There with the Grace of God

This week I will write about the little-g grace of God.  The little ways he blesses our lives.

A year or so ago a speaker at the LDS church's general conference told a story of biking home to work and praying to find a quarter so he could buy himself a piece of chicken.  He wasn't starving, had food in his home, but he had a long, hard day at work and thought a piece of chicken would make him a happier person for his family when he got home.  And just as he got to the chicken store he found a quarter on the side walk and was able to buy himself a piece of fried chicken.

When I heard this story I thought, "What???  That is just weird.  Are we really being encouraged to pray for stuff we don't need just because it will make us happy?"  The more I thought about it over the weeks ahead, the more I began to see the hand of God in my life in small, seemingly insignificant things.

The meeting that got canceled and I was able to make a night out with friends that I thought I would miss.    The parking spot in the convenient garage where I always look but there is never a spot.  Free tickets to a baseball game so I can treat my kids to something fun.  Finding those cool pens I thought I lost.  All green lights when I'm late to pick someone up.
The transmission in my van dying so I had to buy a new van and this one seats 8 passengers just before I was called into the YW presidency and will have to start driving lots of youth to events ... OK, I haven't decided if that is a blessing or just a forced preparation.

Most of the time I call it luck, or karma  or statistical anomalies.  But sometimes, when I look in my heart, I feel the love of God telling me that it was a little blessing to show he loves and cares for me.

There but for the Grace of God

If you are coming to this post to read a story of someone's misfortune that I avoided, and get some schadenfreude,  turn away now.  This isn't that kind of post.

This is about big-G Grace.  I was talking to my friend yesterday, and she commented on how hard it is for people in the LDS church to believe that we are saved by grace.  Focusing on the "after all we can do", they drive themselves crazy with trying to be the best person so they are worthy of salvation.

You will never be worthy of salvation by yourself.  Stop beating yourself up over it.  Because it is only through the Grace of God that you can be saved.  He asks for one thing from us, a broken heart and a contrite spirit.  As I explain to the Primary kids - all you have to do is say you are sorry every time you don't do what you are supposed to and really mean it and God will forgive you.
Christ took your sins upon himself already.  With Christ by your side you are already perfect.  Without Christ by your side you will never be perfect.

Will you continue to sin?  Of course.  Guess what - God knows that already.  You don't get to repent just once, you can repent as much as you need to.  And every time you repent your sins are washed clean.

Heavenly Father loves you.  Romans 8:38-39  Take a big breath, step back to the simple faith of a little child and trust in the Grace of God.

If you want to read a fabulous book about this subject, I highly recommend:

Believing Christ the Parable of the Bicycle and Other Good News by Stephen E Robinson Permalink: http://amzn.com/0875796346

And I'm Back...

It's been a while since I've added to this blog.  Life got busy.  I got serious about our "screen free Sunday" policy in the house.  Which meant no more blogging on Sunday.  Which rule I am now breaking.  Gotta figure out a way to explain to the kids that blogging is OK but not video games.  Maybe I shall call it "public journaling"...

But someone read a post and left a nice comment.  It made me feel good to think that I could maybe uplift someone.  The whole point of this blog is to share my thoughts in case they can be helpful to someone else.
And now I have some more things to share.
On with the blog.

I Told Your Child How Babies Are Made

14 years and I finally had someone who wanted to know.

When I am seeing early adolescents for well child visits I frequently start my discussion about sexuality with the question, "Have your parents told you where babies come from?"  Most laugh a little and say they already know and we move on to deeper discussions of the topic.  Every few months a patient will tell me that they haven't learned about it yet.  So I ask if they want to know.  For the first time I had someone who said yes.

I told the adolescent about the fact that babies are made from genetic material from each parent.  (I used basic medical terminology that I won't repeat here because I don't want this page to get flagged as inappropriate content.)  And then I gave a brief description of the basic way the genetic material from the father gets to the genetic material from the mother.  The patient said, "Oh, that makes sense."  The patient then went on to tell me their erroneous thoughts about what the process entailed - the same things I have heard from other kids whose sole knowledge about the process comes from watching PG13 TV shows.

To the parent, I'm sorry if it upset you.  Though I suspect maybe it is a relief that now you don't have to be the one to have "the talk."  Patient education is one of the things I like about being a primary care doctor.

20 Years

Our 20th wedding anniversary was about a month ago.

