Please enjoy my short audio about my “trial” and what it has taught me about thankfulness.  And as always please leave a comment!

A PROGRAM OF ANTICIPATORY GUIDANCE FOR THE PREVENTION OF EMERGENCY DEPARTMENT VISITS FOR EAR PAIN

McWilliams, D.B., et al, Arch Ped Adol Med 162(2):151, February 2008

Let me know what you think.

Tozer proceeds to share another of our burdens: Pretense.

“Then also he will get deliverance from the burden of pretense. By this I mean not hypocrisy, but the common human desire to put the best foot forward and hide from the world our real inward poverty. For sin has played many evil tricks upon us, and one has been the infusing into us a false sense of shame. There is hardly a man or woman who dares to be just what he or she is without doctoring up the impression. The fear of being found out gnaws like rodents within their hearts. The man of culture is haunted by the fear that he will some day come upon a man more cultured than himself. The learned man fears to meet a man more learned than he. The rich man sweats under the fear that his clothes or his car or his house will sometime be made to look cheap by comparison with those of another rich man. So-called `society’ runs by a motivation not higher than this, and the poorer classes on their level are little better.”

Tozer then points the solution to our pretense.  The way of the child.

“Let no one smile this off. These burdens are real, and little by little they kill the victims of this evil and unnatural way of life. And the psychology created by years of this kind of thing makes true meekness seem as unreal as a dream, as aloof as a star. To all the victims of the gnawing disease Jesus says, `Ye must become as little children.’ For little children do not compare; they receive direct enjoyment from what they have without relating it to something else or someone else. Only as they get older and sin begins to stir within their hearts do jealousy and envy appear. Then they are unable to enjoy what they have if someone else has something larger or better. At that early age does the galling burden come down upon their tender souls, and it never leaves them till Jesus sets them free.”

The first burden that A.W. Tozer discusses in Chapter 9 of The Pursuit of God is PRIDE.

“Let us examine our burden. It is altogether an interior one. It attacks the heart and the mind and reaches the body only from within. First, there is the burden of pride. The labor of self-love is a heavy one indeed. Think for yourself whether much of your sorrow has not arisen from someone speaking slightingly of you. As long as you set yourself up as a little god to which you must be loyal there will be those who will delight to offer affront to your idol. How then can you hope to have inward peace? The heart’s fierce effort to protect itself from every slight, to shield its touchy honor from the bad opinion of friend and enemy, will never let the mind have rest. Continue this fight through the years and the burden will become intolerable. Yet the sons of earth are carrying this burden continually, challenging every word spoken against them, cringing under every criticism, smarting under each fancied slight, tossing sleepless if another is preferred before them.”

Tozer proceeds to point out the link between Jesus wisdom in Matthew 5:5 regarding the meek, and His ability to lighten our burdens (Matthew 11:28-30)

“Such a burden as this is not necessary to bear. Jesus calls us to His rest, and meekness is His method. The meek man cares not at all who is greater than he, for he has long ago decided that the esteem of the world is not worth the effort. He develops toward himself a kindly sense of humor and learns to say, `Oh, so you have been overlooked? They have placed someone else before you? They have whispered that you are pretty small stuff after all? And now you feel hurt because the world is saying about you the very things you have been saying about yourself? Only yesterday you were telling God that you were nothing, a mere worm of the dust. Where is your consistency? Come on, humble yourself, and cease to care what men think.’

The meek man is not a human mouse afflicted with a sense of his own inferiority. Rather he may be in his moral life as bold as a lion and as strong as Samson; but he has stopped being fooled about himself. He has accepted God’s estimate of his own life. He knows he is as weak and helpless as God has declared him to be, but paradoxically, he knows at the same time that he is in the sight of God of more importance than angels. In himself, nothing; in God, everything. That is his motto…As he walks on in meekness he will be happy to let God defend him. The old struggle to defend himself is over. He has found the peace which meekness brings.”

