Month: September 2020

All laboratories that perform diagnostic blood work analysis must be licensed and certified by a professional organization that meets the federal standards for accreditation. At least once a year, these organizations will send check samples to the laboratories as part of the maintenance of requirements for quality assurance and control. The most common check samples are blood and urine samples that may be completely normal or have an abnormal level of a metabolite or blood chemistry. These samples are run on the same analyzers that the laboratory regularly uses to test all patient samples. Once a diagnosis is rendered, the result is submitted to the accrediting organization and graded for accuracy. If a laboratory fails to correctly diagnose the check sample, it may face disciplinary action or even lose their accreditation. 

The caveat is the check samples are unknown to the bench technologists who usually perform the testings. Only the section supervisors or the laboratory director knows which samples are the unknowns. The samples are given a random patient’s name and demographic information and run through the analyzers as routine specimens. In this manner, a check sample should be treated as all other patient samples, presumably with the same careful attention that all specimens would receive and not be given preferential treatment if it was known it was a check sample test. The system works very well and check samples are considered a real world test of a laboratory’s quality and expertise. 

If only our relationships reflected this same egalitarian approach. We should not treat anyone we meet or interact differently than anyone else. Yet we do, particularly with those whom we already know or is a known acquaintance of one of our friends or family. The challenge is when we meet complete strangers or are in circumstances that are unfamiliar to our sensibilities. We are cautious, sometimes even suspicious and it may be reflected in our behavior. Perhaps we would behave differently if we pondered the following Bible verse. 

Keep on loving each other as brothers and sisters. Don’t forget to show hospitality to strangers, for some who have done this have entertained angels without realizing it!

Hebrews 13:1-2 (NLT)

Angels are God’s messengers. They are created beings who serve God. There are numerous events recorded in the Bible when God sent angels to intervene in the lives of people or announce extraordinary events, such as the birth of Jesus Christ. There may be controversy over the role that angels play in the events of our lives but there is no question that they do walk amongst us. Wouldn’t it be thrilling to know that we have entertained an angel by showing hospitality to a stranger? If we knew they were angels, would we treat them differently? Like the check samples, God does not reveal the identity of the angels who come to us as strangers, asking us to treat all with the same grace and mercy that He shows to us. 

Of course, we are to always exercise good judgment when meeting any stranger. Yet, it is comforting and encouraging to know that God does give us opportunities to serve angels. Mother Teresa of Calcutta movingly embodied this Bible verse with her life of devotion and service to the poor and forgotten. Not only did she treat all strangers as angels, she saw everyone as an embodiment of her Lord and Savior. “I see Jesus in every human being. I say to myself, ‘This is hungry Jesus, I must feed him. This is sick Jesus. This one has leprosy or gangrene; I must wash him and tend to him.’ I serve because I love Jesus.”

Check sample.

Perhaps God is sending a check sample in the form of a stranger to test you. Will you pass the test and care for the stranger in the same manner if you knew it was an angel sent by God?

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

A retrospective analysis occurs when we look backwards and review and analyze the variables or conditions that may have led to the outcome or result. This is frequently done in medicine and in my practice of dermatopathology. For example, after reading a new medical article that makes an astute and novel observation about some disease, I often go back through my study case files and examine cases of that disease, searching for the new observations that were described in the article. In the majority of cases, I am pleased to discover the article does indeed describe a previously overlooked detail and I am continually dumbfounded why I never made the previous observation. 

What is true in medicine is even more true for my spiritual life. When I am going through a difficult period, I am sometimes unable to see God’s Hand and His providence guiding and directing the situation. How can the loss of my mother through a painful bout of cancer be something I can rejoice over? How can a worldwide pandemic with the loss of countless lives and jobs be meaningful? So many questions and no immediate solutions. Am I willing to do a retrospective analysis and allow God to show me His purpose and plans?

We can rejoice, too, when we run into problems and trials, for we know that they help us develop endurance. And endurance develops strength of character, and character strengthens our confident hope of salvation. And this hope will not lead to disappointment. For we know how dearly God loves us, because he has given us the Holy Spirit to fill our hearts with his love.