Brian will brag to everyone he meets about how we have been married for so long.  Even in the hospital after the surgery he introduce me to every team of doctors who came by and tell them that we had been married for 19 years.  They all nodded with a congratulatory grunt.  One morning a resident on one of the teams was making conversation and asked if there was a secret to getting a marriage to last for 19 years. I said, "You make it work."  The attending stopped them all and said, "Do you here that?"  He reinforced that a good marriage doesn't just happen, it is work and you have to make it work.  I hope the resident's learned something that morning.

Here are the beautiful roses Brian got me for our anniversary, surrounded by the bits of our life.  The Cub Scout rain gutter regatta boat, because that is how I spent the evening of our anniversary.  The thermos from the new school lunchbox, the canning jar for the jam I keep intending to make, the McDonald's bag from the dinner I picked up on the way home from the office.  The books and toys of the day.  The actual trappings of family life after 20 years of marriage.

Thank you, Brian, for 20 years.  Kisses.

Seriously, It Takes Time

I am learning patience.  Still.

11 months since Brian's cancer diagnosis.  10 months since his surgery.  6 months since the end of his radiation treatments.  He has come a long way.  He can walk on the treadmill again and drink liquids.  Haven't used the tube feeds for a long time.  Things are much better than they were, and yet things still seem a long way from where they used to be.

Is this the new normal?  A constant question, how much better will things get?  I feel deep down that he will continue to improve and still has lots of improvement potential.  Yet I realize that he may never be back to the same energy level he was before all this started.   So I continue to take life one day at a time.  People ask, "What are your plans for vacation?" and I just shrug and say, "Depends on how Brian is feeling."  I plan but I am emotionally prepared to change at a moments notice.

I guess that is the gift this whole experience has brought to me.  I am not wed to the future, I am more comfortable in the ebb and flow of here and now.

My Kids Don't Do Activities

http://www.nytimes.com/2011/08/13/your-money/childrens-activities-no-guarantee-of-later-success.html

I am no Tiger Mom.  My kids are all older elementary school age and I have never signed them up for activities.  The oldest did piano lessons for a couple years until my friend stopped teaching due to family needs.  That's right, no soccer, no dance class, no karate.  Nothing.  No weekend games to get in the schedule.  No recitals to sit through.  And now with this article, I feel even better about myself.  Isn't it great to find something which justifies your world view?

My kids are kids.  They play, they bicker, they spend way too much time on electronics.  They scooter and play with kids in the neighborhood.  My theory is that when they get to middle school they can sign up for school sports and extracurriculars.  Until then I'm not going out of my way to sign them up for stuff.  When they are older they can complain to friends about what a bad Mom I am.  For now I want my schedule to be free to do what we want when, not juggling to fit in our needs around some activity they will declare they hate after I spent a couple hundred dollars.

Hey kid, go outside and play!

Eternal Salvation is the Best Revenge

I am so proud of my YCLs from girls camp!

It all started when my YCLs (I was YCL leader this year) did a morning cheer that made fun of the 4th years.  OK, I was not proud of that and I stopped them all on their way to breakfast to tell them there was one way out of this to avoid war with the 4th years - an obsequious apology.  (No, I didn't use the word obsequious with them.)  At the first opportunity they needed to do a cheer or sing a song expressing how wonderful the 4th years are.  Nothing makes your enemy look worse to others than being nice to them.  So they sang a "We love you song" to the 4th years and I thought we were done.

Until  the next night some candy was taken from the YCL cabin.  And the next day when the cabin was TP'd and more candy taken.  (Can I mention that this kind of stuff is strictly forbidden at our girls camp?)  I was worried about what the response would be from my girls.  Would they escalate the war?  Certainly some of them were upset.

At evening flag their response was clear - they did a peppy cheer about themselves and then sang a  verse of "I'm trying to be like Jesus."  I got tearful looking at these 18 girls from all over the stake and thinking how much I love them and how proud I was of their behavior.  In that moment they really turned the other cheek and loved their enemy.

Choosing the higher path and enjoying the blessings of eternal salvation is the best revenge.  Even better, though, is when those despitefully use you choose the higher path and get to enjoy eternal salvation with you.

Why are you REALLY declining the HPV vaccine?

It is not evil to vaccinate your child against a sexually transmitted virus.

The Gardasil vaccine has been on the market in the US for 5 years now.  I suppose as pediatricians we realized up front that some people would have a moral issue with this, not sure the message they are sending to their child.  I am OK with that and happy to talk about it.

Please don't lie to me and tell me that you heard there were terrible side effects so you don't want to immunize your teenager.  There have been great studies recently showing that Gardasil definitely causes a sore arm and some people pass out after they get it (we are talking teen age girls getting shots here).  It is no more harmful than any of the other vaccines which you have already quite willing given your child.

