Forgiveness=Trust? (Romans 5:7-8)

Some time ago, a colleague of mine experienced a devastating loss when his company was taken over by an unscrupulous group of investors. Under the guise of a round of venture capital funding, the investors wrested control of the board of directors, firing him and his wife from the company they both founded. As he recounted the painful episode to me, I was surprised by his relatively calm demeanor.


“You know, I have always known you to be very level-headed, calm when chaos is happening all around you. Does your wife feel the same way about everything that has happened?”


My colleague’s lips pursed. “If anything, she is even more level-headed.”


“What do you mean?”


“She thinks that if we are able to resolve this with our attorneys, we may even be able to work together with them.”


I was stunned by this admission. “And what do you think?”


My colleague was tentative, but out of respect to his wife he said, “I don’t think I can do that.”


“Because the trust is gone.”




For one will scarcely die for a righteous person–though perhaps for a good person one would dare even to die– but God shows his love for us in that while we were still sinners, Christ died for us.

Romans 5:7-8 (ESV)


God calls all believers to forgive one another for sins they have committed or that have been inflicted upon ourselves or upon others. In relationships broken by sinful behavior, we are commanded to forgive the perpetrator but we do not naively continue to place ourselves in the same path of danger. Forgiveness is unconditional but it is not equivalent to trust. Trust is earned when the forgiven person demonstrates contrition, and this takes time, sometimes a lifetime.


However long it takes to restore trust, our responsibility as believers and followers of Jesus Christ is to pray for the one who sinned against us. We do this because of the example Jesus Christ gave to us. When we were still sinners, Christ died for us. He forgave our sins even when we rejected His initial offer of salvation and nailed Him to the Cross. His sacrifice for us demonstrated the trustworthiness of His Word.


Forgiveness is unconditional. Trust is earned.


Love and trust the Lord; seek His will in your life.


Adequate Margins (Psalms 51:1-2)

“Dr. Smith is calling about this case. He is asking about your recommendations for margins.”


My secretary handed me a report that I issued a few days ago on a melanoma that I diagnosed for his patient. As I discussed the case with the doctor, we both acknowledged the difficulty in deciding upon adequate margins because of the lack of definitive published guidelines for cancers in this body site. The cancer was located near the patient’s eyelid and the usual recommendation for margins would impinge upon the normal eyelid, potentially resulting in a very difficult final repair.


What are adequate margins for a malignant skin tumor? This is a controversial area of skin cancer management but the basic premise is to determine what would be a sufficient amount of normal tissue to be taken around a malignant tumor that will minimize or eliminate the risk of local recurrence and still preserve a good cosmetic outcome for the patient. Numerous clinical trials have produced guidelines and treatment recommendations. However, there are still cases that even when adequate margins are taken, a local recurrence may occur. There is still more research that needs to be done to identify the biology of these cancers and prognostic factors that may predict treatment failures. The days of radical and disfiguring surgeries are diminishing and hopefully, the day will soon arrive when the precise distance margins will be agreed upon, minimizing the amount of normal tissue that needs to be taken around the cancers.


Have mercy on me, O God, according to your steadfast love; according to your abundant mercy blot out my transgressions. Wash me thoroughly from my iniquity, and cleanse me from my sin!

Psalms 51:1-2 (ESV)


God has needed to perform many radical spiritual surgeries in my life for the egregious sins that I have allowed to infect and corrupt my entire being. Unlike the uncertainty over the adequacy of margins with skin cancers, God is able to precisely remove the sins, the life-robbing cancers in my life, leaving me whole. He is able to do this because He paid the ultimate penalty for my sins by dying on the Cross and being resurrected by the power of God.


When I submit myself to God’s will, His mercy and grace precisely removes my sins and cleanses me through faith and belief in the death and resurrection of his Son, Jesus Christ.


Love and trust the Lord; seek His will in your life.


Duet (Matthew 11:28-30)

“Take out your recorders, time for music!”


I eagerly fished out the plastic musical instrument, tucked away in my bag. Like thousands of children in the United States, I was learning to play this instrument in my elementary school in Hawaii. While many of my classmates hated or were ambivalent toward it, I adored the instrument. It was my first exposure to a musical instrument and learning to read music. I diligently practiced and it undoubtedly contributed to my love for music that still pervades my life. My effort got the notice of my teacher and one day after class, she approached me. “I would like you to play a duet with Jake.”