Romans 5:3-5 (NLT)

I don’t like encountering problems or trials but I can accept them when I realize that God is helping me to develop endurance, leading to complete assurance of my salvation in Jesus Christ as my Lord and Savior. I am unable to rejoice in the moment. Only upon retrospective analysis will I be able to see that God was using the situation to bring me into a deeper understanding of Himself. I overlooked a fine detail that God was using to sharpen my faith. When I look in the rear view mirror of God’s actions in my life, I can confidently look forward to God’s guidance in every problem I encounter. 

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

Every other television commercial seemed to be heralding the new style.  It was the late 1960’s and long hair was in! Groovy! And it wasn’t only for the teenagers, even middle aged men could be cool, and my father would not be left behind. My father sported a crew cut since he was a child. Grandma, his mother, was a barber and for many years, she cut our hair. However, now she was retired and my father needed to find a new barber. But the times, they are a changin’, and with his desire for long hair, he was convinced he needed to go to a hair stylist, not a simple barber. The result was unexpected.

Every evening, my father would place a woman’s stocking over his scalp and face. He looked like a bank robber as we all laughed and teased him. Nonplussed, my father declared, “The hair needs to be trained!” I do not know how many contemporary hair stylists would insist on doing something like this but my father was determined to follow the instructions he was given. After all, the advice came at an expensive stylist’s price, rather than a simple barber’s advice. Imagine my surprise when a month later, he came home, his head completely shorn to a crew cut once again. 

“What happened, Dad? I thought you were going to have long hair?”

My father shook his head. “I wasn’t happy with how it was growing and I saw a new hair stylist who told me I was doing it incorrectly. So I have to start all over again!” My father’s initial attempt at growing his long hair did not discourage him. He eventually sported a longer mane which also made it easier for me to adopt a longer hair style.

When we attempt to assimilate or adopt a new trend or idea, our initial attempts may be unsuccessful. From learning the newest politically correct verbiage or joining the newest social media craze, initial attempts may be awkward and fraught with do-overs. My spiritual life is no different. Forty years ago, I struggled to assimilate a new vocabulary of Christian words and theology as I took my first halting steps as a new Christian believer. Fellowship. Quiet time. Devotions. Today is no different. The world is rapidly changing and I still struggle to adapt. Long hair and short hair are black and white. Today’s choices are shades of gray. How do I understand and assimilate transgender individuals and alternative lifestyles into the Church? How do I reconcile the latest advances in genetic engineering, literally redefining the definition of life, with what the Bible teaches? 

The answer is by my own efforts, it is impossible. It is only by seeking God’s guidance through His Word and prayer will I be able to find the correct pathway. I have already made many mistakes, stumbling over my own preconceived notions and seeking advice from others who may not have been qualified to give a godly answer. 

This hope is a strong and trustworthy anchor for our souls…

Hebrews 6:19 (NLT)

The times, they are a changin’.

Indeed. Praise God that He is the eternal, unchanging, and permanent Creator of this world that is passing away. He is the only anchor for our souls. 

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

The smiling face of a young girl munching on a hairy spider elicited howls from my office staff. I recently brought two books to my office illustrating a wide variety of bugs and insects that different cultures around the world routinely eat. Both books were replete with recipes for the more adventurous. During my travels, I have frequently encountered markets and restaurants that featured various insect dishes. Although I was unwilling to try them, it was very clear that the insects were nothing out of the ordinary for the native people and in many instances, were a rare treat and delicacy. They were more amused or confused by how I, and other Westerners, viewed the insects with a combination of fascination and repulsion.

When one encounters different cultures, our inherent prejudices may hinder our willingness to engage and embrace their customs. The converse is equally true and undoubtedly many American and Western customs may appear odd or even offensive to other cultures. 

