Beyond The Parking Lot

Both of his eyes were tightly closed with tears streaming down his face. He covered the left eye, apparently it had the dust or something in it. “Doctor Johnson please help me. This pain is unbearable. Please, please do something quickly. Can you please help me, Mr. BJ cried? This is awful.”

Immediately, the differential diagnoses came to mind. Glaucoma? Detached retina? Retinal hemorrhage? Or, maybe just simply, dust.

I did this recitation at the same time as I reached for the emergency eye tray. In the emergency eye tray are an assortment of drops, ointments, solutions and instruments to retrieve foreign bodies. However, before doing anything, I must relieve his pain. A few drops of Proparacaine instilled and he is smiling. Proparacaine is a VERY EFFECTIVE AND VERY SHORT, BRIEF acting anesthetic.

Wow! Doctor Johnson! That is awesome. That is like magic. Thank you.

You are most welcome, I respond. Having said that, I ask the medical assistant to take Mr. BJ to the visual acuity chart. This allows me to see another patient and at the same time reconsider the broad differential of life and vision challenging illnesses. I see the patient with the sprained ankle, another with bronchitis and another who has been non-compliant with either her blood pressure or diabetes medications. I comfort one, treat the other and scold the last. Then, I return to Mr. BJ and his eye pain.

He is a bit calmer now. “Dr, Johnson those eye drops are excellent. I was able to pass the eye exam. I saw all of the letters clearly. Can I go now?

I respond. “Well let me examine you first sir. I want to make sure there are no foreign bodies or injuries to your cornea or conjunctiva. Having said that, I instill more of the Proparacaine and do a Fluorescein stain of the eye. This allows me to see under an ultraviolet light any evidence of scratches or scars to the outer eye. Then I take a cotton swab, turn the upper eyelid upside down and search for particles under magnification.

You are good to go Mr. BJ. I don’t see any damage to your eye. There is just some irritation that will resolve with these other prescribed antibiotic eye drops. Use these drops four times daily and within one week, your eye will heal. If you have any problems between now and then call me and I can refer you to an eye doctor.” I say this in hope that Mr. BJ will be healed and with the knowledge that he can’t afford or easily access and eye doctor. I pray to myself, ‘Lord please heal Mr. BJ’.

Mr. BJ is excited and so thankful. “That is good Dr. Johnson. The best part, I don’t have any more pain. I feel perfect. By the way, how long will these eye drops for pain work?”

I mumble an answer. “Probably until you get to the parking lot. Not much longer than that.”

Mr. BJ looks on me with both eyes wide open now, with unbelief. “You can’t be serious, Dr. Johnson. What happens after that?”

I go on to explain that the pain relief is temporary and these eye drops of Proparacaine are not available commercially as the intent is that Dr.’s do not prescribe this in an effort to not mask the pain. We need to know our patients are not in pain while in our presence. Once they are out of sight, they may as well be out of mind.

How often do I practice this ‘out of the parking lot’ medicine? How often do I ignore the fact that the Mr. BJs in my clinic are going back home to job loss, limited or no income, caring for very sick family members, addicted children and unsafe housing? How often do I ignore the beyond out the parking lot situations? I am very callous. As long as I have made you feel better, right here, right now, I have done my duty. The rest is up to you. The pain relief will last 6 minutes, 6 days, or 6 months, while the circumstances of Mr. BJ’s life remain unmet. Lord help me to think beyond the parking lot.

Colossians 3:12 Therefore, as God’s chosen people, holy and dearly loved, clothe yourselves with compassion, kindness, humility, gentleness and patience.

Hurt or Harm

This is meant to alert not alarm you
I pray you will know my intent
I’d rather be hurt than to harm you
My harsh words are not what I meant

When I do such an unkind action
When I speak a word that offends
It is too late to make a retraction
The fire once started won’t end

Forgive my presumptuous behavior
My actions that caused you such grief
I know it happens too often
This explanation gives no relief

But it does hurt me when I wound you
It is an offense to the God that I claim
I will ask my Father in heaven
Help me to love as He loves in His name

Romans 13:10 Love does no wrong to a neighbor; therefore love is the fulfilling of the law.