Sally Beth Roe, a character in Piercing the Darkness by Frank Peretti, becomes a Christian, but Peretti provides us with a glimpse of what is occurring in heaven during the very moment that Sally Roe becomes a Christian.  It is a remarkable moment of angels celebrating and the lamb of God embracing her.  We have NO idea.

“Above, as if another sun had just risen, the darkness opened, and pure, white rays broke through the treetops, flooding Sally Beth Roe with a heavenly light, shining through to her heart, her innermost spirit, obscuring her form with a blinding fire of holiness.  Slowly, without sensation, without sound, she settled forward, her face to the ground, her spirit awash with the presence of God…All around her, like spokes of a wondrous wheel, like beams of light emanating from a sun, angelic blades lay flat upon the ground, their tips turned toward her, their handles extending outward, held in the strong fists of hundreds of noble warriors who knelt in perfect, concentric circles of glory, light, and worship, their heads to the ground, their wings stretching skyward like a flourishing, animated garden of flames.  They were silent, their hearts filled with holy dread…As in countless times past, in countless places, with marvelous, inscrutable wonder, the Lamb of God stood among them, the Word of God, and more:  the final Word, the end of all discussion and challenge, the Creator and the Truth that holds all creation together–most wondrous of all, and most inscrutable of all, the Savior, a title the angels would always behold and marvel about, but which only mankind could know and understand.  He had come to be the Savior of this woman.  He knew her by name; and speaking her name, He touched her.  And her sins were gone…”-pg 321, Piercing the Darkness by Peretti

Edwin Abbot in his book Flatland shares with us, through parable, mathematics, and physics, the very real possibility of dimensions and realities so very close to us, but we remain unaware of them.  What if string theory is true?  What if there are dimensions just beyond our reach?  What if God and the heavenly realm is all around us, surrounding us, embracing us?

What would it be like to get a glimpse into heaven uninhibited, over joyed, overwhelmed in celebration?  Here is a brief video of a wedding that brought laughter and joy to my heart as I imagined….dancing and rejoicing in heaven over US!

METHODS: These Israeli authors evaluated the influence of bias introduced in a patient history on physicians’ perceptions regarding clinical findings and actual management. Healthy actors visited 32 clinicians (30 trained outside the U.S.), reporting a history consistent with viral infection (headache, fever, cough and runny nose for two days with throat discomfort and hoarseness on the day of the visit) or bacterial infection (sore throat for one day with headache and fever with malodor of the mouth but without cough or nasal discharge). None of the actors had physical findings consistent with illness, as confirmed on pre-visit evaluations and photography.

RESULTS: The experience level of the participating physicians ranged from 5 to 32 years (mean, 19 years), and 13 of the physicians were board-certified in family medicine. The physicians recorded slight, moderate or severe pharyngeal erythema for 41%, 34% and 6% of the actors presenting the viral script, and for 22%, 31% and 22%, respectively, of those presenting the bacterial script. An exudate was recorded for 6% and 25% of the actors presenting the viral and bacterial scripts, respectively, and lymphadenopathy was recorded for 16% and 26%, respectively. Throat culture was done for 47% of the actors presenting the script consistent with viral illness, and for 73% of those presenting the bacterial illness script, and antibiotics were prescribed for 21% and 79%, respectively.

CONCLUSIONS: These findings demonstrate that physicians often “find” physical findings consistent with what they expect to find, based on a patient’s history, and that this appears to be true regardless of the level of physician experience.

• The 10 commandments are for our benefit.  God wants us to know as Christians the path that will benefit us.
• Coveting leads to jealousy which is a painful dead end
• Life is unfair sometimes
• Be grateful for what you have
• YOU are enough!

“I heard a guttural scream,” Rich says, “and a man was handing me his lifeless son.”

“How old?” I ask.

“Nine months. We worked on him for over an hour.”