But what message are you giving your child by vaccinating against a sexually transmitted infection?  I get it - you don't want your child to have sex until they are married.  Guess what?  I don't want your child to have sex until she is married either - and I told her that during our visit.  So if you vaccinate your child for an STI are you telling her that you think she might have sex with multiple partners anyway?

Let me tell you what I am likely to tell your child.
I don't think you should have sex until you get married.  A lot of people may try to pressure you to do things, and the choice is yours, but please don't let anyone pressure you into doing something that you don't want to do.  If you choose not to have sex until you get married you protect yourself 100% from getting a sexually transmitted infection before marriage.  However, what if the person you choose to marry did not wait to have sex until marriage?  They could be a wonderful person who repented and is fully worthy - and they could also have HPV.  Better to protect yourself.

That is what you can say to your child too.  Getting the HPV vaccine is not a signal that you think your child will have premarital sex.  It is a way of protecting your child from the potential consequences of someone else's bad choice.

Why I Believe

Don't bother trying to post rebuttal.  This post is an essay, not a conversation.

I am fascinated when I read the comments on articles about the Mormon church.  It quickly becomes a discussion of how Joseph Smith was a fraud, physical proof shows something else, yada yada.  So people should wonder why I, a reasonably intelligent person trained in science, would be a faithful, devoted Mormon.  So here goes.

It is because when I was 17 I didn't know if the Book of Mormon was really true or if the Mormon church was right.  So I got down on my knees and I prayed, as I had done many times before, but this time I received an overwhelming knowledge that it was true.  I knew then, and I know now, because of personal revelation from God to me.  Revelation that God knows who I am, loves me, cares about me and lets me know that the Book of Mormon is true.

For those of you who want to point out the evil actions of Joseph Smith or any other human being, or point out that the Mormon church has changed over time or that scientific evidence refutes Joseph Smith's interpretation of the Book of Abraham or whatever - my testimony is not based on today's scientific evidence or my respect for another human being or consistency of actions.  I believe because I continue to have a personal relationship with my Heavenly Father.  I pray and feel his answer.  So don't be sad if you can't convince me with your words and graphs and expert opinion.  For me there is only one expert opinion that counts, and that is the hand of God in my life.

Zen and the Art of Suck it Up

This one is for all my Gen X peeps.

Brian and I were talking the other day about Buddhist philosophy.  You know, "Desire is the root of all suffering."  And he said, "Can't it all be summed up as Suck it Up?"

Made me think.  So here, for the benefit of my fellow Gen Xers, are the Four Noble Truths of Buddhism translated into a language you can understand:

1.  Life is full of suck.

2.  Your desire for life to not suck just makes you unhappy.

3.  You won't be so unhappy if you stop wanting life to not suck.

4.  Suck it up.



Peace.
ALB

All Good Things

"...every thing which inviteth and enticeth to do good, and to love God, and to serve him, is inspired of God."  Moroni 7:13


We have Buddhist prayer flags hanging from our play set in the backyard.  Multi-colored and bright, they flutter in the breeze, saying their prayers.  Brian hung them up a month ago.  He can see their gentle waving from our bed as he lays there recovering from his cancer treatments.


I am not a Buddhist.  I belong to the Church of Jesus Christ of Latter-day Saints.  I am really very Christian.  Some might look at it and say, "Why would she have a heathen symbol in her yard?"  Or if they knew Brian put it up they may wonder why I didn't complain.  Complaining would be amazingly hypocritical of me, since I am the one who put the Buddha head statue back there several years ago.  Got that one from my Bishop; it was given to him by a good friend who had died but I think he felt a little uncomfortable having it in his yard.


So why do I have Buddhist things in my backyard?  To try to fit in with all my Buddhist neighbors?  (A lot of my neighborhood is Vietnamese.)  Because it is trendy and cool?  No.  Each item has its own reason.  I put the Buddha head there because I admire Buddhist philosophy - it's acceptance of life as it is and the belief one can bring change through changing ones self.  It resonates with my Christian beliefs of doing good because it is the right thing to do.  It resonates with my life experience that the only time I am truly happy is when I accept life is what it is and choose to be at peace with it.


Why did Brian put up the prayer flags?  I don't know, but I think it is a small way of reaching out to God.  As he watches the flags wave I imagine he thinks of prayers being said to God.  And I do believe that any thing which invites you to approach God is a good thing.  It is not the fullness of good, but it is good.


That is why Buddhist pray flags softly sway near a statue of Buddha in the back yard of this Christian house.