A Donut on Salad

Try this recipe. Make a nice fresh salad with Romaine lettuce, those tiny cute tomatoes, oil and vinegar dressing and a little pepper. Don’t add salt please. Everybody knows that salt is not good for you. Sprinkle some sesame seeds and maybe a bit of smoked salmon to add flavor. Then take a sugary, cream filled donut (chocolate icing if you like) and place it on top of the salad. Sounds good doesn’t it. Makes my mouth water. Go ahead and enjoy this concoction of self denial and self indulgence at the same time.

The problem with either swing of this dietary pendulum is that it tends to go to extremes. Along with these extremes, I become judgmental of people who are not eating or thinking as I do. There are the yogurt eating yoga people and the beer bellies who burp. I deny that I want to belong to either group, but they both have some appeal to me.

Paul recognized this when he wrote: Galatians 5: 16-17 I say then: Walk in the Spirit, and you shall not fulfill the lust of the flesh. For the flesh lusts against the Spirit, and the Spirit against the flesh; and these are contrary to one another, so that you do not do the things that you wish.

I become intolerant and critical of what I perceive as your moral failure not because you fail, but because I fail to recognize the moral failures in which I still indulge.

We divide ourselves into political, social, civic and even religious groups of salad or donut eaters. The truth is that neither is a perfect food. Any habit, custom, opinion can be taken to extreme.

The take home message to me is that I must keep a balance in order to recognize that I am human. I must keep a balance so that I am not intolerable or intolerant of the humans around me.

My advice, put a donut on your salad.

Better yet: Psalm 34:8 ‘O taste and see that the Lord is good’.

Are You Approved

Mr. AK layed the blueprints on the table. Then he spoke.

You need to look at the weight bearing girders and rafters on this wall. Also, you should know your heating ducts and conduits should run parallel. Lastly, since we have to redo the entire circuitry, you may as well add enough breakers to accommodate the special medical equipment.

I am listening. I understand the language but that is as far as it goes. AK is the contractor. He is describing some of the details for the renovation of the office. He may as well speak Gaelic. I nod in agreement. If this goes on I will nod to sleep. This is mumbo-jumbo.

Dr. Johnson, are you alright?

Mr. AK is either telling me the truth or he is a very confident liar. I don’t even know what questions to ask him. I feel uneasy questioning his sincerity and integrity. Is he really aware of the latest fire codes and city ordinances. Can I trust his information? Has he studied? Is he approved?

I now understand how Mr. AK felt when I advised him about his colonoscopy. He looked at me as though he fully understood. I pulled up my computer generated graphics on the screen.

You see here Mr. AK, your colon has three parts before it empties into your rectum. Your biopsy showed cancer in some of the polyps or growths. The polyps are here in the proximal transverse….,Mr. AK are you alright?

I take the medical lingo for granted. I study constantly and take the certification exams for one or another discipline yearly. I know my diagrams like the back of my hands.

It is important for me recognize that what I consider to be clear and concise descriptions are really mumbo-jumbo to most people. Am I telling them the truth? Or am I just a confident liar? Is he afraid to question by sincerity and integrity?

Have I really completed my latest professional credentialing? Have I studied? Am I approved?

The next time I show my computer graphics I must be aware that the lack of questions or the acceptance of whatever I say is not necessarily informed consent. I must study and I must be up-to-date. I must be prepared both intellectually and spiritually to be sensitive to the questions that Mr. AK has. I need to be approved. Am I ready to share the truth or am I just a confident liar?

Study to shew thyself approved unto God, a workman that needeth not to be ashamed, rightly dividing the word of truth.
2 Timothy 2:15 KJV

Conspiracy comfort

Some call me crazy
Some say I’m bizarre
But at least I can say
Who my enemies are

The witches and warlocks
The shamans soothsayers
They’re morphing into
Strong political players

They remind me of whom
I should trust and obey
Who is for and against me
Who will kneel and betray

And after all that is said
After all that is done
The rumors are true
If we haven’t won

‘They’ should never defeat us
Their news is all fake
This conspiracy is comfort
We won’t bend, bow or brake


Us killing us

Where is the outrage?
Where is the fuss?
It’s also a crime
When it’s us killing us

Where are the protests?
The riots the looting?
Why are we silent
When we do the shooting?

Where are the speeches?
The media chatter?
Where are the voices
That cry black lives matter?