Rich moves his chair, coughs. It’s freezing in the conference room. [Note: For privacy, nurses are mentioned only by first name.] The muffled din of the emergency room is audible through closed metal doors. It’s 7 a.m., and Rich’s 12-hour shift has just ended. “I flashed to something I heard once about how a casket doesn’t weigh very much—just enough to break a father’s heart,” he says, “and I lost it. I’m standing there, between beds one and two holding that dead baby, and I’m sobbing. I am in charge, and I’m crying.”

As an 11-year volunteer in Cedars-Sinai Medical Center’s emergency room, I’ve seen close up what ER nurses deal with. It takes rare emotional courage not to burn out when you know that every time those doors open—whether you are working triage in front, where a guy may stumble in with a heart attack, or in back, where paramedics may race in with a girl who has been knifed or shot—it’s bad news. Then there’s the physical strength required to survive 12-hour shifts with two half-hour breaks and 45 minutes for lunch. ER nurses never sit. But it’s the children—every ER nurse will tell you—who take the biggest toll.

“For a very long time,” Rich says, “I viewed it as a badge of honor—How much crap can I take? How much horror can I see and not show emotion?” He clears his throat. “But you can’t keep stuffing it down; you have to deal with the emotion.”

Rich has been a nurse for 22 years. He has a 12-year-old son. There are 98 nurses in Cedars’ ER. Their ages range from 24 to 67, and they are as different as heavy metal is to polka. What they share are guts and a desire to give. “I was an operating-room tech in the army. My CO said, ‘Nursing?’ And I thought, Maybe,” Rich says.

He is big and bulky, with soulful eyes and a wild sense of humor. When I ask why he really became a nurse, he jokes, “I liked the cute little hats, the white nylons and the sensible shoes.”

Rich was diagnosed with leukemia last year in his very own ER, when he showed a doctor some large bruises on his body. The doc ran tests while Rich was on shift and returned with the diagnosis. The story goes that he asked the doc if he could finish his shift so he wouldn’t get docked pay. After eight months off, five rounds of intravenous and oral chemo and too many bone-marrow biopsies, Rich is back working nights. I don’t know how he does it. I don’t know how any of them do it.

“It affects your soul,” Melissa says. She could be called the queen of trauma, having done 20 years in what she terms “the knife and gun club” at St. Luke’s Roosevelt Hospital in Harlem and five years in Newark, New Jersey, before coming to L.A. “Newark made New York look like kindergarten,” she says.

Hearing Melissa’s accent is like flying to N.Y. and walking into Original Ray’s. She recalls a guy “who was having a big heart attack in room nine…In the middle of his pain, he heard me, looked up and said, ‘What part of the Island are you from?’ ”

“Why nursing?” I ask.

“I had a scholarship to the American Ballet Theatre, and I was good, but I wasn’t brilliant…and my dad said, ‘You need an education—go be a nurse.’ ”

I can’t imagine Melissa in ballet shoes, but 29 years ago, she traded them for a stethoscope. We’re at Orso, across the street from Cedars, having dinner after Melissa’s 7 a.m.–to–7 p.m. shift. She’s wearing a chic black jacket over blue scrubs, but there are smudges under her eyes. “Where do you find joy in the job?” I ask.

Without blinking, she says, “Using my knowledge to participate in stopping bad things that happen to people.”

Of course, they can’t always be stopped. You can’t stop a mother’s pain when her 18-month-old drowns. “The mom was still wet,” she says, “making a puddle by room three. When she knew her baby was gone, she wailed…just melted to the floor.” She pauses. “I swaddled her in warm blankets. It was all I could do for her.”

“What do you do for you?”

“I compartmentalize,” she says, finally smiling. “And I buy very expensive shoes.” She must have a closet full of Manolos.