He was a transfer to my elementary school from Michigan. We were only in the fourth grade but Jake was a recognized prodigy on the flute, performing with several symphony orchestras in his home state. Recognizing his talent, the school principal asked Jake to give a solo performance before the entire school to the delight of our parents and faculty. A similar and far simpler musical instrument, the recorder was a breeze for him and he immediately established himself as the best in the class, if not the state. I was asked to play a duet with him because I was the next best. This was akin to placing me alone in the same room as Steph Curry and declaring I was the next best basketball player!


I was a complete amateur and did not deserve to share the stage with Jake. Yet, he graciously accepted our relationship and gave me pointers and helpful suggestions to improve my playing. When we performed, all my fear was gone as I was buoyed by this amazing artist.


Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light.

Matthew 11:28-30 (ESV)


Many years later, Jesus Christ invited me into a relationship with Him. Like playing with Jake, I had no right to even be in His presence. I am a complete and degenerate sinner. Yet, through His grace and mercy, Jesus accepted my broken life when I confessed and repented of my sins and accepted Him as my Lord and Savior.


Jesus gave me rest when my soul was restless. He took my burdens when I was weighed down by the worries of my life. He accepted me when I wouldn’t accept myself. All fear was finally gone when my life was paired with God and He allowed me to enter into a relationship with Him.


I am so very grateful for this eternal duet of my life.


Love and trust the Lord; seek His will in your life.


Reconnect With My Faith (Revelation 2:4)

He was a stern-faced bearded man, draped in robes, bearing an upright sword in his right hand and documents in his left hand. It was the grand Basilica of St. Paul in Rome, Italy. This massive marble sculpture of the Apostle Paul greeted my wife and me as we entered the hallowed grounds of his tomb. I was overwhelmed and filled with awe. Was it because the Apostle’s body was actually buried here? Was it because I shared his name? I could not explain why I felt such a deep connection with this basilica compared to the many other amazing sites when we first visited in Rome in 2007, but it was my favorite.


Taking copious photos, I was anxious to share them with my friends and family. Before the ubiquitous social media sites that billions now utilize, I managed a website which I used to post family photos. These photos were posted in 2007 and recently, I read the copy I placed under the photograph of the massive sculpture of St. Paul. “Our visit to St. Paul’s Basilica was inspiring and helped me to reconnect with my Christian faith.”


Reconnect with my faith?


I was embarrassed to read this. Why would I write this? Was my faith so anemic and distant that I had to reconnect with it? I reflected for a moment and shook my head. Sadly, at that time in my life, my walk with God was an afterthought. Our family had two young children, the oldest just beginning school. I was focused on building my medical practice, shuttling between several different distant locations. Time was in short supply and I sacrificed my relationship with God to make up for it. Instead of taking the lead as the spiritual head of our family, I used my responsibilities as an excuse to push God aside.


Nevertheless I have this against you, that you have left your first love.

Revelation 2:4 (NKJV)


God never leaves me, I leave God. He will never leave me nor forsake me. In far too many times in my life, I have compromised my relationship with Him and justified it by devoting time to other relationships. My marriage, family, and jobs are noble and important relationships but these should never take the place of my most important relationship with Jesus Christ, my Lord, and Savior. He is my first Love and if I am to live the fulfilled and abundant life that God created me to have, I must first remain faithful to Him.


Love and trust the Lord; seek His will in your life.


Checkpoint Inhibitors (2 Corinthians 7:9-10)

There is a new class of drugs known as checkpoint inhibitors that have revolutionized the options to treat many diseases, including cancers that were previously thought to be untreatable. Many of these drugs have been in the news as well-known patients, like former President Jimmy Carter, have received a checkpoint inhibitor to treat his metastatic melanoma. What is the mechanism of these novel drugs?


The body’s immune system contains several proteins known as checkpoints. As their name suggests, they regulate the activation or suppression of critical steps or checkpoints of the immune system. PD-1 is a key protein present on some immune cells. With normal cells, PD-1 will recognize another cell’s protein known as PD-L1 and allow it to survive. Cancer cells produce an aberrant PD-L1 molecule that fools the body’s immune cells into recognizing the cancer cells as normal. This defect in the checkpoint mechanism allows the cancer cells to bypass and elude the usual pathways by which the immune system may eliminate these and other foreign cells.


By synthesizing drugs that can inhibit or block these abnormal PD-L1 proteins on cancer cells, these drugs allow the body’s native immune system to effectively eliminate these cancer cells, overcoming their resistance. Thus, an entirely new class of drugs, the checkpoint inhibitors, has emerged.