Politically correct
Self righteous convenient
Moral posturing
I’ve seen it

If we want to be truthful
This one thing we must
Be enraged and engaged
When it’s us killing us

When The Doctor Kills You

by Michael D. Johnson, MD, FACS

The issue of physician-assisted suicide is gathering momentum across the na-tion and specifically within our state. As a healthcare professional, I was trained to comfort the sick and preserve life. I was trained to “do no harm.” What I was not trained to do is to help hasten a patient’s death.

And that’s exactly what will happen if physician-assisted suicide is legalized in Delaware.

There is a high potential for abuse and misuse in proposed assisted suicide laws. To put it frankly, it is simply too dangerous. We cannot trust the mo-tives of the families seeking to end an elderly family member’s life so they can inherit the estate. We cannot trust the motives of the insurance compa-nies that know it will be far cheaper to cover the cost of a handful of pills as opposed to the cost of years’ worth of care for a patient facing a terminal disease. Furthermore, we cannot blindly trust the physician’s prognosis as it’s an educated guess at best.

These types of mistakes and abuse are already happening in states where physician assisted suicide is legal.

One such example is Thomas Middleton. In 2008, Middleton was diagnosed with Lou Gehrig’s disease. A month after moving into the home of Tami Sawyer, his estate trustee, Middleton died by assisted suicide. Just days af-ter Middleton’s death, Sawyer listed the property for sale and deposited $90,000 into her own bank account. Inexcusably, no one caught this blatant abuse while it was happening. Only after an investigation into real estate fraud was the abuse Middleton suffered at the hands of Sawyer exposed.

Another example is Kate Cheney in Oregon. Cheney, 85, was diagnosed with an early stage of dementia. When her physician refused to provide the lethal assisted suicide drugs, Cheney doctor-shopped until she found a physician willing to prescribe the drugs. The second physician that Cheney sought the lethal drugs from ordered a psychiatric evaluation. The evaluation concluded that Cheney was not in the right frame of mind to make a decision about as-sisted suicide and her request was denied. Determined to obtain assisted su-icide drugs, Cheney sought another physician. After a second psychiatric evaluation, Cheney’s was deemed competent enough to request assisted suicide, but the report evaluation noted that external factors, such as Chen-ey’s daughter, were potentially coercive. Instead of investigating the extent to which Cheney’s daughter was coercing her into assisted suicide, Cheney received the drugs and died.

Assisted suicide laws simply are not capable of protecting vulnerable patients from this type of abuse and coercion.

Physician-assisted suicide is promoted as a patient taking a pill and dying a peaceful death. In reality, dosage has evolved from taking 100 capsules of Seconal to use of experimental drug cocktails. Experimenting with combina-tions of drugs is “research,” which has not been approved by any ethics re-view committee like an Institutional Review Board. And that violates re-search ethics standards. According to The Atlantic, “No medical association oversees aid in dying, and no government committee helps fund the re-search…The doctors’ work {to experiment with drugs which kill patients} has taken place on the margins of traditional science. Despite their principled in-tentions, it’s a part of medicine that’s still practiced in the shadows.”

Giving healthcare professionals the power to assist a patient in ending their life is dangerous. There is nothing compassionate about it. We must protect our patients. After all, if we won’t protect them, who will?

I urge you to please take the time to stay informed about the dangers of physician-assisted suicide. I also strongly encourage you to share with others about this devastating piece of legislation. Let the no vote always be no. It is the right thing to do.

Michael D. Johnson, MD, FACS, is a board certified general surgeon who spent 23 years working on the mission field before returning to Philadelphia, Pennsylvania to found the Miriam Medical Clinics that offer hope and heal-ing to the city’s underserved. He is the Delaware State Director for the Ameri-can Academy of Medical Ethics.