Critics of the Bible and Christianity aver that it is based upon traditions of Western cultures and therefore not applicable to all nations and cultures of the world. When the Roman empire, under Emperor Constantine, officially recognized Christianity as the state religion in the fourth century A.D., Christianity spread throughout the world. Thus, while it may appear that Christianity is a Western religion, it began as a religion in the Middle East. It is heavily steeped in the traditions of the ancient world of that time, familiar not only to Israel but also the ancient empires of Babylon, Egypt, Syria and Greece. How did Christianity expand beyond its origins and become embraced by the entire world?

Peter began to speak: “Now I truly understand that God doesn’t show favoritism, but in every nation the person who fears him and does what is right is acceptable to him. He sent the message to the Israelites, proclaiming the good news of peace through Jesus Christ—he is Lord of all.”

Acts 10:34-36 (CSB)

If the first Christians were prejudiced against other cultures and groups of people, the Gospel of Jesus Christ would never have spread beyond Jerusalem. God, the Holy Spirit, intervened and dramatically showed the Apostle Peter that the Good News of Jesus Christ was for every nation and every person who fears God and desires to place their faith in Him.

Whether it is eating bugs or different foods, wearing unfamiliar clothes, or expressing emotions and affections in an unexpected manner, we are all created by God and are His children. We must learn to embrace our differences and seek to find unity and harmony that unites our souls through the grace and mercy of our Lord Jesus Christ. 

Amen!

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

The two teens were locked in a grueling wrestling match, copious drops of sweat pouring from both of their brows. It was the state championship and these two gladiators had outlasted all other athletes. The match was tied and it came down to these final minutes. As each awaited the referee to begin their last period, the wrestling coach for one of the players yelled out.

“There is no prize for second place!”

Some scattered boos and hisses were heard and several audience members dismissively shook their heads. A few seconds later, there was a quick takedown and the match ended. The player whose coach yelled the inflammatory remark held up his trophy while his defeated opponent slunked off. 

There is some truth to this statement but it is entirely dependent upon the activity. For example, in golf, one measure of accomplishment is the winning of one of the four major golf tournaments (The Masters, U.S. Open, the British Open, and the P.G.A. Championship). Jack Nicklaus, still acknowledged as one of the greatest golfers who ever played, holds the record of most wins in the majors with 18. These are very impressive numbers but do not reveal the true greatness of Nicklaus who also came in second an even more amazing 19 times in these same majors. If the eventual winner faltered for just a stroke or two, Nicklaus may have won 37 majors!

Second place. 

The world may sneer at someone who comes in second but it does not mean failure. In fact as Jack Nicklaus demonstrated, a second place finish may encourage a greater performance that leads to success. In God’s Kingdom, He turns our understanding of this in a most unexpected manner. 

John the Baptist was the first prophet that God sent to speak to the people of Israel in nearly four hundred years. As one might imagine, there was tremendous excitement surrounding his appearance. In fact, many thought he was the Messiah. John was adamant to tell all who came to hear him and be baptized that he was not the Messiah but was sent by God to prepare the hearts of the people to receive the true Messiah, Jesus Christ. When Jesus Christ began His ministry, even some of John’s disciples left him to join Jesus. He boldly declared the following statement to his remaining disciples who were perturbed by the sudden change of events. 

He must become greater and greater, and I must become less and less.

John 3:30 (NLT)

John had no problem placing himself second to His Lord and Savior. This was his God-given task, to lead as many souls to confess and repent of their sins and accept Jesus Christ as their Lord and Savior. John’s selfless actions were a direct result in trusting in God’s promises for a better life, even if meant that his own life would be cut short by execution for his obedience to preach the Truth. 

The world may give all of their accolades to the competitor who comes in first. In God’s Kingdom, our expectations are reversed and he who is first may be last and the last may become first. 

Amen!

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

Jake was two years younger than I was. We attended the same high school in Hawaii and years later, I learned that he also became a physician and recently completed his pathology residency. Like myself, he pursued further subspeciality training in dermatopathology. I reconnected with him while he was doing his fellowship training. 

As we bantered about our shared experiences, he abruptly went off topic and pointed to his neck. “This lymph node has been growing over the past few months.” He began massaging the area with his finger. “Wouldn’t it be funny if this turned out to be a cancer?”

