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Being human Medicine Reflections on Life, Being Human, and Medicine Reflections on the Christian Life

Freedom

It was late on a Saturday night in January when the call for our ambulance came in. We were being called to someone injured in a fight. He was outside of a bar several miles away from town. We asked if the sheriff had a car going also and they said, “No.” They did not currently have anyone available. We were to let them know if it was needed.

When we arrived, we saw eyes peeking out of the door of the bar but no one standing outside with him. He was all alone sitting on the icy cold pavement. He was huge – muscular – tall. All he was doing was grunting – loudly. “Grrrr. Grrr. Grrr.” Over and over again. He was dressed in torn jeans and a torn dirty t-shirt. He did not have a jacket or coat on. It was January in Michigan and the temperature was very cold. We pulled up next to him. I could see blood on his head. He didn’t get up. He just sat there grunting. I tried to talk to him. He refused to answer. He continued to grunt, “Grrrr, Grrrr, Grrrr.” 

Eventually a couple of people came outside. We asked what happened. They either didn’t know or didn’t want to tell us. I asked if anyone knew him. They said his name was, “Mike.” 

“Mike. Mike. My name is Mike too. I am here to try and help you. Can you tell me where you hurt?”

“Grrr, Grrr, Grrr.”

We got the stretcher out of the ambulance. Normally with unknown injuries including a possible head injury we would take spinal precautions. In this case “Mike” stood up and sat down and then laid down on our stretcher. We put the blankets and safety belt on him and lifted him into the ambulance.

The next thing I know I was sitting next to Mike alone in the back of the ambulance.  My partner started driving to the hospital. As he drove, he called the sheriff dispatcher and asked the police to meet us at the Emergency Department. I looked for what I could do if Mike got violent with me. I had a big Maglite flashlight, but I was not sure that even with that I could fight him off. It felt like an unsafe situation. 

As Mike warmed up, he stopped grunting.

“Do I look like your brother?” he asked me.

“No,” I said.

“Well you don’t look like my brother either!  But you are just like my brother.” He was getting angry.

I tried to calm him, “What do you mean? How can I be just like your brother? You don’t even know me. I am trying to help you. Can you tell me where you are hurt?”

“You are just like my brother! You are just like my brother because you will never understand me. My brother never understands me, and you are just like my brother so you will never understand me.” He continued on and on.

“How does your brother not understand you?” I asked.

“He doesn’t understand me because he is just like you and you will never understand me. And you will never understand me because you are just like my brother,” his circular reasoning continued. Then he looked at me and said, “For you see – I am free.”

I am free.  That is what he said. It seemed odd to me to hear him say that.

“They can do whatever they want to me but no matter what anyone does I am always going to be free,” he continued.

I was suddenly overcome with a complex mix of pity, compassion and anger. Fear left me as the reality of his world and the lies and deceptions that he believed confronted me.

We did sit in stark contrast to each other.  He was all alone sitting on the ice in a cold dark parking lot in a Michigan winter in January. He had no friends coming to his aid or supporting him. He had blood on his head.  He was cold, injured, alone and friendless.  The world had been unkind to him.  He was angry and trapped and imprisoned by his circumstances and by his anger.

I was at work at a job that I truly enjoyed. I had on a clean uniform that I was proud of. I had on a very warm jacket. I was working with a friend. We enjoyed working together. I knew and benefited from the love of my family and friends. I knew the love of God. And in this I had a much different understanding of the meaning of freedom.

I was free. 

I was not free because I had no ties or obligations. I was not free because I had no limits on what I said or did. I was busy. During the week I was in college with hours of study and classes. On the weekend I worked 14 hours at the ED and another 24 hours on the ambulance every other weekend. Built around me were huge expectations. I also was (and am) committed to my Christian faith and my submission to the Lordship of Christ on my life. My life was and is not my own. And yet, there was no question in my mind at that moment about freedom. 

He was deeply imprisoned in his circumstances. He was a victim of the cruel deception of this world. By trying so hard to be free he was being chained deeper and deeper in misery. It is usually so subtle that we do not see it. We live our lives missing the paradox of what true freedom is. But sometimes the circumstances make it abundantly obvious. Sometimes you end up all alone, sitting in torn and dirty clothes, sitting outside in an icy parking lot in the middle of January evening and all you can do is grunt. 

The deception had overplayed its hand. He was not free. He was horribly empty and imprisoned in his misery.

For you see there is a secret. It is a mystery. It is a paradox. Freedom does not come by breaking free from all the ties and restrictions on you. Freedom comes from being where and who and how you are supposed to be. Freedom does not come from running away. 

I had a patient once who ran away from home. He was in his 60s with a wife, children, grandchildren, a mother, a home, and a business. He felt the pressure of it all and one day when he was driving home, he didn’t go home. He just kept driving and went on and on. He settled somewhere else and started a new life. He was seeking freedom. But he was not free. Eventually he came home. Running away from his obligations didn’t make him free.

Freedom comes from being home or wherever you are supposed to be. Freedom is strong in a room surrounded by your family and friends who love you. Freedom is not found when you are running away from all of them. The things that the world might try to sell you as being free – making your own decisions – driving your own life – actually are deep deceptions. Freedom is understanding who you are – where you are supposed to be and how you are supposed to function. 

On the deepest level freedom is found in submission to the one who knows you and has created you and loves you. Freedom comes from knowing love and forgiveness from God. Freedom comes not from fighting and scrapping to prove yourself to others and to God, but from accepting His forgiveness, and starting new as the person who you are meant to be.

