Jesus, MD: A Doctor Examines the Great Physician
by David Stevens, MD, MA (Ethics), with Gregg Lewis
Today's Christian Doctor - Spring 2001
Adapted from Jesus, MD by David Stevens, MD, MA (Ethics) with Gregg Lewis
The Great Physician Volunteered to Be On Call
As the resident on call for internal medicine, I took Mr. Adams’ case when he showed up in the ER early one evening. An elderly man who had smoked all his life, he had chronic pulmonary disease (COPD) and manifested a low oxygen saturation in his arterial blood gas. I increased his oxygen level, but when he failed to improve, I sent him to the ICU. Even with a number of medications and respiratory therapy, his condition continued to deteriorate.
Eventually I had to intubate him and put him on a respirator, leaving orders for the nurses to contact me if his condition changed. At 1:00 A.M. I was called back to the ICU because my patient was fighting the respirator, trying to pull out the tubing. We were still not seeing significant improvement in his oxygen saturation level. As a result, I tried to sedate him enough to keep him from fighting the respirator, but not enough to stop his own breathing. It was going to be touch- and-go through the night, trying to find the right balance and save this man’s life.
I was writing new orders and still monitoring Mr. Adams’ response to the sedative when I got another beep, this time from the medicine ward. Another of my patients, a Mr. McCreary, had just died. This wasn’t unexpected, for he had terminal lung cancer and had been in the hospital hanging onto life by a thread for an entire week.
I hurried to Mr. McCreary’s room and examined him to be sure his breathing had stopped and he had no pulse. His pupils were fixed and dilated. I made a note on the chart to pronounce him dead and jotted some orders as to what to do with the body. I then went out to speak with his relatives. By now it was 2:00 A.M., and the family was very distraught. Many of them had been without adequate sleep for a number of days.
Even though they had been expecting the news, my telling them he had finally died prompted a flood of tears. It’s difficult to know how to be compassionate at 2:00 A.M., especially when you’ve just received another beep from the emergency room. But I sat down and began to explain to his family that Mr. McCreary, from all we could tell, had died peacefully in his sleep, and they could thank God for that. After a few more moments of encouragement and brief instructions as to what would happen next, I ran down to the ER to see a diabetic patient whose blood sugars had come back dangerously high.
The patient was breathing quickly and showing other symptoms of a life-threatening condition called diabetic ketoacidosis. I did an examination, checked the lab tests and began to write the complex orders that were going to be needed to stabilize this patient.
This was my third admission to the ICU that night, and it didn’t look as if I was going to get any sleep at all. After following the patient to the ICU and discussing the case with the nurse, I stood by as the first of a series of lab results started to come back and adjusted the insulin and fluid orders accordingly. It became clear in an hour or two that the patient was responding to treatment.
At 4:30 A.M., feeling totally exhausted, I headed for the house staff unit, hoping to get a least an hour of sleep before running down to check on my diabetic patient again and pulling all of the information I would need for rounds at 6:30.
I dropped off as soon as I hit the sack. Minutes later the phone rang. ICU was calling: Mr. Adams had coded. I went from full asleep to full awake in a split second as I grabbed my white coat and stethoscope and sprinted out the door, down the steps, through the long hallways of the hospital, and burst into the ICU. The nurses were already doing CPR as I checked the cardiac monitor for any sign of arrhythmia and simultaneously began drugs to try to get his heart started again.
An hour later I finished my notes and abatch of orders. We had successfully cardioverted Mr. Adams’ heart and his vital signs had stabilized. No more sleep tonight, for I had just enough time to check on my diabetic patient before rounds and another incredibly full day of work. The Lord willing, in another twelve hours I would get home.
Being a resident on night call means that the needs of others control your life. You have no rights to sleep or food or even to go to the bathroom. You are at the beck and call of patients, nurses, ER doctors, senior residents and any attending who admits to your hospital. You outrank the medical students, but you also have to answer all their questions, supervise their work and provide any help they need. Being on call requires a total commitment to do whatever is needed, whenever it’s needed, to get the job done. Indeed, while on call your life is not your own.
Jesus on Call
The Great Physician obviously knew what it meant to be on call. His healing skills were often in great demand. Mark 1:32-34 describes one of the times He took night call: "That evening after sunset the people brought to Jesus all the sick and demon-possessed. The whole town gathered at the door, and Jesus healed many who had various diseases."
From the context, it is clear that this particular night call began after an incredibly busy day. Jesus had entered Capernaum on the Sabbath, which gave Him an important opportunity to get His message out. He went to the synagogue and spent much of the day there teaching. The people who heard Him were amazed that He was speaking to their needs. The crowd got larger and larger. Folks were probably leaning into the windows and doorways, trying to hear what He was saying. Everything was going well until the service was interrupted by a shouting and screaming man possessed by an evil spirit.