“Dude! Don’t even joke about that!” 

He chuckled. “I know, it’s probably just an infection.”  A month later, I found out through a mutual friend that a lymph node biopsy revealed a lymphoma, a cancer of the white blood cells. Although some lymphomas are completely curable, this one was a rare aggressive type. Within two years, in spite of multiple rounds of chemotherapy and additional treatments, he passed away from his disease. He left behind a young wife and child. 

I was in my early thirties and this was the first time that I experienced the passing of a friend, who was nearly the same age. I was at the beginning of my career, feeling invulnerable, confident in my abilities and my newly minted credentials and certifications as a surgical pathologist and dermatopathologist. Single and with no family, I only focused upon myself and my career. I had pushed God aside, exalting my abilities rather than recognizing that it was only through His grace and mercy that I was able to live and accomplish anything in my life. The tragic passing of my friend shook me to my core. My friend could be me. My priorities were awry and misguided. God was giving me an opportunity to return to Him. 

Our lives last seventy years or, if we are strong, eighty years. Even the best of them are struggle and sorrow; indeed, they pass quickly and we fly away.

Psalms 90:10 (CSB)

It is prescient that although this verse in the Book of Psalms was written thousands of years ago, when the average life span was about 35 years of age, God looked ahead to the current times and recorded this remarkable statement when the average life of male in North America ranges from 76-80 years! How true that these years pass quickly and are often filled with struggles and sorrows, but it is because of a solemn purpose, ordained by God. 

Teach us to number our days carefully so that we may develop wisdom in our hearts.

Psalms 90:12 (CSB)

God, through His grace and mercy, reminded me of the brevity of life many years ago. Now, nearly thirty years later, I feel very vulnerable. I have a family and I feel the aches and pains of a body that is no longer as nimble or flexible as it once was. He continues to remind me to cherish each day I am alive so that I can gain wisdom through faith in His Son, Jesus Christ. 

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

“The University is requesting the melanoma case you read out yesterday!”

It was a request for a second opinion originating from the patient’s surgeon. My staff retrieved the patient’s slide with a copy of my diagnostic report and mailed it to the university. A week later, our office received a fax of the university dermatopathologist’s diagnosis. Thankfully, he agreed and concurred with my diagnosis. The patient could now undergo his definitive treatment; both he and his treating physician were confident of the diagnosis I rendered. However, this is not always the case. Occasionally there is a slight disagreement between my diagnosis and the other consulting dermatopathologist. Usually there are no serious medical consequences and the treatment is the same. The converse is also true. I am often consulted by other laboratories, dermatologists, and dermatopathologists to render an expert opinion and while I am usually in agreement, there are also occasions when there is a minor disagreement. 

Several well designed studies have investigated this issue. Even amongst expert pathologists, there may be a wide range diagnostic concordance with melanomas and atypical moles. Perhaps even more disturbing is when the same case was blindly given to the same pathologist, their own diagnostic concordance sometimes differed by as much as 10%, depending upon the type of cancer and the complexity of the diagnosis. Breast cancers, prostate cancers, cervical cancers-all of these different cancers have their own ranges of diagnostic concordance. 

It is not only pathologists who fall victim to this lack of diagnostic concordance. Radiologists, psychiatrists, internists-every medical specialty exhibits a degree of lack of diagnostic concordance amongst its everyday practitioners and experts. If even the experts in medicine cannot uniformly and completely agree upon a diagnosis, how can a patient have confidence in their diagnosis? This is why second and even third opinions rendered by reputable institutions and experts are always recommended for patients to seek out before receiving definitive treatment. 

When God renders a diagnosis on my life and reveals a truth, am I willing to accept it without question? Sadly, I sometimes wonder if God is correct. Do I need another opinion? Perhaps God would change His mind if He reviewed my circumstances once again? Is God consistent with His own decisions or is He fallible like the medical experts who cannot be internally consistent with their own decisions?

God is not a man, so he does not lie. He is not human, so he does not change his mind. Has he ever spoken and failed to act? Has he ever promised and not carried it through?