Cancer cells are remarkable in their ability to camouflage their lethal identities and mimic normal cells, eluding the body’s usual immune system defenses. This sounds suspiciously like sin in our lives. Sin masquerades as good or noble behavior but in reality, is feeding our pride and ego and guiding us on a path to self-destruction. Is there a way to reverse the effects of sin? Is there a checkpoint inhibitor for the sin that ravages our lives?


As it is, I rejoice, not because you were grieved, but because you were grieved into repenting. For you felt a godly grief, so that you suffered no loss through us. For godly grief produces a repentance that leads to salvation without regret, whereas worldly grief produces death.
2 Corinthians 7:9-10 (ESV)

The Holy Spirit indwells within every believer in Jesus Christ and He helps us to recognize the sins in our life that we may be unwilling to recognize. One’s sin of pride may be camouflaged under noble pursuits of charitable work, seeking accolades for our activities rather than focusing upon helping others. The sin of greed may be sublimated under a dubious tax deduction.


How can we be assured that it is truly a sin that we are confessing and repenting? When He convicts us of sin in our lives, we have the assurance that when we truly repent, it will be godly grief that leads to salvation and peace with God. The Holy Spirit is the Absolute checkpoint inhibitor who leads us to salvation through faith and belief in Jesus Christ.


Love and trust the Lord; seek His will in your life.


“Is There A Doctor On Board?” (Romans 4:21)

We were eight hours into our family’s return flight from Thailand. I was dozing, content after eating our dinner and was hoping to get a few hours of sleep. The crackle of the overhead announcement jolted me out of my brief rest.


“We have a medical issue with one of our passengers. If there is a doctor on board or anyone with medical training, please identify yourself to a flight attendant.”


My daughter looked at me and I nodded to her and proceeded to identify myself to a flight attendant. On a long flight such as this, I anticipate such an announcement to be made. In fact, this was the fourth time I have answered this type of call on an airlines flight. After sharing my medical credentials in the form of my medical license, the flight attendant ushered me to the row where a young girl was reclining. Taking a quick history, I learned she was feeling nauseous, about 1 hour after eating her dinner, throwing up once. Prior to the flight, she was fine and she had no underlying medical conditions or currently taking any medications. I did a cursory physical examination and noted her pulse to be normal and strong and she was in no obvious pain or distress. I stayed with her a few more minutes and instructed the flight attendants to give her some clear liquids and keep her reclined. It appeared to be a stomach flu or a reaction to the food but in my mind, more dangerous scenarios emerged. Appendicitis? Bleeding ulcer? I checked on her every hour and thankfully, the entire episode resolved without any worsening of the symptoms and we were able to land without further drama.


Although I am a physician, the options I had to care for the patient were limited. I am not a surgeon nor did I have the proper facilities to adequately treat someone, even if I could. If it had been a true emergency, the patient may have perished before we would be able to land.


…fully convinced that God was able to do what he had promised.

Romans 4:21 (ESV)


Life presents all of us with continual challenges. Unlike my professional credentials, God gives us the complete spiritual credentials we need to successfully see us through every situation and crisis. God promises every believer that He will never leave us nor forsake us by confessing and repenting of our sins and accepting Jesus Christ as our Lord and Savior.


I am a physician, but I place my faith and trust with the Great Physician, Jesus Christ.


Love and trust the Lord; seek His will in your life.



Some, But Not All (2 Corinthians 12:7-9)

Nearly everyone has heard or witnessed dramatic changes in the behavior and character of people who accept Jesus Christ as their Lord and Savior. Stories of hopeless alcoholics losing all desire to drink; addictions to pornography and drugs are eliminated; life-threatening cancers are healed. The stories are real and I am no exception.

God did change me when I confessed and repented of my sins and accepted Jesus Christ as my Lord and Savior. For decades, I suffered from allergic rhinitis. Only when I prayed to God to heal me did I find relief. The same happened with my GERD or gastrointestinal reflux. Many other behaviors, for which I previously harbored carnal desires for, were now eliminated. Yet, others still remained and I still struggled with these sins, behaviors that I would have gladly traded to be healed rather than my allergic rhinitis or GERD. Why did God take away some of my sins and desires but allowed others to remain? The Apostle Paul asked God the same question.