Jesus healed the man right there in front of everyone. I rather doubt the people who saw what happened actually settled down again immediately. Instead, as Jesus continued teaching in a hot, crowded room full of people, they probably began yelling and calling out (or at least buzzing in amazement), hoping to be healed.
When Jesus finally did break away to eat a meal and spend a little time with His friends at Simon and Andrew’s house, He arrived to find Simon Peter’s mother-in-law lying sick in bed. Jesus healed her, and then everyone got fed. I imagine them enjoying some casual and quiet conversation. After a full day of public teaching and ministry, Jesus was worn out and probably thinking about getting a little sleep.
That’s just about the time the sun went down, marking the end of the Sabbath. Now everyone felt free to travel, to bring and even to carry all their sick or demented relatives and friends to Jesus for healing. Yet instead of turning them away and telling them the doctor’s office was closed, Dr. Jesus began night call.
Can you imagine the impact that example must of have made on His followers? The disciples were no doubt tired, too. But Jesus was showing them what it was like to put others’ needs ahead of His own. He could have taught them this lesson with words, but they probably weren’t ready for that. At this point in their relationship with the Great Physician, His interns needed a real-life object lesson.
It wasn’t until later in His ministry that He verbalized the concept this way: "If anyone would come after me, he must deny himself and take up his cross and follow me" (Matt. 16:24). Do you hear what He is saying? "You must be willing to do whatever I say, go wherever I go, imitate Me. That’s going to require you to deny yourself, your own needs, your own wants, your own concerns. That’s what it means to sacrifice—to take up the cross and follow in My footsteps." In other words, the Great Physician is saying to us all: "If you are going to be My interns, you are going to take night call."
Let’s now consider a few of the implications of that principle, because night call means a lot of different things to those of us who have done it . . . whether we be medical or dental professionals, pastors, counselors, police officers, flight attendants, factory supervisors, corporate executives or parents—on call 24 hours a day, seven days a week!
First of all, taking night call means taking responsibility. When you are in residency, you take call for a particular service. The night I described at the beginning of this article involved night call for internal medicine; other residents were on call for pediatrics, OB, surgery and the like. I was responsible for my section of the hospital, and I thought that was a heavy load.
But when I got to Africa, night call at Tenwek meant accepting responsibility for the entire hospital—for every patient. One time we had as many as 480 people in our 130 beds, though 150 to 200 percent occupancy was the norm.
When I left Tenwek after eleven years of service, during my very last night on call for the hospital, as a sort of gag gift, the other doctors presented me with an "official" framed "Last Night on Call" certificate. I was only half-kidding when I laughingly thanked my colleagues and assured them that their award would forever be one of my most prized possessions. For me it did have a deeper, significant meaning because of what it had meant to be on call and accept responsibility for the entire hospital. I felt an awesome weight in knowing others were dependent on me and on my skills and knowledge. Understanding this required a real commitment on my part, a willingness to accept the responsibility—to deny myself and do what needed to be done.
After all those years at Tenwek I felt a real sense of satisfaction in having done that, in part because I knew that such willingness hadn’t always been there. There were times I really had struggled over the sacrifice and the surrender of my own needs.
The whole thing had come to a head for me when, near the end of my residency, Jody and I were invited (along with a number of my colleagues and spouses) to an all-expense-paid weekend at Calloway Gardens, a beautiful resort north of Columbus, Georgia. Community representatives from small towns and rural counties in Georgia and Alabama had banded together and sponsored this extravagant weekend. They covered our hotel bill, fed us steak and lobster and paid our greens fees if we wanted to play golf. I shot skeet for the first time in my life. There was horseback riding along beautiful azalea-lined trails through the park. There were saunas and hot tubs, and swimming in the pool. You name it—they picked up the whole tab.
Naturally, Jody and I realized that the real purpose of this weekend was recruitment. But we had been assured that there were no strings attached. So I figured: Sure, I’m going as a missionary to Africa, but my mama didn’t raise no fool. We’ll go and enjoy this weekend with our friends. It’ll be great.
And it was!
But that first night a business leader from a small community in Georgia walked up to me and introduced himself. He had obviously done his homework because he said, "Dr. Stevens, you are the chief resident?" When I told him I was, he said, "Well, let me tell you about our community; it may be something that you want to consider."
This gentleman was very polished, a real salesman. He told me all about their community and how badly they needed a doctor. Right now, he pointed out, they had to drive more than ten miles to the county seat just to see a physician. So they had put together a committee of prominent business, civic and religious leaders to recruit a doctor to come to their community. He assured me they already had this nice office that they would let me use free of charge. "We’ll even guarantee your salary for the first couple of years"—and he threw out a dollar figure that was more money than I had ever dreamed of making.