The paradox is this: Freedom is found in submission. What might look like restrictions or rules if they were forced on you, become freedom when you see and chose and accept them.

Freedom does not come from a lack of ties or obligations. Freedom comes within them. Freedom can come with a house with a mortgage, bills, a job and a bunch of expectations. Freedom comes from being where you are supposed to be. Freedom is like finding a set of clothes that fit you perfectly. Without them you are naked and awkward and incomplete. But in them suddenly everything is right. 

We turned a corner toward the hospital.

I was angry. I wasn’t angry at him. I was angry at a mean and cruel world and how it was destroying him. I was angry how it could make him an “object of wrath.” I was angry at how deceived he had been and how empty he was. I no longer cared about my safety or trying to keep him calm.


“You don’t understand. You do not know the first thing about freedom,” I said to him. “Look at you and what has happened to you. You are the one who was sitting injured and all alone in a cold parking lot. Wake up! You have got to see it. You are trapped. By trying to be free you are imprisoned. There is so much more to freedom than what you understand. You need help.”

I didn’t know what he was going to do next. He might get violent. And just then my partner backed up to the doors at the ED. The back doors of the ambulance were opened by two sheriff’s deputies who were waiting for us. I hopped out to safety. We brought him into the emergency department.

I never saw him again. 

Categories
Updates on my health

Nine Months NED

Adrenal cancer has a high rate of reoccurrence. I have been told that the experts don’t use the word, “cured.” They have also warned me that there are no magic number of years and then you can say it is all behind you. Instead they use the words “no evident disease” or “NED”.

I just had my 9-month CT scans and they were “NED”. We were very happy to see this. This was of course very reassuring. Once you get a cancer diagnosis every ache and pain and strange feeling makes you wonder. It is helpful to know that there is no obvious disease. We will continue on these CT scans every 3 months for the foreseeable future.

People ask me how I am doing. That is a surprisingly complicated question to answer. I came off of the mitotane (chemotherapy) in mid-February because of side effects.  I seemed to have every side effect and then a few more. In the end my doctor agreed that it was better to have me stop taking the mitotane. I then falsely assumed that in a few weeks I would return to feeling like myself again.  I was wrong. People who have been through cancer or other major illnesses know this. I didn’t understand.

For one thing, mitotane is a medicine with a long half-life. That means that it stays in your body a long time (like 9-12 months).  Second, our bodies don’t just pop back to normal again. Surgery, radiation, and then drugs like mitotane can take from months to a year or more to recover from. As I have walked this journey other people who have gone through a variety of health problems have told me of their often-silent struggles to finally feel normal again. “It took me about a year,” is a common phrase I have heard.

What are the issues?

Fatigue:I can still get tired easily. It used to be that I was tired all the time. That is better. When I am not working, I am doing pretty well now. I have energy and can do things again. I never realized how intense I am at work. Focusing on patients and working through their problems is far more strenuous than anything I do at home. The amount of energy that takes has come as a surprise to me. I can feel good starting out in the morning and then by 11 am start to feel very tired. It gets worse as the week goes on.

Dizziness:Mitotane has some neurologic side effects. One of them is dizziness. It was pretty intense while I was taking the mitotane. People may not have known it but when I was talking to them about 30% of my mental energy was being spent trying to not fall out of my chair. It has gotten better. It gets worse when I am tired or fatigued (see above!) 

Brain fog:This is another common thing I have heard from cancer survivors. It is also a mitotane side effect. When I was taking the mitotane I came to realize that if I continued on mitotane this was likely to make me completely disabled. My reasoning is intact. I hope these blogs have demonstrated some of that. But it has destroyed my ability to recall names. It is an odd thing because they can be people I know really well and have used their names a hundred times and then my brain blocks. About 30-90 seconds later the name hits me but then it is too late. The same thing happens with trying to get the correct word. It slows down my speech at times. It has gotten better. It gets worse when I am tired.

We have tried to figure out how to work through all of this. I have been told that I will get better with time. I am seeing gradual improvement. In the interim, I have looked at reducing my work schedule. For now, we have strategically scheduled vacation days to achieve the same thing. Once we get into the next couple of months we are hoping for continued improvement or we will need to reassess again.

So how am I doing?  

I am doing pretty well. I am NED. I am working kind of a full schedule. I am gradually getting better. Last week was better than early July. The dizziness is not quite as intense or frequent. Caffeine helps with the fatigue. I did get very weak several days ago and an increase in steroid dose for a day did a world of good also. 

I saw a patient last week who is young and has struggled between disability and working. She lives in the in-between where she has some energy and ability to work but also not enough to handle the stress of her job. As a physician I have always found it hard to fill out disability statements. We might have been trained on how to diagnose and treat disease but how are we qualified to say what someone is or is not able to do? It is so individual. There is no guidebook or guideline to tell us the answers.

Dealing with her had always been a challenge for me. 

Until last week. 

I could look in her eyes and face and I could see and understand. Fatigue. Exacerbation of her symptoms from her brain injury under the stress of work. It all made sense. We worked through things together. I needed to listen because it was not easy for her to explain how she was doing in just a few words. But for once it clicked and all made sense to me.

I have been learning:

  1. It is possible to “look good” and feel really tired.
  2. Limitations are crummy. At times I feel really impaired. I used to be able to call on reserve to pull me through when I needed it. It just isn’t there like it used to be. It makes me feel a bit guilty to not be able to push through and get everything done.
  3. It is hard to learn to live within your limits. I want to jump back to my old life. The limits are making me learn about dealing with things differently.  

So how am I doing? Fairly well. Getting better but it is moving slowly.  

Thanks for asking!