Numbers 23:19 (NLT)

In medicine and in life, we may seek different opinions to help us make a decision. In the back of our minds, however, we may wonder if the opinion that is given can be trusted. Thanks be to God that we can always be confident that His decisions are the correct ones. He is not like us and susceptible to changing His mind. He is eternally consistent with all of His decisions regarding my life and for everyone who has ever existed. 

When I allow God to take control of my life, I can have complete assurance that my life is in complete accordance with His divine guidance. 

Amen!

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

The chess board displayed the hand painted cast pewter pieces, replicating famous Disney characters. I inherited it from my father and it now sat on a coffee table in our master bedroom. It was a conversation piece and only rarely saw an actual match. The other day, my daughter was admiring the pieces and laughed. “Someday I will inherit this…and I don’t even know how to play chess!”

“Really? I’m not good, but I’ll teach you!” 

“Is it difficult?”

I picked up a knight and nodded. “Understanding how each piece moves is not difficult. It is all about strategy. The objective is to trap the opponent’s King.” I moved some of my pieces around her King. “You see, your King has no where to go. If it takes this pawn, the knight could kill him. You have to be able to visualize the next three or four moves, anticipating how your opponent is attempting to trap you.”

As I was explaining the game to my daughter, I realized why I was not good at chess. I was unable to look far enough ahead, anticipating my opponent’s next move and strategy. I can identify the moves but I cannot synthesize it into a strategy that allows me to succeed. 

During this COVID19 pandemic, I have witnessed God moving different pieces of my spiritual life. I am mentoring several young men who have just completed college and in their gap years, preparing for medical school. I have made contact with the leaders of my daughter’s college Christian church and fellowship group, one of whom is a physician. My volunteer consultation teledermatology and teledermatopathology practices with hospitals and physicians in Cameroon has tripled in volume over the past few months. I don’t know what plans God has for any or all of these seemingly disparate activities but I know He is in control. He is moving the different pieces of my life into positions that only He knows the outcome.

Many are the plans in the mind of a man, but it is the purpose of the LORD that will stand.

Proverbs 19:21 (ESV)

Like playing chess, I am limited in my ability to plan ahead. Thanks be to God that He is my King and He weaves the disparate activities in my life into a grand and beautiful strategy, all designed to bring glory to my Lord and Savior, Jesus Christ.

Amen!

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

When I first began my career as a surgical pathologist, I joined a large prestigious group in Southern California. One of the senior partners was the medical director for the hospital laboratory to where I was assigned. In addition to his prodigious knowledge of surgical pathology and hematopathology, he was an expert in computers and networking. Frankly, he knew more than the IT experts in our hospital! He was a Jack of All Trades, a modern Renaissance man!

The curse and blessing of being a Renaissance man is everyone wants or needs your help, no matter how trivial the task. His plate was already overflowing with the responsibilities of a medical director. Yet, nearly everyday, I witnessed hospital employees and physicians unexpectedly drop in his office, asking his advice from tweaking their upcoming computer presentation to getting rid of a computer virus affecting their laptop computers. My partner was one who could never refuse a request, even if it meant sacrificing his own personal time. 

I was also guilty of asking him for assistance with computer issues as well. Cautiously I would approach his office and make sure he was not in the middle of an urgent issue. Whatever my request, his response was always amiable but at times, a fleeting weary look briefly appeared, as he agreed to take on yet another task. I was always grateful for his assistance and did not want to take advantage of our relationship. He had far more important things to deal with, like running the laboratory and caring for his patients. 

Don’t worry about anything, but in everything, through prayer and petition with thanksgiving, present your requests to God. And the peace of God, which surpasses all understanding, will guard your hearts and minds in Christ Jesus.

Philippians 4:6-7 (CSB)

Whenever I am confronted with a trivial problem in my life, I am hesitant to turn to others because I don’t want to abuse the privilege or waste their time. Unfortunately, this reticence has carried over into my spiritual relationship with my Lord and Savior, Jesus Christ. My knee jerk reaction to many problems is to say to myself, “I don’t want to bother God! He has more important things to do, like running the universe!”

