and Medicine Reflections on the Christian Life Updates on my health

A Scarf in the Carburetor and a Near Tragedy Averted!  

Update: I wrote this a few years ago when my adrenal insufficiency symptoms were much worse. As I posted a few weeks ago, this past year has brought improvements for me. I am honestly doing a lot better now but thought the principles shared here are helpful enough to still post this story and the lessons it contains.

The snow was several inches deep in the driveway as I left for work. As my car carved its tracks through the snow, I thought back to my teen years and my snowmobiles.

I owned a variety of snowmobiles growing up. We lived on a farm with big fields which in the winter would be laid out open, clean and white with snow. I would ride around my families’ fields with big wide expanses of smooth snow. I could turn or twist anywhere and race across the open fields. It was a great feeling of freedom. 

I would mostly ride around my parents’ fields but sometimes would ride further. We couldn’t normally ride on the roads as they would have been plowed clear (and not “street legal to ride there anyway.”)  We had a sort of secret path that we could follow to get around this. These paths would go from my parents’ fields and along the back of the various fields owned by our neighbors. In this patchwork way we could move from field to field to stay off the roads and have enough snow on which to ride. This patchwork was enough that we could ride long distances and even be able to make the 7 miles to town. If (or when) a blizzard hit, it was exciting to be able to be the one who was to get to town. I could imagine myself as the rescuer getting the mail and anything else that we might have needed.  

My snowmobiles had lights on them and so I could go out riding in the evening too.  Sometimes riding alone in the dark winter evening my imagination would start playing with me.  “What if there was someone hiding back in the woods on the edge of the field?” It wasn’t rational but once the seed of that thought got in my head, it would grow. “Maybe someone was watching and waiting for me, seeing the lights of my snowmobile streak across the field.” As I drew near the woods on the edge of the field the thought would flare up into my head. “Perhaps they were at any minute going to run out and get me!”  I would give into these thoughts. The invented terror would grow in my head. As it did so, I would push hard on the throttle and the snowmobile would sling itself away from the woods.  As it did so, my mind’s eye showed me the evil mass-murderer, or perhaps the science fiction monster, or the wild animal jumping out of the woods only to be disappointed at my rapid acceleration away from them. 

“Ha! Take that! You’re not going to catch me tonight!” 

One day I was riding back home from town. With the short winter days, it was already getting dark and with the darkness had become a cold evening. I was bundled up in my snowsuit, helmet, and down filled mittens. I had wrapped a big scarf around my face and neck to protect myself from the wind. I was doing the usual jog around the back of our various neighbors’ fields. In one spot the path led down an angled hill, by a pond, and then angled back up out of the depression and into a more open area. I carefully navigated the snowmobile down into the depression. As I did so, my imagination started up again. “Whose field was this anyway? What if someone or something was down the hill away from the traces of moonlight and therefore hidden from sight? What horrors could be waiting for me down there?” I was eager to get down and back up before I could find out. My hope was that once heading up the hill I could squeeze hard on the throttle and fly away from the dark and gloomy area. 

As I slid down the hill however the heavy scarf I had around my neck rocked forward just enough to get close to the air intake for the carburetor. The carburetor sucked the scarf into the intake area and effectively choked the engine. 

This was not good. 

I was sliding down the hill, right where all my terrors were waiting. This time, instead of accelerating back up the hill, due to my wayward scarf, my engine bogged down with no power. 

I squeezed hard on the throttle and when I did so the engine completely quit. In that instant, I was left sitting in the dark, all alone, at the back of an unknown neighbor’s field with a killed engine.

I forced myself to calm down. Why did I have to give in so often to my active imagination! Calm. Think. Be okay.

I pulled my scarf out of the carburetor and more carefully tucked it into my coat.  I reached down and pulled the engine over. It wouldn’t start (flooded as it was by my scarf in the carburetor and then the full throttle I had put on.)  I tried to pull again and again. As I did my fears gradually gave way to frustration. I pulled off my heavy mittens to be able to pull with more force. I started unzipping and peeling back layers as I pulled and pulled, my body heating up with the exertion of trying to get the engine to start.

After a several minutes I got the engine running again.

It was just in time (or at least that’s what my imagination told me!) 

I didn’t even take time to put my gloves back on but instead threw them between my legs to hold them and accelerated up the hill and into the open field. 

Ha! I had cheated death again! The savage animal (or monster or mass murderer or whatever it was going to be) clearly was very disappointed this time.  It thought it was going to get me but just as it charged down into the depression I was finally off and away!

As silly as that story is, I am reminded of that moment of the engine bogging down in recent years. While I can laugh at myself and my overactive teenaged imagination my remembrance is not about that, however.  Instead it is that feeling of the scarf in the carburetor that comes back to me. 

For most of my life I counted on my engine’s power being available. I was sure in my ability at will to squeeze hard on the throttle and have the engine reward me with a burst of energy. I could put myself in situations (like my invented near terror experiences as a teen) and then rescue myself by the reserve power within. 

But then my scarf started getting sucked into the carburetor.  

I don’t know what I thought the various chapters of life would bring but I had not anticipated that a lack of energy would define this current chapter. I had always enjoyed a mind that saw things to do and then a body that could do them. Now however there are times when my engine suddenly bogs. I squeeze the throttle, but my scarf has been sucked into the carburetor. 