Shari runs to cope with the stress. She did the 2007 Boston Marathon. “I’ve also run after psych patients who escaped the ER and took off down Gracie Allen toward 3rd Street.” She works mostly as a charge nurse, overseeing patient flow. If paramedics bring you in on a gurney, you’ll see the charge nurse first. That’s who decides whether the man in room four gets kicked into the hall because the room is needed for the woman the LAFD just scooped up off the pavement.

Some ER nurses charge, but all work triage and patient care. There are approximately 15 nurses on each shift, and shifts change all day. There are 41 beds in the ER—58 if they fill the halls. Cedars is a number one trauma center—the wait can be 10 minutes or four hours. Think of all the L.A. hospitals that have closed.

Shari, who was raised on a farm in Racine, Wisconsin, has been a nurse for 21 years. The only other job she considered was a baker…and that was when she was five. “How come you didn’t do that?”

“They have to get up really early,” she says, taking a bite from her perfectly wrapped homemade sandwich. She expertly cuts her peach with a paring knife.

Shari came on at 11 a.m. and will work until 11 p.m. We’re in the cafeteria on her dinner break, but she looks like she has just showered—blond curls escaping a perfect ponytail—a Goldilocks nurse who behaves like a general. I have seen her hustle a parade of bloody, broken patients through the door with the cool calm of an air-traffic controller moving jets through a bank of thunderstorms.

Abby and Sylvia carpool from Santa Clarita. They call the drive back and forth to Cedars their “psychotherapy hour.” Abby, fast and funny, was born in the Philippines. She has been a nurse 27 years—Hoboken and then L.A. “Why nursing?” I ask.

“I got into the short line,” Abby says, and she and Sylvia fall into a fit of laughter. “I’m Chinese, and when you’re Chinese, you’re supposed to study math—go into accounting, banking. So I went with my girlfriends to apply to school. All of the lines were really long, but there was this one short line, so I got into that one.”

“It was the premed, premed tech and nursing line,” Sylvia adds, smiling widely.

“I passed the test,” Abby says, “and I said to my friends, ‘Nursing?! My mom is going to kill me.’ ”

The ER can bring out the worst in people—not just the patients but the people bringing in the patients. Week after week, I see fear breed anger and despicable manners. I ask Abby how she deals with that. “You can’t take it personally,” she says. “You have to get over it and move on.”

“What’s the joy in this job?” I ask Sylvia, who has three children and has been a Cedars nurse for 19 years—not long enough to dim her radiant smile.

“You get to help people,” she says. “You make a difference.”

The nurses remind me about the funny stuff: the toddler whose potty got stuck on her head when she tried to put it on like a hat; the four-year-old who shoved an aspirin up his nose. “Did you have a headache?” Rich asked the kid.

Some of the nurses are on their second careers. Paul, one of the calmest in the ER, was a Navy SEAL. Jerry, who could find a vein in a stone, was a fashion designer. Joe was in marketing at Anheuser Busch. “And then came 9-11,” he recalls, “and I was watching those firefighters on TV, and I just knew I had to change my life. I had to do something honorable.”

Clean-cut, in pressed scrubs and Clark Kent glasses, Joe is the one you’d want to marry your daughter. “Can you have the same compassion for a drug addict as you do for a cardiac arrest or the patient back for the third time with terminal cancer?” I ask.

“You have to. What about the guy booked on a double vehicular manslaughter, still drunk, spewing ef-yous and showing no remorse? He’d kept driving after he hit them,” Joe says, eyes narrowing. “You have to give him the same care.”

Lots of people are brought into the ER in cuffs—think of gang shootings, car wrecks, domestic violence. Bad guys get hurt just like good guys, and they’re all brought to the same ER.

Kelly wanted to be a cop. “First an actress, second a cop,” she says. Raised in Tennessee and Arkansas, she calls herself a hillbilly but looks like a movie star. She hunts, motorcycles, parachutes and has an 11-year-old son. A nurse for 10 years, she once did CPR on a woman in the ER driveway.