So to keep me from becoming conceited because of the surpassing greatness of the revelations, a thorn was given me in the flesh, a messenger of Satan to harass me, to keep me from becoming conceited. Three times I pleaded with the Lord about this, that it should leave me. But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me. For the sake of Christ, then, I am content with weaknesses, insults, hardships, persecutions, and calamities. For when I am weak, then I am strong.
2 Corinthians 12:7-10 (ESV)

For much of his ministry, Paul suffered from an affliction, either spiritual, physical, or both. Although he pleaded with Jesus to remove this affliction, Jesus’ answer to Paul realigned his faith. Instead of pleading God to take it away, he now boasted of his weakness and affliction knowing that it was proof that God was working in his life.

My faith continually needs to be realigned with God’s will. It is my persistent arrogance that I would not be content with being healed of one affliction but left with others. In His mercy, God allowed some of my sinful behaviors to remain so that I may learn of the true power of God in my life. It is a painful process but slowly, He is transforming and conforming me to the image of His Son, Jesus Christ.



Love and trust the Lord; seek His will in your life.



“How Can You Ever Repay That Gesture?” (Psalms 116:112)

Today, March 15, 2019, is National Match Day for all American medical students and residents. All medical students participate in the National Match Program. In the spring of every year, on the same day and time, all fourth-year medical students will learn where they will spend the next few years of their life, hopefully within their desired medical specialty and training program. A computer program matches the applicant’s rank listing of programs and matches it to the training program’s rank listing. If all goes smoothly, the applicant’s highest ranked program will match the program’s top choices and the applicant will become a resident at that training program. There are two caveats. There is an option to do a couples match. With this option, two individuals may link their application together, hoping to be placed in the same training program or in different training programs in the same city so they may be together. If the applicants are of equal class ranking, this is usually not a problem, but there is another caveat. If the desired specialties are very competitive, it may result in one or both of the applicants failing to match. Dermatology is one of the most competitive specialties and even applying as a solo applicant, there are many who may not match. When one or both applicants are applying in competitive specialties, the chances of failing to match are increased. A few days before the National Match Day, the deans of all medical schools and residency training program directors are notified of any students who did not match. A frantic scramble results and hastily arranged interviews are conducted either by phone or flying to hospitals that still have unfilled positions, to interview in person.


Many years ago, I had the honor to meet a medical resident applying to our dermatology residency program. Poised, intelligent, and effusing a vivacious personality, she had all the right qualifications to be an excellent dermatologist or a physician in any specialty that would be fortunate to accept her application. As I perused her letters of recommendation, one immediately stood out. The dean of her medical school recounted an incident that occurred in the prior year with this resident, then a medical student. Unfortunately, this medical resident did not match in dermatology and she and another student, who also did not match, were both called into the dean’s office. They were both near the top of their class in ranking and both were attempting to match in dermatology. However, the other student was also doing a couple’s match and her partner was attempting to match in an equally competitive surgical subspecialty. The dean explained the situation and informed both of them that there was only one dermatology spot open in a hospital in another city. He solemnly told them that ordinarily, it would not be a difficult decision to decide who to select to interview, but because both of them were equally ranked, he had a difficult decision and was unsure how to decide between the two of them. Without hesitating, my resident spoke up and volunteered. “Please allow my friend to interview. She is doing a couple’s match and it is much more difficult for both of them to match in their specialties. This hospital is in a city where her partner has already matched in his program.” In spite of sincere pleading from her friend, this resident remained firm in her decision, allowing her friend the opportunity to interview for this dermatology position which she eventually was offered. For the next year, instead of living her dream and beginning her dermatology residency, this resident spent a year in research and was now interviewing once again.


When I met her for her interview with our program, I told her how inspiring her story was, recounting what a tremendous sacrifice she made on behalf of her friend. She was a bit embarrassed by my praise and said, “I believe everything in life has a purpose. It will all work out if it is meant to be.”


She ultimately matched at a very prestigious dermatology program in a city close to her family. She met her future husband there and is now a renowned professor of dermatology. It did all work out!  As this year’s National Match Day was now upon us, I shared this story with my current dermatology residents. After listening to my story, one of my residents, in awe over what she just heard, addressed our group. “How can you ever repay that gesture?”


With an alacrity that surprised me, I responded, “By being the best physician you can possibly be, always putting the needs of your patients first, and always being thankful for what this other person did for you.” My residents all nodded in agreement.


What can I offer the LORD for all he has done for me?