How Far

It is not how high you’ve risen
it is not, how much you’ve gained
Our God makes His decision
Based on did you let Him reign

It is not how far you fell
How deep you were in sin
Our God keeps you from hell
Based on did you let Him in

Many good with great resource
Reputations and fine deeds
Will find within this discourse
Only Christ can fill their needs

Those impoverished and lonely
Who despair and spirits hurting
Will find comfort in Christ only
From eternity this is certain

Don’t measure your salvation
Based on personal observation
How far you fall and how high you rise
Only God has this information

Look beyond your situation
Ignore your status high or low
God sees your reputation
And He determines where you go

Matthew 21:32 For John the Baptist came to you showing you the right path to take, and you would not believe him; but the tax collectors and the prostitutes believed him. Even when you saw this, you did not later change your minds and believe him

Another Reason

Another reason to complain
Another chance to doubt
It still escapes my feeble brain
God always works things out

My memory is so very odd
It seems only to retain
Disappointments I have with God
I keep reasons to complain

No matter how He blesses me
In sweet affirming ways
I fail to show Him thankfulness
I fail to give Him praise

Instead when I awaken
I resubmit my list
My doubts remain unshaken
I tell God what He missed

I will only know the good and best
When I start to realize
Christ alone is peace and rest
The soul’s reward and prize

Thou wilt keep him in perfect peace, whose mind is stayed on thee: because he trusteth in thee.
Isaiah 26:3 KJV

The Mirage of Merit

TJ went to bed hungry. His mother was working the late shift at the nursing home and his father works as a mechanic but there have been slow downs and layoffs. His father is not getting the hours he wants and subsidizes his income by delivering food for a restaurant. TJ went to bed hungry. This is not because of the lack of care or love of his parents but due to their busy schedule which makes it difficult to provide for him and his two sisters. TJ wakes up still hungry but his parents are too tired to make him breakfast so he hurries on his walk to school. By the time he stands in the cafeteria and gets his morning meal, he does not feel ready to learn his math lessons.He falls asleep in class.

Across town in a more affluent neighborhood ST goes to bed with a full stomach. His mother finished her tennis lessons just in time to help him with his homework. His father comes home in time from the office and after dinner with the family, he goes upstairs and reads ST and his two brothers a bedtime story. ST awakens in the morning to the smell of waffles and bacon. After having a tasty breakfast his mother drops him off at school. He is well prepared for his math, science and French classes. He has even started college prep classes.

The trajectory for these 2 young boys is determined not by who they are or their capabilities. It is life chances. It has very little to do with their personal merit.

Two apples falling from the same tree will fall to the earth at rates depending upon the height from which they fall. That is, the slower apple falling from a lower distance will hit the ground sooner than the faster apple falling from a greater height. The apple that is higher is further from the center of gravity. It moves faster but the distance traveled means it will arrive last. That is a well established law of physics.The principle of acceleration, first posited by Newton defines which apple wins this race to the ground. Life chances in the human condition are determined by position more than ability. Merit is a mirage.

We operate in a world that denies this and claims meritocracy is the basis for advancement, success. If you are unsuccessful, you must be undeserving. We assume that the ‘have-nots’ have not because they have not tried hard enough.

This is also social Darwinism which dictates the survival of the fittest, strongest, smartest, prettiest and hardest working. This would mean that if you don’t achieve, you have none of these attributes and it is your fault that you remain at the bottom rung of society.

Mendelian genetics if allowed to be hijacked into the eugenics debate would dictate that we achieve based upon some inherited fault or advantage in our chromosomes. Despite the fact that 99.9% of mankind has the exact same genetic makeup, some find comfort or despair in the notion that others are inferior by nature.

Merit is a mirage. No one of us deserves any more than any other of us. All of us have what we have because of what someone else bequeathed to us. To be sure, we do have the responsibility to take advantage of what was given to us. But if we were given little, further from the center of gravity, no matter how fast we run, we may not reach the goal first.

It is critical as Christians that we divorce ourselves from the notion of the ‘undeserving poor’. We believe that we merit both the favor of God and society. Nothing could be further from the truth. Merit is a mirage.

We are who we are, we have what we have, by the grace of God. Once we have, we are mandated to share with the have nots. It is not a choice for the Christian. It is a command of Christ.

Matthew 25:41-42 Then shall he say also unto them on the left hand, Depart from me, ye cursed, into everlasting fire, prepared for the devil and his angels: For I was an hungred, and ye gave me no meat: I was thirsty, and ye gave me no drink:

1 Corinthians 5:10 But by the grace of God I am what I am: and his grace which was bestowed upon me was not in vain; but I laboured more abundantly than they all: yet not I, but the grace of God which was with me.

Matthew 5:45 That ye may be the children of your Father which is in heaven: for he maketh his sun to rise on the evil and on the good, and sendeth rain on the just and on the unjust.