Month: September 2020

“Another one? What is going on?”

“I know!” I texted back. “It’s not just you. All of my dermatology clients are seeing a huge increase in patients with melanoma diagnoses.”

“Wow! Hopefully it means we are all getting better at our diagnostic skills, especially with our dermatoscopes.” 

Ever since most dermatology offices reopened a few months ago, after modifying their office workflow to accommodate the new safety precautions necessitated by the COVID19 pandemic, I have noted a dramatic increase in the number of melanomas I have been diagnosing. At first, I thought it was because of the backlog of patients who were unable to see their dermatologist because of the prioritization of urgent and acutely ill patients and the overall shutdown of most outpatient physician offices. However, when this trend continued even after the initial weeks of reopening, I thought there might be other explanations. This dermatologist with whom I was texting is very adept at using a dermatoscope. This hand-held device magnifies the visual features of moles and many other dermatologic conditions. In the hands of an expert like my colleague, it can be a valuable diagnostic aid to determine which moles are pre-cancerous and need to be biopsied. Her explanation was plausible but her next text caught me off guard.

“And maybe it’s because we are spending more time with our patients!”

Was that a tongue in cheek statement or was she serious? Regardless, how does one respond to such a statement? I gave an emoji thumbs up and reflected upon the exchange. Today’s physicians have many tools to assist them in arriving at an accurate diagnosis. However, the most important remains the one between our ears. Nothing will ever substitute for the time a health care provider spends with their patient and pondering their disease. Additional laboratory or radiological examinations can help to narrow the differential diagnostic possibilities or confirm a diagnostic impression, but it all begins with the precious time spent taking a careful history and performing a thorough physical examination. 

The Bible tells us of many examples of how Jesus Christ took the time to listen to the people who came to Him. One touching exchange involved a rich young ruler. 

Just then someone came up and asked him, “Teacher, what good must I do to have eternal life?” “Why do you ask me about what is good?” he said to him. “There is only one who is good. If you want to enter into life, keep the commandments.” “Which ones?” he asked him. Jesus answered: Do not murder; do not commit adultery; do not steal; do not bear false witness; honor your father and your mother; and love your neighbor as yourself. “I have kept all these,” the young man told him. “What do I still lack?” “If you want to be perfect,” Jesus said to him, “go, sell your belongings and give to the poor, and you will have treasure in heaven. Then come, follow me.” When the young man heard that, he went away grieving, because he had many possessions.

Matthew 19:16-22 (CSB)

Jesus precisely diagnosed the rich young man’s sinful disease of being attached to his worldly possessions. Jesus spent the time with him when presumably all his advisors and servants who relied upon him, simply gave him lip service and agreed with him that he was good enough to merit salvation and eternal life. In spite of these sycophantic answers he was receiving, he knew something was not right and he sought out Jesus Christ. 

Jesus did not tell everyone who came to Him to sell all of their possessions. Each answer He gave was unique, directly addressing their deepest needs. He spent time with and truly listened to this rich young ruler’s plight. He knew what truly ailed him and gave him the honest solution. It is regrettable that the young man, after hearing Jesus, did not take His advice, but left, knowing that he was unwilling to act on His answer.

When we are willing to spend more time with Jesus Christ, He will reveal all the sins that are afflicting our souls and preventing us from living a fulfilled life that He intended for all of us to enjoy. It is up to us to accept His diagnosis and act upon it.

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

A few years ago, we hired a contractor to do some repairs for our home. His balding head was concealed by a cap that allowed his back hair to emerge, a remnant of a mullet that he had displayed in the 80’s as a roadie for several rock bands. Big, brash, and boisterous-he was supremely confident in his abilities. He dictated his preferences to me over how we should do the repairs rather than listening to my opinion. Once he began the job, which only took about ten days, he managed to antagonize the guard at the gate of our development twice and insult the aide to my son. The final straw was when he presented bids from subcontractors to do some additional work. When my neighbor, who was looking at similar repairs for his own house, directly contacted one of the subcontractors to see how much of an upcharge he was applying for his services as a contractor, we were shocked to discover a doubling of the price! 