I was in clinic seeing patients. It was near the end of a full day. I was seeing a patient and doing my best to work with them to deal with some challenging issues. There were no easy answers. I did my best to try to honestly navigate their complex but real questions. 

I could feel it starting. 

My engine started bogging down. The first sign for me is dizziness. Next comes achy muscles. If I stand quickly, I will feel lightheaded. 

My scarf was sucked in the carburetor. I have lived this enough now however and I have learned a lot. I now know not to just squeeze hard on the throttle. I have become adept at keeping the engine running. I was able to finish the visit and make it back to my desk.  Then, I was able to pause and take a break.  In essence, I was letting the engine shut down for a minute. I would be sure to more carefully tuck my scarf in away from the carburetor before I started the engine again. Having stopped for a minute, I was able to go on with my day. 

The issue is not that I don’t have any energy.  I feel odd complaining about this. As I go through each day, I will have times of fatigue and times where I feel better. In the times when my energy comes back, the old me wants to take on new things. When my engine bogs down I wonder if I am trying to do too much.

I have learned to understand this. I have more good times of day than bad and more good days than bad days. 

The longer I have dealt with this, however, the more I have realized that it is a common issue for people with chronic disease.  

I share this post now hoping to help everyone understand the realities of chronic disease. 

My experiences have helped me to honestly listen and hear what my patients are experiencing.  With that I have learned a few lessons that I can now use to help them.

  1. Fatigue is a common and unifying symptom of many diseases.  It is clearly a part of heart failure but many other conditions as well. For me it is a sign of my primary adrenal insufficiency. 
  2. Ups and downs of energy are normal.  “How are you?” is actually a hard question to answer. There is so much variability from day to day and from moment to moment that there is no one way to truly define how you are. I am fabulous/crummy/okay/wonderful/tired all in one day.  (I am just happy that this past year is bringing more good than bad for me…)
  3. Dizziness or what I call “ill-defined lightheadedness” is a common symptom of fatigue and tiredness.  It is not low blood pressure or low blood sugar or an inner ear problem. It is just my brain telling me that my body is exhausted.
  4. Trying to just “push through” generally doesn’t work. A period of rest, even a very brief one, can be restorative. I now am fairly blunt with my patients. They can choose to make themselves miserable, or they can face reality and accept their limitations. They need to have a realistic understanding of the limits of their energy. They need to think about taking a rest period not as a failure but as a way to reclaim the rest of their day.
  5. Rebound fatigue is common and normal. Just because you feel good does not mean that you can do what you want. You might pay for it the next day.  With my internal drive to “do”, Monday’s have often been hard for me, reflecting the things that I pushed to do over the weekend.
  6. Recognition of your limitations can have value in forcing you to focus on what is important. I tell patients, “You can’t save the world anymore. You never really could but you used to be able to try. You need to stop trying. What is there to do that is important for you to do? Choose those things and shake off the rest.”  This also includes a favorite expression that I use with patients, “The things you really don’t want to do is what young persons were invented for! Ask for help!” They usually laugh at this as they recognize that it is okay to not feel guilty about hiring young energetic persons to do what they don’t want to do or don’t have the energy to do. 

As I continued to drive to work I drove past an open field. I looked out fondly at the smooth expanse of snow and thought of the hours that I spent riding around on my snowmobile. I laughed at myself when I recall that evening in the little depression where my engine died. The monster didn’t get me that evening. More importantly, life went on and despite the engine dying it started back up again.

For you see, the engine was still fairly sound underneath it all. It still had more power to give and more things it could do. I just needed to take care of it properly. I needed to give it enough air. I needed to have realistic expectations of what it could do. I needed to appreciate what it could do rather than being frustrated at what it couldn’t do.

So how am I?

I don’t really know. A lot of the time I am great. Sometimes my scarf gets stuck in the carburetor. It can be frustrating, but I have gotten used to it and have learned how to cope. And every day in my practice as my patients talk, I can hear them in ways that I was not capable of before. They may not realize how their words resonate with the experiences that I have learned to live with and cope with. 

What are the lessons in this?

  • Many, many people have fatigue as a limiting factor in their lives. They would love to do more. They can’t. 
  • Paul talked about having a “thorn in the flesh.” While we don’t know exactly what his struggle was, we do clearly know his response to it. “Three times I pleaded with the Lord to take it away from me. But He said to me, ‘My grace is sufficient for you, for My power is perfected in weakness.’ Therefore I will boast all the more gladly in my weaknesses, so that the power of Christ may rest on me.”[1]  
  • This is a fallen world. So many have illnesses and limitations that they deal with on a daily basis. This is not the world that God originally designed for us. It is also not the future hope that He has in store. But by our limitations we perhaps are able to realize that we are not strong enough on our own. We need each other. We need Christ. His grace is sufficient for us, and his power is perfected in our weakness. 
  • In this life we will face illnesses, limitations, and deficiencies. It is a reality of life. I hope and pray that I (we) can respond like Paul.

Oh – and a couple of more lessons:

  1. If you have an exposed carburetor on your snowmobile, be sure to tuck your scarf safely inside your coat.
  2. If there is an evil monster waiting for you as you are driving by, be especially careful to have your scarf tucked away!

[1] 2 Corinthians 12:7-10