“I was triaging, the doors opened, and someone was yelling for help. It was the sound of the help; the hairs on the back of my neck stood up,” Kelly recalls. “Female, mid seventies, cold as a cucumber, not breathing, in the passenger seat. I pulled her down onto the cement. There wasn’t any time; her feet were still in the car.”

Flor nods. She, Kelly and I are at Du-par’s on their day off. “I did CPR on a doctor once,” she says. “We were moving him to the OR, and he went into cardiac arrest. I jumped up on the gurney, straddled him and did CPR—in the elevator. It probably didn’t look good,” she says, brown eyes wide.

Flor is a “good Catholic girl” from Manila—nuns and rosary beads to Kelly’s bikes and rifles. “My aunt was a nurse in the U.S., and when she’d come home, it was like she was a celebrity. People gathered around—they made a fiesta: We have to kill a pig,” she says, grinning. “They respected her, and I thought, I want to be like that.” She has been a nurse for 31 years. She has three kids in college and looks like she’s their age. “I’m a caregiver,” she says. “That’s what I took the oath for.”

Triage is the hardest, most ER nurses agree. It’s not just the patients’ vitals. What are the skin signs, the alertness, the level of consciousness? Sweaty, pale, faint, red? It’s not just their pain.

“Triage is the most dangerous,” Nili says.

“You use your clinical judgment to assess the patient. You can’t let anyone slip past you, and you can’t make a mistake.” Tall and impressive, if Nili walked into your room with a needle, you’d extend your arm. “Why did you go into nursing?” I ask.

“Oh,” she says shyly, “I was out of control at Cal State Northridge, and my parents said, ‘It’s either nursing school or leave home.’ ” She has been on the job for 16 years. “Not everyone can do it.”

Well, that’s for damn sure. I’ve seen Nili on the trauma team, suited up in blue plastic, waiting for the paramedics to arrive, like a solider about to take a hill. I’ve sat next to her at the radio when the LAFD calls. The silent blue lights in the corners of the ER flash and spin, and a nurse on the blue team hotfoots it to the radio room. “Cedars base, copy,” and the line crackles: “This is Rescue 41. I have a 57-year-old male, altered LOC, in moderate distress; this is Rescue 27, I have a 16-year-old female…” And on it goes.

“Every day is a crisis,” Nili says.

ER nurses don’t give long-term care. They don’t get to know you, and they don’t even know what happens to you after you leave the ER. They are a platoon of adrenaline junkies with invisible capes and angel wings, there to take care of you at your worst moments. And it never ends. “Patients are like waves of ocean hitting the beach,” Shari says. “New ones just replace the old ones.”

“If I have to cry, I cry,” Mark says. “You can’t carry it to the next shift.” Blond and lanky, he has the mischievous air of a reformed bad boy. He did 10 years as a paramedic before his 10 as a nurse, so he has seen his share. “I wanted to be that person who knew what to do, how to run a code—perfectly.” A code, even laypeople know, is when the heart stops.

Mark thinks about the process for a moment and flashes one of his rare smiles. “It can be a miracle,” he says.

“Does it scare you anymore?”

“No,” he says. “I’m either enlightened or f–ked up.”

Chapter 11 of Ruthless Trust by Brennan Manning is a life changing concept and chapter.  The chapter is titled: The Geography of Nowhere.  The concept is simple.  If we are NOT NOW HERE then we are NO WHERE!  So lesson #1 is to live in the NOW.  Don’t worry about the future or the past.  Live in the Now Here.

 “The music of what is happening,” said great Fionn, “that is the finest music in the world.” …The music of what is happening can be heard only in the present moment, right now, right here.  Now/here spells now-here.  To be fully present to whoever or whatever is immediately before us is to pitch a tent in the wilderness of Now-here.  It is an act of radical trust-trust that God can be encountered at no other time and in no other place in the present moment.  Being fully present in the now is perhaps the premier skill of the spiritual life.”-Chapter 11, Ruthless Trust by Manning