Psalms 116:112 (NLT)


When someone unselfishly sacrifices their ambitions for your benefit, most of us would have an earnest desire to repay that person for their kindness. Like this inspiring example of this resident, we could honor the sacrifice of the other by endeavoring to do one’s utmost in their profession and to live a good moral life. But what can one do to repay what God has done for us? How can we repay God who took the initiative to restore the relationship broken by man’s sin? What can we do to thank God for sending His only Son to die on the Cross as a substitute for my sins? How can a finite human thank an infinite God?


The sacrifice you desire is a broken spirit. You will not reject a broken and repentant heart, O God.

Psalms 51:17 (NLT)


We repay God’s gesture of love, grace, and mercy by always acknowledging that our very existence is because of Him. We come before Him with a broken heart to confess and repent of our sins and accept Jesus Christ as our Lord and Savior. We can never repay God but we can always thank Him, every moment of our lives.


Love and trust the Lord; seek His will in your life.


“The Odds Were Against Us…” (Luke 21:33)

A seemingly miraculous event occurred during a fire that ravaged a Christian church in West Virginia. Firefighters rushed to the burning church on a Sunday morning. Unfortunately, the inferno destroyed much of the structure before it was extinguished by the firefighters. After surveying the damage, the firefighters were shocked to discover that no crosses or Bibles were burnt. Adding to their collective joy, no firefighters were injured. Giving thanks for their good fortune, the firefighters prayed, “Though odds were against us, God was not.”



Heaven and earth will pass away, but my words will not pass away.

Luke 21:33 (ESV)


Was it a miracle? I don’t know, but I thank God that no one was injured. The sparing of the Bibles is symbolic of the prophetic words that Jesus spoke thousands of years ago in the Gospel of Luke. God’s Words are not simply printed books and paper, it is God’s Holy Spirit indwelling within the hearts and minds of every believer who have confessed and repented of their sins and accepted Jesus Christ as their Lord and Savior. God is always with us and if He is for us, nothing and no one will ever be against us!




Love and trust the Lord; seek His will in your life.



Business 101 (Philippians 2:5-8 )

It was the first week of my first job after completing my residency and fellowship training. As I was settling into the routine of a busy hospital surgical pathologist, I received a call from our pathology group’s business manager.


“Hey, Paul! This is Jake! How is everything going for you?”


“Good…great, really!” He had done an outstanding job at making sure I felt welcome with my new group.


“Awesome! Listen, we need to meet to get those credentialing papers signed for our billing services. Will Friday morning around 10 AM be ok to meet?”


I quickly checked my calendar and replied, “Sure no problem. See you then.”


When Friday morning came, I prepared to head over to his office which was on the other side of our building. To my surprise, he appeared at my doorway just as I getting up to leave.

“Oh! I was just about to go to your office for our meeting!”


He laughed. “Hey, that’s Business 101! Employees always come to see management!


I was amused. Until this moment, I never thought of myself as management, and it would be many years until I was a managing partner, but I appreciated the gesture and overture. I was not accustomed to being served by others. I had always strived to do things on my own, whether in my education, business, or personal life. When it came to spiritual matters, this dogged independence carried over and I was convinced that I could achieve enlightenment and salvation on my own. If I read enough books about religion and philosophy, if I was truly observant about my relationships and surroundings, I could crack the secret to a spiritually fulfilling life. I definitely tried but all it brought me was despair and frustration.


Have this mind among yourselves, which is yours in Christ Jesus, who, though he was in the form of God, did not count equality with God a thing to be grasped, but emptied himself, by taking the form of a servant, being born in the likeness of men. And being found in human form, he humbled himself by becoming obedient to the point of death, even death on a cross.

Philippians 2:5-8 (ESV)


After years of trying to do it myself, I was confronted with the Truth of Jesus Christ. I was trying to reach the infinite with my finite body and existence. The only way this could truly happen was for an omnipotent God to condescend to my finite existence and show me the way to restore a broken relationship with Him. Jesus emptied Himself and put aside His eternal glory when He became a man and was born on this earth. By living a sinless life, completely obedient to God, He showed me that if I confess and repent of my sins and accept Him as my Lord and Savior, I would have salvation and eternal life. This is what it meant to be truly human, to give my life to Jesus Christ.


In the workplace, the employees come to management. This is Business 101.


In life, God came down to earth as a man to live, die on the Cross, and be resurrected. Jesus served me so that I may serve Him.


This is Humanity 101!


Love and trust the Lord; seek His will in your life.