Yet, this is exactly what God asks me to do. In EVERYTHING, through prayer and petition WITH thanksgiving, present your requests to God. When I do, I do not have to worry that I am distracting God with my requests, no matter how trivial they seem to me. He proves this by answering my requests and giving me complete peace with His answers through faith and belief in His Son, Jesus Christ. 

Praise God!

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

The letter was sent to me by my health insurance provider reminding me that I was due for a colonoscopy. I couldn’t recall when my last screening was but I knew it had been at least several years. I called my gastroenterologist to schedule an appointment. After giving the receptionist my name, his response surprised me. 

“Sir, according to our records, you are not due for another two more years. Your last colonoscopy was in 2012 and your doctor cleared you for ten years.”

I was confused. “Then why did I get this letter from my health insurance?”

“Sometimes their record keeping is not up to date. We will notify them of the proper date.”

“Darn! And I was soooo looking forward to doing that lovely bowel prep!”

“Ha! I am sure you are disappointed, Doctor!”

I had to praise the office’s medical records system. “That is an impressive EMR (electronic medical record) you have! It can put in reminders for an appointment scheduled for ten years later. So, I can be confident that you will notify me in two years, correct?”

“See you in 2022!” He laughed. 

It was interesting to see two professional organizations, so dependent upon the precision of their information systems, be so discongruent on a very important future date. I rely upon both organizations for the accuracy of their medical records and although I verified the gastroenterologist’s office was correct about my future appointment, I wondered if their system was as good as they claimed, given the snafu by my insurance company. If only our lives ran with the precise efficiency and perfect timing that God ordains for his people!

This entire land will become a desolate wasteland. Israel and her neighboring lands will serve the king of Babylon for seventy years. “Then, after the seventy years of captivity are over, I will punish the king of Babylon and his people for their sins,” says the LORD. “I will make the country of the Babylonians a wasteland forever.”

Jeremiah 25:11-12 (NLT)

In this passage above, the Prophet Jeremiah proclaims God’s judgment upon Israel for their hundreds of years of disobedience by sending them into captivity and exile in Babylon. Their exile was decreed by God to last seventy years. Jeremiah issued this prophecy about twenty years before it occurred. 

During the first year of his reign, I, Daniel, learned from reading the word of the LORD, as revealed to Jeremiah the prophet, that Jerusalem must lie desolate for seventy years.

Daniel 9:2 (NLT)

Nearly seventy years later, the Prophet Daniel, living in exile in Babylon, read Jeremiah’s prophecy and learned that the Israelites would be allowed to return home after seventy years of exile. To Daniel who lived his entire life in exile, it must have seemed impossible. Yet, God, who cannot lie, fulfilled His promise in a most unexpected way. He changed the heart of Cyrus, the reigning Babylonian king, to allow the Israelites to return to their homeland. The Prophet Ezra records the amazing transformation of Cyrus. 

In the first year of King Cyrus of Persia, the LORD fulfilled the prophecy he had given through Jeremiah. He stirred the heart of Cyrus to put this proclamation in writing and to send it throughout his kingdom: “This is what King Cyrus of Persia says: “The LORD, the God of heaven, has given me all the kingdoms of the earth. He has appointed me to build him a Temple at Jerusalem, which is in Judah. Any of you who are his people may go to Jerusalem in Judah to rebuild this Temple of the LORD, the God of Israel, who lives in Jerusalem. And may your God be with you!”

Ezra 1:1-3 (NLT)

See you in seventy years!

A prophecy made through God’s prophets and His promise fulfilled exactly seventy years later! No faulty record keeping or discongruent information between three different prophets of God, who never met or directly communicated with one another. God directed the events of the world to keep His promise. It is a magnificent reminder that God is very precise in keeping His appointments with His people! 

He wants to do the same for your life. Will you trust an omnipotent, omniscient and omnipresent God to keep His appointment with you? Will you allow Him to tell you about His Son, Jesus Christ? Will you accept His appointment for salvation and eternal life?

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