ALB

Dear Graduates - You Knew that Already

No surprise to you, all of your plans will not come to fruition.

It is graduation season so I've read a couple articles and speeches that were aimed at high school and college graduates.  One of the themes is, "Life doesn't turn out the way you dream and plan it will, so be prepared for failure and change."  Guess what - you already knew that.

Childhood is the time of biggest struggle for change.  Learning to walk takes a lot of effort and painful failed attempts.  As does learning to ride a bike.  As does learning to get along with other people.  And talk about failed dreams - you can't fly like superman, you won't make a ton of money with a lemonade stand, you can't collect the biggest ball of chewing gum because your mom said no way.  You struggle to balance  the profoundly differing stories about Santa that are told by your parents and by kids on the playground, or ponder the existential motives of a tooth fairy.

You struggle for separation from parents, yet desire their support and nurture.  You long to make an identity for yourself, and then long to re-invent it.

Here is my message to you - grown up life is not that hard compared to negotiating the minefield of childhood and adolescence.  The school room and play ground become the work place.  You turn from child to parent.  Your friends are ... maybe as immature as ever, maybe not.  You come to this place in your life having navigated a myriad of difficult mazes.

You already know that the only constant in life is change.  Keep on keepin' on.

ALB

What Not to Say

http://www.nytimes.com/2011/06/12/fashion/what-to-say-to-someone-whos-sick-this-life.html

This is a great article in the NYT about what not to say, and what to say, to someone who is seriously ill.  And, I would add, to their family members.  The author went through cancer treatment.  His suggestions are spot on.  All the things I want to say to people but feel too polite to say.

I recall a time when I was in the hospital quite ill and in a lot of pain.  Five days into the hospital stay a newly consulted specialist walked into the room and said, "You look miserable."  I wanted to cry and hug her.  That was what I really wanted to hear, an acknowledgement of how I felt.  If you had asked me how I felt I would have said, "I'm hanging in there."  Which I was.  But it was miserable.  I try to remember as a physician that if I can't do anything else, I can always acknowledge a patient's suffering.  "This is such a miserable experience, I am sorry you have to go through this."

Compassion is the best medicine.

Why Good Parents Make Their Children Cry

I heard screams coming from the shower.  When I went to investigate, there stood a child with a large amount of shampoo in her hair, crying that shampoo went in her eyes and now it burned.  I told her the best thing to do, which would make her feel better faster than anything else, is to put her head under the shower and let it rinse all of the shampoo off her head and out of her eyes.  She hates getting water on her face and refused.  I raised my voice - she refused and continued to cry.  I yelled - she refused and continued to cry.  So I took her screaming, wiggling body and shoved it under the running shower until all of the shampoo was out of her hair and off of her face.  As she stood wrapped in her towel after the experience she looked at me with scorn and said, "A good parent wouldn't make her child cry!"


Good parents do things all the time that make their kids cry.  Get them immunized.  Refuse to buy them toys they don't need or can't afford.  Reprimand them for bad choices in their behavior.  A parent's job is to see the big picture and do what is best for the child, even when it causes temporary pain and sorrow in the child.

Our Heavenly Father sees the big picture much better than we do.  I wonder how many times I have stood before him crying out for help and the answer I got was painful and made me cry.  How many times have I figuratively screamed in the shower and refused his gentle advice to put my head in the shower - only to have myself bodily pushed under the falling water.

At those times, when we are sputtering in the midst of hard times and sorrows, and we are tempted to yell at God, "A good parent wouldn't make his children cry!", we need to remember that he sees the big picture.  Bad things things happen because it gives us the chance to learn.  Whether we cry and become bitter, or consider the good that could come of each bad experience is up to us.

God lets bad things happen to us because he loves us.

ALB

My Beautiful State of Denial

Brian has a sore in his mouth.

For anyone else I would say, "Big deal, put some numbing medicine on it, it will go away."
Life after oral cancer, however, is a waiting game.  Will it come back?  If so, where?  Will we recognize it if it comes?  A simple mouth sore is a pit in my stomach.

I have been living in a beautiful world of denial since Brian ended radiation treatments.  The hard part is over, the long road of recovery ahead.  Long, slow, but upward ... positive in direction.  My brain wouldn't even let me consider the possibility of relapse.  It is a peaceful place, this world of denial.  Not easy and not joyful, yet not filled with anxiety.
All it takes to crack the walls of my peaceful world is a little mouth sore.  At his surgical margin.