"We know it’ll take a little time to build your practice," he went on, "and we’ll make sure you won’t be taking any risk. Moreover, we’ll give you a free membership to the country club." I could hardly believe I was hearing all this.
The man went on for about ten or fifteen minutes before I finally managed to say, "You know, I’m planning on going as a missionary to Africa as soon as I finish my residency." You’d have thought I told the man I had contagious TB, he left so quickly. When I saw him cornering several other residents throughout the evening, I couldn’t help smiling at the memory of his sudden reaction when he had realized that he had been wasting his time with me.
But that conversation initiated a time of real struggle for me. I began thinking how nice it would be to go to that small town and have that financial security. In medical school and residency we had denied ourselves a lot and learned the meaning of delayed gratification. By this time many of my college friends had bought houses, were driving nice cars and had gotten a fast start on good careers. Here I was still plugging away with my training almost seven years after college. We were renting a small house, driving a second-hand Volkswagen Beetle I had bought my first year of med school and living on a shoestring with two young children. And suddenly here was Shangri-la being offered to us if I would just be willing to say "yes." I began to daydream about what it would be like to open a private practice of my very own, to be the town doctor in some idyllic community where the folks were friendly and the fishin’ was fine. The more I thought about it, the better it sounded.
I didn’t know then what I have come to understand since—that when God asks us to do something, when He wants us to be on call for Him and we are committed to do that, the Devil knows better than to try to get us to completely turn our backs and change our plans. Instead, he tries to get us to alter our course just a little, maybe to settle for second best.
I started thinking: If I went to some nice little town, I could be the best family practice doctor for miles around. What an impact I could make for Christ in my community by being a witness in my practice. I could be a lay leader in my church and teach Sunday school. I could help with the youth group and work with the schools. I could earn enough money to help support lots of missionaries and even pay my own way to go overseas on a short-term mission trip every summer. I wouldn’t need to be a medical missionary in order to do a lot of things for the Lord right here at home.
Whenever I speak to doctors today, I assure them that there’s nothing wrong with practicing in the United States—unless God’s will for them is to be somewhere else. I knew that God’s perfect will in my life was to go to Africa, that doing anything else, for me, would mean settling for second best. But for a while there, second best looked pretty good. I really struggled with Jesus’ call to deny myself, take up my cross and follow Him.
One night about 2:00 A.M., as I was tossing and turning, unable to get to sleep, I finally woke Jody up and said, "Honey, we really need to pray!" So we got down on our knees by the bed, and I told the Lord again that I was willing to answer what I knew was His call to serve Him in Africa, "no matter what it means." I was ready to accept that responsibility, and so was Jody.
Giving Up Control
Like most doctors who not only have control-type personalities, but are then taught to take charge and to make decisions, I realized I had some control issues to deal with. Surrendering control to God is hard enough for a controller. But turning my life and career over to a mission organization to make major decisions that would impact every facet of my professional career and my personal life went against my very nature. It was tempting to think: I’ve spent all these years in school to become a doctor only to let someone else decide my income, where I live and what kind of car I will drive?
Don’t get me wrong. World Gospel Mission, the group we served with for eleven years, is a great mission agency. More than just an organization, it’s a family of missionaries involved in highly effective ministry around the world. They do a fine job of meeting the needs of their missionaries. All the same, when we agreed to go "on call" with them, we had to give up a lot of control. It wasn’t easy.
Making Yourself Available
As chief resident, I had observed two types of residents. The good ones weren’t always the smartest (although intelligence is important, as are diligence and an ability to apply what one knows). The good residents were the ones that didn’t make excuses to try to avoid the work. The work was almost always demanding, but the good residents were there, with the right attitude and a spirit willing to help.
By contrast, a few residents weren’t good. Again it wasn’t a matter of intelligence, for nobody can make it that far without being bright. Their problem was a matter of attitude. The bad residents would do everything they could to avoid work. When they were paged by the nurse from the ER their first response often was, "Well, have you done this? Have you tried that?" Then they would direct, "Do this or that, and then call me again." These residents didn’t want to answer the call, so they thought up excuses not to examine the patient. They weren’t making themselves available.
By not being available, they put the work back on the nurses, who had a low tolerance for this approach because they knew that it was the patients of these residents who tended to get into trouble because the doctors preferred sleep to providing quality care. When they did finally answer a call, they arrived with a bad attitude, which often showed through in their work. Patient care suffered; sometimes patients were even put at risk.
By contrast, the Great Physician, by His example and through His Word, asks us to assume responsibility, give up control of our own lives and make ourselves available for whatever He wants us to do. That’s the way He plans to get the job done. Amazing as it seems, He chooses to use us to relieve suffering and carry His healing message of life to those in danger of dying spiritually and facing eternity separated from God.
