DEATH: The Enemy?

1Now a man named Lazarus was sick. He was from Bethany, the village of Mary and her sister Martha. 2This Mary, whose brother Lazarus now lay sick, was the same one who poured perfume on the Lord and wiped his feet with her hair. 3So the sisters sent word to Jesus, “Lord, the one you love is sick.” 4When he heard this, Jesus said, “This sickness will not end in death. No, it is for God’s glory so that God’s Son may be glorified through it.” 5Jesus loved Martha and her sister and Lazarus. 6Yet when he heard that Lazarus was sick, he stayed where he was two more days.

7Then he said to his disciples, “Let us go back to Judea.” 8“But Rabbi,” they said, “a short while ago the Jews tried to stone you, and yet you are going back there?” 9Jesus answered, “Are there not twelve hours of daylight? A man who walks by day will not stumble, for he sees by this world’s light. 10It is when he walks by night that he stumbles, for he has no light.” 11After he had said this, he went on to tell them, “Our friend Lazarus has fallen asleep; but I am going there to wake him up.” 12His disciples replied, “Lord, if he sleeps, he will get better.” 13Jesus had been speaking of his death, but his disciples thought he meant natural sleep. 14So then he told them plainly, “Lazarus is dead, 15and for your sake I am glad I was not there, so that you may believe. But let us go to him.” 16Then Thomas (called Didymus) said to the rest of the disciples, “Let us also go, that we may die with him.”

Jesus Comforts the Sisters

17On his arrival, Jesus found that Lazarus had already been in the tomb for four days. 18Bethany was less than two miles[a] from Jerusalem, 19and many Jews had come to Martha and Mary to comfort them in the loss of their brother. 20When Martha heard that Jesus was coming, she went out to meet him, but Mary stayed at home. 21“Lord,” Martha said to Jesus, “if you had been here, my brother would not have died. 22But I know that even now God will give you whatever you ask.” 23Jesus said to her, “Your brother will rise again.” 24Martha answered, “I know he will rise again in the resurrection at the last day.” 25Jesus said to her, “I am the resurrection and the life. He who believes in me will live, even though he dies; 26and whoever lives and believes in me will never die. Do you believe this?”

27“Yes, Lord,” she told him, “I believe that you are the Christ,[b] the Son of God, who was to come into the world.” 28And after she had said this, she went back and called her sister Mary aside. “The Teacher is here,” she said, “and is asking for you.” 29When Mary heard this, she got up quickly and went to him. 30Now Jesus had not yet entered the village, but was still at the place where Martha had met him. 31When the Jews who had been with Mary in the house, comforting her, noticed how quickly she got up and went out, they followed her, supposing she was going to the tomb to mourn there. 32When Mary reached the place where Jesus was and saw him, she fell at his feet and said, “Lord, if you had been here, my brother would not have died.” 33When Jesus saw her weeping, and the Jews who had come along with her also weeping, he was deeply moved in spirit and troubled. 34“Where have you laid him?” he asked. “Come and see, Lord,” they replied.

35Jesus wept.

36Then the Jews said, “See how he loved him!” 37But some of them said, “Could not he who opened the eyes of the blind man have kept this man from dying?”

Jesus Raises Lazarus From the Dead

38Jesus, once more deeply moved, came to the tomb. It was a cave with a stone laid across the entrance. 39“Take away the stone,” he said. “But, Lord,” said Martha, the sister of the dead man, “by this time there is a bad odor, for he has been there four days.” 40Then Jesus said, “Did I not tell you that if you believed, you would see the glory of God?” 41So they took away the stone. Then Jesus looked up and said, “Father, I thank you that you have heard me. 42I knew that you always hear me, but I said this for the benefit of the people standing here, that they may believe that you sent me.” 43When he had said this, Jesus called in a loud voice, “Lazarus, come out!” 44The dead man came out, his hands and feet wrapped with strips of linen, and a cloth around his face. Jesus said to them, “Take off the grave clothes and let him go.”
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You know, death is an interesting event. As a physician in training it kind of feels like failure. Throughout the ages people have learned to deal with death in different ways. In Madagascar the dead are buried in tombs more elaborate than many people’s homes. Some of them even redress them and keep them in their house, hoping that this will bring good fortune to their household. The story of Lazarus is important for many reasons, especially for us in the healthcare profession. Like my mother, I am pretty afraid of flying in airplanes. If there is any kind of turbulence my hands start to sweat because I am just “sure” that the plane is going down. When I read the passage above on the flight across the Atlantic, the part I bolded really stuck out to me. When Jesus finally went to see Lazarus, He encountered Martha first. Of course she was distraught, and Jesus seemingly gave her the reassurance that all Christians give to friends and family that have lost someone, “It’s okay, it’s okay…one day you will see him again!” Martha knew the scriptures and agreed that she would see Lazarus again at the resurrection/the second coming of Christ. But she failed to realize something quite vital; Jesus IS the resurrection. Life can’t but help to pour from Him.