He already has an appointment scheduled with the surgeon for a follow-up appointment in 4 days.  Will I be able to see in the surgeon's face how worried he is?  Will he try to reassure us, yet walk out of the room with a pit in his stomach and feeling that this will not end well?  Will he take one look and say, "That is completely normal for this stage of healing"?  Whatever his response, he will be blunt.  And my world of denial will have to create new boundaries.

ALB
-----------------------
5/31/11 Update - saw the surgeon today.  He was cautious about the lesion.  Come back in 2 weeks, if it isn't gone by then he will biopsy it.  Seems fair enough.  Back to blissful denial.

6/14/11  Update - saw the surgeon again.  The spot looks better.  No biopsy, follow-up with the other surgeon at our regularly scheduled appointment in 4 weeks.  Back to blissful denial.

I Am a Child of God

Watch the whole thing, don't get overwhelmed if the beginning seems too sweet.  It gets even cuter when the big children appear!

And so are YOU!

ALB

Cooks Anonymous

Hi, my name is Angela and I just figured out how to cook rice at age 40.


Yes, the simple "one cup rice, two cups water, simmer covered for 20 minutes, voila perfectly fluffy rice."  I just gained confidence in doing this.  I have no idea why I have feared cooking rice so long.  Fear of burning or crunchiness maybe.
I could never remember the ratios (I realize how stupid that sounds).  It's like I had rice dyslexia.  I own a rice cooker, but that always produces an overcooked layer on the bottom.  Deliciously crunchy but not what I want on a regular basis.
This is a dumb post ... but I am proud of the fact that I managed to cook a perfect pot of rice without looking up instructions.  I will now slink off in embarrassment.

ALB

Why I Will Not Phone in Antibiotics

Dear Parent on the other end of the phone,


I am so sorry that your child is not feeling well and you are leaving on vacation tomorrow/out of town/can't afford another copayment/sick of coming in to the office.  I realize that having a miserable/feverish child makes your life hard and makes you feel stressed.  I know that you are sure the ear pain/sore throat/pain with peeing must be an ear infection/case of strep/urinary tract infection.  And I know you are very unhappy that I will not phone in a prescription for antibiotics for you.

Unfortunately not ever fever and ear pain is an ear infection - many of these kids have normal looking and functioning ear drums when I examine them in the office.  Most of the sore throats we see do not test positive for strep.  Most of the pain with peeing in young children is not a urinary tract infection.

I will not prescribe an antibiotic "just in case".  This makes your child more likely to have bacteria that are resistant to the antibiotics that we commonly use to treat infections.  And what if your child has a reaction to the medication?  Aside from a bad allergy, getting diarrhea or a yeast infection or a rash is still not a pleasant thing from a medication your child didn't need in the first place.

There is also the possibility that your child really has a bacterial infection and needs an antibiotic - it just isn't the infection you think.  What if that ear pain is a swimmers ear rather than a middle ear infection?  What if the ear pain is caused by a strep throat infection?  What if that pain with urination in your teen is a sexually transmitted infection, not a urinary tract infection?  I can only tell by talking to and examining the child.

I am sorry that your employer has contracted for a high co-payment insurance plan, or your insurance company doesn't cover out-of-area care.  I am happy to speak to you and problem solve, to suggest over the counter medications and other ways to make your child feel better.  I will even advocate for you with your insurance company the best I can.  But I will not phone in antibiotics.

I am used to the anger, the pleading, the threats to file a complaint.  I will try hard to be patient when I talk to you on the phone.  But I will not compromise my standards of giving your child the highest quality medical care I can provide.   If that means I need to examine your child to determine the best course of treatment then I will let you know that.  And I won't back down.

Sincerely,
Dr. Beeler


ALB

It takes time...

You know how I wrote that post about how the body heals itself?  And how miserable the radiation treatment's were?  Well, the treatments are all done for 2 months and the recovery is happening.  S-l-o-w-l-y.  He is talking well (I think).  Able to drink some by mouth and swallow medications rather than having to use the PEG tube for everything.  Walking without pain or walker.

As a physician I knew that progressive illnesses take a decline-plateau-decline-plateau pattern as they worsen.  I hadn't considered that healing takes the same pattern but in reverse: improve-plateau-improve-plateau.  But that is what is happening.  The improvement is great.  The plateau is freaky because it makes you wonder, "Is this it?  Is this as good as it gets??"

Statistics I have read say that only half of people feel back to normal 6 months after they end radiation and chemo.  This is reassuring since Brian is only 2 months out from treatment.  We will continue to watch and see how long the healing takes.

ALB