Of course, not everyone is called into medicine or overseas missions. But all believers are called to something. Maybe God wants you to organize a Bible study in your home to reach out to your neighbors. Maybe He’s calling you to be more responsible and make yourself more available as a parent. Perhaps He wants you to befriend and share your faith with a business associate, to serve on a committee at church or to teach a certain Sunday school class. Maybe the Great Physician is asking you to volunteer to care for an aging parent or relative in your home. Maybe He wants you to answer the call to give of your wealth or use your influence for His kingdom.
Developing the Deepest and Most Meaningful Relationships
Over the years, I’ve heard all kinds of excuses (from myself and others) for being reluctant to be on call for the Lord. Many people worry that making themselves available to meet people’s needs will somehow damage their other relationships.
In fact, the disciple Peter brought up this very subject in Mark 10:28-30 when he complained to Jesus, "We’ve left everything to follow you." Jesus promised Peter that anyone who has left home and family to answer His call would be rewarded a hundredfold. And He was not just talking about eternal rewards, but in terms of present relationships.
I can personally speak to the truth of that promise. As someone who took his family around the world to be on call, I know it wasn’t easy to miss Christmas and birthdays and other such things with our parents, siblings and extended families. But God made up for that by giving us closer relationships with our missionary family than the vast majority of people have with their own blood relatives. In Africa we were not only on call with each other (which builds relationships), we were on call for each other.
We took care of each other when we were sick and covered for each other on vacations. All the children called the other missionary parents "aunt" or "uncle." In many ways they became closer than they were with their true aunts and uncles back in the States. To this day some of my family’s dearest and closest friends are those missionaries who became our substitute family. It wasn’t that our own family became less, it was that this extended missionary family became more.
Before we went to Africa, Jody and I had worried about how the whole experience would impact our family. We soon found that despite the long hours spent dealing with the obvious and overwhelming needs all around us, we had more interaction time with our kids than ever. Unless an emergency arose at mealtime, we ate together as a family three times a day. With no television to distract us, we played games, read or worked on hobbies together most evenings. The kids could come up to the hospital to see me just about any time they were free. Being on call actually broadened and enriched our relationships in many ways.
I have seen the same thing happen in my life more recently. I do a lot of speaking at retreats and other getaway type settings. It’s often tempting after those public presentations to go off by myself, or with Jody, to go fishing, hiking, horseback riding or some other fun thing a lot of others are doing.
But I have found that my most significant ministry to individuals with special needs often occurs when I announce, "If you want to talk, let me know. I’ll be sitting out on the veranda afterward." Or, "I’ll be down by the lake later if anyone wants to chat." Or even, "Stop by my cabin and we can take a walk." A doctor may sit down and begin sharing about marriage problems, his struggle with a bad habit, a difficulty with a partner or anxiety over a malpractice suit.
Here, too, I’ve learned it’s impossible to support what God is doing in people’s lives unless I am willing to make myself available, learn what God is doing and see the whole course of what is happening. It’s not only being on call at crisis points that enriches relationships, it’s not just emergency help and short, timely platitudes, but it’s standing by and letting them know you are with them for the long haul. It’s our presence over time that makes the difference.
Making the Greatest Impact of All
Perhaps the greatest reward is that what you do on call often makes the greatest impact. As a doctor, when you’re on call and an emergency arises, you can be the difference between life and death. If you’re on call for a friend in crisis, you may be the only one who can help that person persevere. When you’re on call as a parent for your child, over time you will make an immeasurable difference.
When we are privileged to actually see the difference we’ve made by our being on call, whatever sacrifice was required pales in comparison to the result as God turns our "cross" into blessing—just as He did with Jesus.
The cross was a symbol of being accursed. It was the most horrible way imaginable for someone to die. Yet, because Jesus died on a cross, for us, the cross has become our symbol of hope. We put a cross on our churches or in front of the sanctuary, because its meaning has changed.
The meaning of being "on call" has changed for me over the years as well. I sleep better now that my current position no longer requires me to take night call for a whole hospital full of sick people. But I have to admit there are days (and nights) when I think about that "Last Night On Call" certificate. Sometimes I miss that opportunity of really making an immediate and concrete difference in people’s lives.
The Great Physician’s last night on call in the Garden of Gethsemane pushed Him to His absolute limit. But that’s when He told His attending Father, "Yet not what I will, but what you will" (Mark 14:36). Jesus gave up control, made Himself available, and willingly took responsibility not for a ward or a service or even an entire hospital. He volunteered to stay on call to save the entire world. If the Great Physician could do that for us, surely we can take our turn when He asks us to be on call with Him.