At the end of the job, I paid him and informed him I would seek my own subcontractors to complete the job. My same neighbor soon texted me. “Would you hire this person again?”

This is a favorite question of employers and human resource managers when checking on the references of prospective job applicants. Without directly commenting upon one’s abilities and work habits, it allows former employers a means to discreetly disclose the truth about how they feel about their former employee or independent contractor. In this case, I tersely replied, “No.”

When one enters into a work relationship, it is with the hope and understanding that the employee or contractor will fulfil their obligations to their employer and it must be performed with a good attitude and minimal drama. Experiences like the one with this former contractor have reminded me that when asked by another to perform a job or task, I do so knowing that I am not only working for the other person, I am working for God. If I fail to do my job well, it hinders my witness as a follower of Jesus Christ. 

After this, he left Athens and went to Corinth, where he found a Jew named Aquila, a native of Pontus, who had recently come from Italy with his wife Priscilla because Claudius had ordered all the Jews to leave Rome. Paul came to them, and since they were of the same occupation, tentmakers by trade, he stayed with them and worked.

Acts 18:1-3 (CSB)

The Apostle Paul had another occupation. In addition to being one of the greatest missionaries of the Gospel of Jesus Christ to the known world of the first century, he also supported himself and others by his occupation as a tentmaker. In this passage from the Book of Acts, Dr. Luke records the meeting of Paul and the couple Aquila and Priscilla, who were also tentmakers and fellow missionaries. The Bible does not record the granular details of his tentmaking work but undoubtedly he faced the same deadline pressures and expectations of any contracted worker to their employer. One wonders if Paul was also thinking about his duties as a tentmaker when he later wrote these words in his letter to the Colossians.

And whatever you do, in word or in deed, do everything in the name of the Lord Jesus, giving thanks to God the Father through him.

Colossians 3:17 (CSB)

If Paul was a poor tentmaker and did not fulfil his obligations to his employers, it probably would have hindered his witness to the greatness of His Lord and Savior, Jesus Christ. Paul had the correct attitude to always work with the intention and goal of doing everything in the Name of Jesus Christ, giving thanks to God. 

I need to do the same with everything I do in my occupation and relationships. 

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

A frozen section gives as close to a real time diagnosis of what is happening in the patient. No other procedure or test in medicine can render such a rapid and definitive diagnosis. The surgeon will take an intraoperative biopsy of the diseased tissue. In some cases, he may be unsure if what he is dealing with is cancerous. In other cases, he may know the diagnosis is cancer but wants to make sure he has completely removed the tumor and submits margins of the surrounding tissue. It is the most demanding task of a surgical pathologist since an entire surgical procedure may hinge upon the diagnosis that is rendered. 

With an experienced surgical pathologist, a definitive diagnosis can usually be rendered within 10 minutes. However, it is also limited by the skill of the surgeon who needs to correctly sample the diseased tissue. If the wrong section is submitted to the surgical pathologist, a diagnosis may be given that is not representative of the patient’s disease. Thus, a successful frozen section requires two physicians-a skilled surgeon and pathologist. There is no surgeon who is able to perform the biopsy, correctly diagnose it under the microscope, and then completely remove the tissue… or is there?

With the precision of a master surgeon and diagnostic expertise of a surgical pathologist, God is able to correctly identify the disease of sin in our lives, completely remove it, and preserve our life, all in the same moment. The Apostle Paul experienced this. As a devout Pharisee, Saul, as he was known then, hunted down Christians as blasphemers and heretics. God had other plans for him. On the road to Damascus, Jesus Christ intervened in Saul’s life and performed the most precision surgery upon him. He removed the sin that blinded him from seeing the truth that Jesus Christ was the Messiah and His resurrected Lord and Savior. God did this while preserving all of Saul’s great knowledge and experience of being a great Jewish leader and scholar. He preserved the passion that Saul had for God while freeing him from the chains of sin. God challenged Saul to allow Him to complete the surgery. 

What are you waiting for? Get up and be baptized. Have your sins washed away by calling on the name of the Lord.