He who believes in me will live, even though he dies. That seems like an odd statement to make, but I think it is vital for doctors to get this through their skulls. What is the most important endpoint for our patient? Of course we want our patients to stay alive…especially while they are in our care, but is that it? He who believes in me will live, even though he dies. Now I don’t know about you, but as a future doctor this statement sounds like the greatest treatment ever invented. Living even after dying? I wouldn’t mind taking that pill. But seriously…after I started to really understand that once my patient believed in Christ LIFE was guaranteed my outlook on death started to change. Remember, death is not a failure on our part (I guess unless we caused it). Death is a natural part of life; what we have to ask ourself as our patients are nearing their last hours is, “Will he or she live again?” Not asking this question of ourselves and of our patients is the real failure.

So now that I have set the morbid tone of my entry, :), my day actually started out with beginning of two new lives. Today, I assisted in a C-section where the mother was pregnant with twins…two beautiful baby girls. I didn’t expect that my mission trip would basically be an OB rotation, but I don’t mind it too much. I feel much more comfortable viewing vaginas as not just a sexual organ, but also an organ that can expel all sorts of horrifying liquids (including babies :) ). The pictures of me assisting and the twins are in the gallery below. As you can see, my back was literally breaking while I was sewing up. If I plan to go into surgery they will simply have to raise the table or else I won’t last a month.

After witnessing two new lives enter this world, I witnessed two leave it. As we were rounding on the male medical ward (which I noticed is composed of mostly HIV reactive patients) we were evaluating a patient who was experiencing dypsnea. About 7 of us were standing around his bed trying to figure out how he got to this point (he had been chatting and joking around with us yesterday). The medical liscensure officer (MLO; the equivalent to a PA, but with more autonomy) said the patient needed a little oxygen, so I ran off to find the oxygen tank. My search was futile since the only oxygen tanks the hospital had were in the OR and the nursery, neither of which was giving up their tank. So I came back empty handed and we continued to watch as the patient struggled to breath. To me, this seemed like what we would call a code in the States, except the resources were no where near what we needed to run a “proper” code. I tried to remember what I saw the resident physicians do (in the States) when they were called for a code, and I remember that they often tried to get an airway on the patient. So I made the suggestion that we try to get an airway, and the MLO agreed. The only laryngoscope the hospital had was located in the OR, so I ran to get it. I saw the nurse anesthetist there and asked him to bring the scope and help us get an airway (I had never tried to do one before and I wasn’t going to practice on a man that sounded like he was drowning in his lungs). He ran and came to the patient with the scope and started to push the tongue aside as he advanced the scope. He got about halfway in when he stopped and said it was useless. I started to get mad; this was the only thing I could think of that we could do to help the patient and he said it was useless, why? He told me to look down his throat, so I looked and didn’t see anything I could discern. He looked at me and said, “Kaposi sarcoma“. There is nothing we could do; the sarcoma had infiltrated his lungs and progressed so far that you could see the vascular papules on his hard palate. He took the scope out and walked away. The MLO told me to feel for a pulse so I tried to feel for the carotid pulse. I didn’t feel anything; then I took out my stethoscope and listened to his heart…it was silent. You know, after practicing auscultation so much for our Patient Diagnosis class during my first year, I was really taken back by listening to someone’s chest and hearing absolutely nothing. Not a murmur, not a split S2, not an ejection sound, nothing. His skin was still quite warm, but he was gone. The saddest part is that I had no idea whether we had the chance to pray with him; I hadn’t yet learned whether he had a relationship with Christ; I didn’t know yet if I would see him again. I was also pissed that even though this patient had been in the male ward for 2 weeks, we didn’t find out that he had Kaposi sarcoma until the nurse anesthetist stuck the laryngoscope down his throat. Lesson learned: its important to do a thorough work up on your patients; you don’t want to let something important go unnoticed.

The second patient that died today, died in the exact same way…gasping for air secondary to Kaposi sarcoma infiltrating his lungs. Both patients had AIDS. There is something about the wailing (and yes it is more wailing than crying) that occurs after someone dies in Africa. The wailing is filled with such sorrow that you can’t help by cry with them. I walked by the family as they received the news of their loved one’s death and I didn’t know what to do. They were wailing so loudly; I could put my arm around them but what do I say? I’m pretty sure that I dropped the ball because I ended up not stopping and at least hugging one of them, but I hope that I do better next time. I’m so happy that one day my M.D. won’t be needed. I’m so happy that one day people won’t die of AIDS anymore. I’m so happy that one day the wailing will stop, and it will be replaced with songs of joy and gladness. But until then, I want to strive to make sure that I see all of my patients again, though they die.

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