Acts 22:16 (NLT)

Saul, the learned Pharisee, accepted God’s challenge and became the Apostle Paul, the greatest missionary and evangelist for Jesus Christ. His sin of ignorance and blindness to the Truth of Jesus Christ was removed. His zeal and passion for God remained and his prodigious knowledge of the scriptures was preserved. 

What are you waiting for? All you need to do is confess and repent of your sins and call upon Jesus Christ to be your Lord and Savior. He is the Great Physician. Only He is able to correctly identify all the deadly sin in your life, completely remove it, and preserve the best part of your soul.

Amen!

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

I have written several blogs about the Beatles, whom, as most of my readers know, is my favorite pop music group. Even as a young boy, I would devour books about the Beatles and this desire to learn everything about them continues to this day. At work, I listen to a radio station that only plays songs by the Beatles and their later solo careers. In spite of this information deluge I am continually astounded that I am still learning new facts about them. One recent encounter on social media revealed this interesting bit of new information for me.

“Sometimes we’d travel the whole of Liverpool just to hear a chord we didn’t know. We heard about a bloke who knew B7. We knew E and we knew A…but we didn’t know B7, that was kind of the missing part. So we got on a bus and trooped across Liverpool and..found this fellow and he showed us B7.”

Paul McCartney-Source: How Much Music Theory Did The Beatles Know?

It is difficult to imagine a time when the Beatles were at such an embryonic stage of musical development. Their creativity broke new ground with each song and album. As this video suggests, they may have had a limited formal knowledge of music theory. Yet it did not limit their creativity. What they lacked in formal training, they more than made up for by their ability to listen to other musicians, incorporate their ideas, and produce a unique sound, one that still reverberates to this day. 

Music theory and formal training can help to refine musical ideas, but it is simply a tool. The creativity always starts with the artist. What is true for music is also true for God. 

The heavens proclaim the glory of God. The skies display his craftsmanship. Day after day they continue to speak; night after night they make him known. They speak without a sound or word; their voice is never heard. Yet their message has gone throughout the earth,

and their words to all the world….

Psalms 19:1-4 (NLT)

Scientists contend the entire universe arose from a random and spontaneous event, the Big Bang. While there is compelling scientific evidence that this occurred, what no one has ever been able to adequately explain is how this could have occurred? Some state that gravitational forces coalesced to create a singularity but even gravity needs an origin. How can something arise from nothing? It is impossible from a purely scientific analysis. It only makes sense if there is a Creator, One who is separate from the universe and created it. Only God is eternal and only He could have created a universe so finely tuned, that all life, could have arisen from the seemingly random assortment of atoms and molecules. 

As in music, there is formal theory that can explain why certain patterns of notes and chords come together to create a pleasing song, but it does not explain how the creator of the song was able to produce it. There are principles and laws that help us to understand how the universe came into existence. However, the creative energy, the means to speak it into existence, could only begin with God. 

Creativity always starts with the artist. God is the Supreme Artist.

All praise to our Living God, the author of all creativity and Creation. 

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

I could hear the television news commentator over the gurgling din of my coffee maker. An airplane had crashed into one of the towers of the World Trade Center in New York City. I emerged from the kitchen and watched in horror as I saw the second plane crash into the second tower. 

The date was September 11, 2001. 

By the end of the day, I was physically and emotionally spent. Everywhere I turned and with everyone whom I met, it was another reliving of the tragic events of the day. As I sat down to dinner with my family, I turned to my wife and looked at my one year old daughter and sighed, “It’s a new world. I don’t know what her generation will face but it looks really dark right now.”

My daughter’s generation, sometimes referred to as Generation Z, has been shaped by many events including 9/11 and the rise of global terrorism, the integration of social media, and the propagation of social diversity and inclusiveness. Regardless of one’s positions on these issues, it has shaped and continues to shape their outlook and values and influences all generations, including mine. 

Every generation faces new challenges. We are now facing the COVID19 pandemic and worldwide unrest from protests demanding racial equality and justice. For this current generation, parents undoubtedly may have the same fears that I had nineteen years ago. How did I respond after that tragic day? My wife and I prayed and asked God to bring healing and hope to this fallen world. 

Hope deferred makes the heart sick, but a dream fulfilled is a tree of life.

Proverbs 13:12 (NLT)

There is a common theme that links every generation since Adam and Eve, we hope for a better life for our children. No matter how dark the circumstances, we have hope in God. The following verses from the Book of Lamentations are often quoted to uplift and inspire our spirits. However, the poignancy of these verses is that it was written during the midst of one of the darkest moments in the history of the Jews. Jerusalem had been destroyed and its citizens were either killed or taken away in captivity to Babylon. If ever there was a time when the future appeared dark, this was certainly it. How did God’s people respond to this crisis?

The faithful love of the LORD never ends! His mercies never cease. Great is his faithfulness; his mercies begin afresh each morning. I say to myself, “The LORD is my inheritance; therefore, I will hope in him!”

Lamentations 3:22-24 (NLT)

There will always be dark days. When we know that God is in control, every day is a renewing of the world. God restored the Jews to their homeland seventy years later. Only when we place our hope in Him alone, will our dreams of a better life for ourselves and our children become a reality. God’s faithfulness is never ceasing!

Amen!

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

Signs and symptoms. 

In medicine, these are two terms that are often presented together and sometimes used interchangeably. However, there are important distinctions. A symptom is a subjective description disclosed by the patient about how they are feeling. A sign is an objective measurement of the disease. For example, a patient may state they feel hot. This is a symptom. If their temperature is measured and found to be elevated at 103F, this is a sign. While one conclusion may be that the subjective symptom of feeling hot may be related to the objective sign of an elevated temperature, there is an important caveat. 

Simply because a symptom lacks an objective sign does not mean it should be ignored or dismissed. Conversely, an abnormal sign may not necessarily be accompanied with a symptom or the reported symptom may not be related to the objective sign. This is why the health care professional must be careful to gather all of the signs and symptoms when taking a history and performing a physical examination and adroitly synthesize them to create a complete profile of the patient’s disease. 

There is a way that seems right to a man, but its end is the way to death. Even in laughter the heart may ache, and the end of joy may be grief.

Proverbs 14:12-13 (ESV)

This proverb is particularly insightful and illustrative of the disconnect we sometimes experience between our signs and symptoms. We may convince ourselves that everything is fine but we are truly hurting. Our subjective disclosure of the symptoms we are experiencing may not reflect the objective signs of what is truly wrong with us. Only God knows the answer and only He knows whether the signs and symptoms are related to one another. 

Signs and symptoms.

Thanks be to Jesus Christ, the Great Physician, who truly understands the nature of our heart and soul and always provides the correct and precise diagnosis.

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

It was only 645 AM but my workload was already quite heavy. I shuffled through my cases, organizing them by urgency and proceeded to look at the first case under my microscope. Without warning, the light flickered off immediately followed by all of the electronic equipment in my office. Power outage!

Our entire laboratory, like the majority of businesses, is dependent upon electricity. From accessing and creating our diagnostic reports to reviewing the microscope slides with a microscope, nothing can be done without an electric current. I quickly looked outside at the neighboring offices and saw our entire complex was down, but for how long? Within five minutes, power was restored and I breathed a huge sigh of relief. I was able to complete about five additional cases and communicate an urgent malignant diagnosis to one of my physician colleagues when the power failed,,,again! This was NOT good. This time, I sat around checking and answering text messages and emails on my smart phone from my clients for thirty minutes. Several years ago, our power was out for over four hours, completely ruining the workday. I texted my staff who were due to arrive in a few minutes, alerting them of the situation. Fortunately, after forty five minutes, the power was restored for good. 

The most frustrating aspect of a power outage, besides the inability to work, is the complete uncertainty when power will be restored. Receiving an email message from the power company informing us that our power is out is truly not helpful unless an estimated time when it will be restored can also be given. Don’t tell us the bad news we already know unless you are willing to give us the solution!

For everyone has sinned; we all fall short of God’s glorious standard. 

Romans 3:23 (NLT)

If God only gave me the message in Romans 3:23, I would be without hope and completely discouraged. What hope is there for me and all of God’s Creation? It would be like the power company telling me the power is out, leaving me without any hope or means to correct my forlorn state. Thanks be to God that He provides the eternal and final solution in the very next verse!

Yet God, in his grace, freely makes us right in his sight. He did this through Christ Jesus when he freed us from the penalty for our sins.

Romans 3:24 (NLT)

God is very clear that if we are left to our own will and actions, we are lost sinners, eternally separated from God. But God never leaves us in the dark! He took the initiative to send His only Son, Jesus Christ, to die for my sins. Three days later, God resurrected Him from the dead, forever conquering death and proving that all who confess and repent of their sins and place their trust in Him will have eternal life and salvation through faith in His Name!

Only God can guarantee a solution for the power outages of our lives. He sealed the promise with the blood of His only Son. 

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

With soaring vistas over the idyllic coastline, thousands of visitors would flock to its campus to be photographed with this stunning backdrop. The grounds were immaculately manicured gardens, replete with fountains and magnificent artwork. It was not the usual tourist destination. It was a church, nestled in an upper class neighborhood. It was a dream setting for tourists, photographers, and weddings. 

The latter event had become so popular that it is now the entire focus of the activities of the church and the primary source of revenue. What about the mission of the Church as declared by Jesus Christ after He was resurrected and ascended to Heaven? What about baptizing believers who confess and repent of their sins and accept Jesus Christ as their Lord and Savior?

Over the years, the doctrine of this church had drifted into a liberal theology, no longer believing in the inerrancy of the Bible or acknowledging it to be the true Word of God. It declared that Jesus Christ had already returned to earth, not in physical Body but as a spiritual presence. Jesus Christ did not come to redeem us of our sins, but merely to reveal the nature of living a true spiritual life. The final blow was that all people were responsible for their own salvation, depending upon what we chose to love and how we live in this present world. 

But you thought your fame and beauty were your own. So you gave yourself as a prostitute to every man who came along. Your beauty was theirs for the asking. You used the lovely things I gave you to make shrines for idols, where you played the prostitute. Unbelievable! How could such a thing ever happen? You took the very jewels and gold and silver ornaments I had given you and made statues of men and worshiped them. This is adultery against me!

Ezekiel 16:15-17 (NLT)

In this disturbing passage, the Prophet Ezekiel declares a harsh judgment by God upon the people of Jerusalem. God had rescued the Jews from certain destruction from their surrounding enemies and made them one of the most powerful and wealthy kingdoms in the ancient world. In spite of these blessings, they soon denied and forgot these spiritual blessings and, instead of acknowledging God’s grace and mercy, exalted their own abilities as the source of their prosperity. 

Comprising or denying the Word of God strips any church of the privilege of declaring itself Christian. This church, once a source of sound Biblical teaching, had allowed itself to divert all of its energy to promoting its building as an idol for financial gain. The beautiful vistas, the magnificent sanctuary, the expansive gardens-all of the lovely things God gave to this church to glorify Him and His Creation by bringing souls to saving grace and salvation through Jesus Christ, had become a mockery of what it once believed.

I pray for a revival in this church and for all who have taken for granted the blessings that God has bestowed upon them. 

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

One of my favorite childhood stories is “Stone Soup.”

Many cultures have their own versions. If one is not familiar with this story, it depicts the tale of a stranger or a group of strangers who arrive in a village. With no money, they tell the villagers they have a secret recipe to make a delicious soup from a stone they possess and convince the villagers to help them prepare this stone soup. Thanks to the internet, I was recently reintroduced to this story through two clever animated versions. They are presented here with two different conclusions. 

Depending upon one’s point of view and the culture that is sharing this folktale, it can be interpreted as a story illustrating how the generosity of a community can come together to help a stranger or strangers in need or it can be a warning to beware of clever charlatans who can dupe the innocent and naive. 

It is fascinating that the same story can lead to such polarizing interpretations with just a slight shading of the presentation. It is not only with folktales. Throughout history and even to this present day, critics of the Bible and Christianity may reach similar polarizing interpretations about Jesus Christ. 

Then a demon-possessed man, who was blind and couldn’t speak, was brought to Jesus. He healed the man so that he could both speak and see. The crowd was amazed and asked, “Could it be that Jesus is the Son of David, the Messiah?” But when the Pharisees heard about the miracle, they said, “No wonder he can cast out demons. He gets his power from Satan, the prince of demons.”

Matthew 12:22-24 (NLT)

Jesus Christ healed a demon-possessed man. Even his enemies and detractors acknowledged it along with the followers of Jesus. Yet to diminish the miracle and impart a different interpretation, His enemies declared that Jesus performed the miracle by the power of Satan and not by God. These were two groups of people witnessing the same event, yet the interpretations could not be more antithetical. 

Like the folktale of “Stone Soup”, we will always have competing versions of the truth depending upon who is telling the story. The Bible is written by God, the Holy Spirit, who directed men to record the interactions between God and man. God is the source of Truth and He cannot lie because He cannot contradict Himself. 

The folktale of “Stone Soup” may be open to interpretation but God does not leave us this option when we are presented with the claims of His Son, Jesus Christ. He is Lord and Savior; there is no other interpretation or option.

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

Imitators.

In the world of entertainment, we may marvel at how adept some performers are at imitating a celebrity or musician. At times, the imitation is almost perfect and if it were not disclosed, we may be completely fooled by the performance. In the world of medicine, there are also imitators. These are diseases that present with signs and symptoms that mimic and masquerade as other diseases and are dubbed “The Great Imitators.”

For many years, syphilis and tuberculosis were diseases that held this dubious distinction. Many other diseases have been added to this growing list, including lupus, Lyme disease, and a broad variety of cancers. 

Recently, I reviewed a skin biopsy of a patient who was COVID19 positive. The dermatologist who submitted the biopsy for consultation also included clinical photographs of the rash. If I didn’t have any history, the rash looked exactly like a type of drug rash known as SDRIFE (symmetrical drug related intertriginous and flexural exanthema), that has been associated with several well-known medications. However, this patient had not been on any medications that have been associated with this type of rash. The biopsy confirmed what I already suspected from the clinical presentation. I communicated my findings to the dermatologist that if we have completely excluded any possible drug reactions, including over the counter medications, this could be an example of a COVID19 associated SDRIFE. This latter disease has been increasingly reported as one of the many newly described skin manifestations of COVID19 infection. 

Ever since the start of the COVID19 pandemic, I have been closely following the case reports and publications of the numerous manifestations of the disease. What is clear to all health care professionals is COVID19 mimics many other diseases, ranging from influenza to drug reactions to strokes. Indeed, it has become another disease that can be dubbed a great imitator.

Only be carefully analyzing all of the information on the patient, can a correct diagnosis be rendered and separated from other diseases it may mimic. In our spiritual walk with God, we must also be alert to imitators of true Christianity. 

…some ungodly people have wormed their way into your churches, saying that God’s marvelous grace allows us to live immoral lives. The condemnation of such people was recorded long ago, for they have denied our only Master and Lord, Jesus Christ.

Jude 1:4 (NLT)

This verse was written by Jude, the half-brother of our Lord Jesus Christ. He makes an insightful observation since Jude grew up with Jesus but did not recognize nor accept Him as God’s Son until after the Resurrection. If anyone knew who was an imitator of Jesus Christ, it was Jude. He issued this stern warning to his fellow Christians to be alert to imitators who had crept into their churches. Under the guise of scholarly Biblical teaching, their teachings focused upon exalting their own selves and subtly denying the deity and supremacy of Jesus Christ in their own lives. 

This is still happening today. There are some religions and churches that have substituted a watered down and diluted version of Jesus Christ. Instead of teaching how the Bible unerringly shows Jesus Christ is God and our Lord and Savior, they focus upon the blasphemous possibilities that Jesus is one of many sons of God, or he is an exalted angel, or even that He is just one of many great prophets who can offer a pathway to salvation. 

Who is behind these imitations? Satan. He masquerades as an angel of light but everything he does casts darkness and aspersions upon God. He subtly twists the words of the Bible leading to the exaltation of man’s accomplishments rather than acknowledging God’s eternal glory. 

The Great Imitator.

What is true in medicine is even more true in our spiritual relationship with the One True God, Jesus Christ. 

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