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Whole Person Care in the Emergency Room

Tim Riesenberger
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Tim Riesenberger

Emergency room physician in the Seattle area

Conference

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  • October 29, 2010
    4:30 PM
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01:05 Loving Father in Heaven, thank you so much for the great honor we have as healers in various capacities, Lord. I want to praise you for the previous presentations because it all does come down to having unselfish love; not only for our patients but for those around us, Lord, because that will bring true and lasting healing. Lord, I just want to be the first to confess I don’t have that unselfish love so I ask you for it now. I ask that you would fill me Lord, speak through me now is my prayer in Jesus’ name. Amen.

01:36 I met John when he was 19. Unfortunately, this young man was hypoxic; he was breathing about 40, 50 times a minute. The triage nurse grabs me out there and says, you need to see this guy. I throw him on some oxygen, his O2 goes on to 100 % but he’s just like hunched over and breathing and I’m like, well tell me what’s going on? He’s like, well, I was in high school and when I was 15 I got osteosarcoma and the osteosarcoma went to my lungs and actually created a malignant effusion so I think what’s happened is that the cancer has come back because I had beat it for awhile but I think the effusion’s back, that’s exactly what it feels like. So I think I just need the lung drained out and I should be okay. 

02:24 He had actually had to drop out of school for about a couple of years in order to take care of the cancer and to have it treated. He finished high school in 2 ½ years; very smart guy. His parents were there with him; that’s his sister, she wasn’t there with him at the time but very loving and very supportive.  So I brought him back right away and I said John, I think you’re going to have to be intubated because I don’t think you’re going to last very long. Is it okay if I just rest you on the ventilator for a little while? I talked to his parents, they said, sure. And I said, anytime someone is facing something life threatening I always like to ask that God would bless. Would you like me to pray for you?—and no one ever says no to that. It’s a very easy way of introducing prayer; all you have to do is put in something in the _____ and say let’s have prayer and if it’s normal for you, if it’s natural for you, it will be natural for your patient.

03:16 You know Mr. Johnson, you have an ST segment elevation MI, I’m sending you to the cath-lab. All the patients that I send to the cath-lab I always pray that God would guide the hands of the cardiologist. Would you like me to pray for you? Who’s going to say no? No one’s going to say no.

03:31 Mrs. Thealin, you have acute appendicitis and every patient I send to the operating room I always pray that God would guide the hand of the surgeon. Would you like me to pray for you? No one says no. I’ve been practicing for ten years now and I can count on one hand the number of people who have said no; and that’s not many people. There are very few people that are going to say no if you approach it that way and this family was no different. They said, if you would pray for our son that would be great. So we had prayer. 

04:04 The problem was there was no IV access. So I can’t put him down to intubate him. So we look and look and look. The nurses can’t find anything so I have to go central. So I notice this guy has all this edema all over his body and it’s kind of strange. I can’t feel the land marks so I decide to “chicken-out” a little bit and go ephemeral instead of IJ or subclavian; and I go ephemeral. As I’m going in there, I’m thinking this is a young guy, he’s a teenager, average is about a centimeter or two below the skin and it’s just not there. It’s not there. I’m looking and looking and looking. Eventually, I hit a pocket of yellow and I’m like oh, no, I hit this guy’s bladder; but it wasn’t. It was actually a pocket of edema; just lymphatic fluid. At that moment, I stopped and with my tech and my nurse I said, we need to pray again. So we had another prayer. And they’re not Christian but they’re like okay, you’re the doctor you can have prayer if you want. So we all had prayer there and I put the needle down one inch, two inches, three inches, put it six inches to the hub and then I hit the vein. So he just had massive anasarca, put in the ephemeral line, threaded it and ended up basically getting it in. Finally, we gave him the meds and put him on the vent. When I took a look, took a chest x-ray, he just had total effusion of his left lung; but I had a lot of patients, and the ICU said we’ll take him upstairs, we can do the thoracentesis, don’t worry about it. So I sent him upstairs to the ICU. Basically the next day, of course, I wanted to know how he was doing so I came in early for my shift, I ran upstairs to go to the ICU—but before we return to John we’re going to talk about the ER in general.

05:53 I work with residents and medical students; sometimes, even in the community. We usually get third year residents or fourth year medical students and they want to see stuff that’s deadly. They don’t want to see colds, they don’t want to see flu, they don’t want to see sprain ankles, they want to see someone like John, someone who is in respiratory failure, they want to do the intubation, they want to do the central line; but I can tell you, there’s something very deadly that I see every day in the emergency department. This thing is so deadly that if I determine that you have the disease I can force the treatment on you. I can make you take the treatment and it’s under observation. I can force you to take the treatment. This is one of the very few places where the doctor patient relationship does not apply. I’m not going to keep this secret. I’m going to divulge, report, whatever you want to say. It’s interesting, in some countries—I had one patient say, it’s illegal for you to force treatment on me. Or maybe someone has religious beliefs and says, hey, you know this is not a part of my religion—some countries do allow you that choice but not in the U.S.—forced treatment, you have no rights. It is the third leading cause of death in one group of leading individuals. But it is very interesting, you’d think everyone would want to see this but my residents and medical students when they go to see the chart they grab it, look and see and they go like this, walk away and they hope that the attendee will pick up the chart or maybe some of the other medical students will pick up the chart because they notoriously avoid it.

07:34 Can you imagine what that might be? Yes, absolutely! It’s depression and suicide. You’re going to see it every single day. It is the #3 cause of death in people between ages 18 and 29, which is my target audience; my audience of ministry—many of you know that I do Week of Prayer and stuff like that—that is my audience. This is one of the things that kill them. It’s behind unintentional injuries and homicide. The reason for that is because a lot of these people are uninsured; they also end up in the ER a lot.

08:17 So, you’re going to see a lot of people in the ER with psychiatric problems. So if you went in to the ER to avoid depression and suicide, you did the wrong thing because they all come to the ER anyway because they’re uninsured. About 30 to 40% of people in the age group of 18 – 29 are not insured. That means no Medicaid, no Medicare, no private insurance, no nothing, just not insured. So they’re going to come to you. It’s interesting because it’s mostly guys, actually; 40% were male and about 30% were female. 

08:47 I don’t know if guys are less responsible. I’m not really sure, the bottom line is you’re going to see a lot of people with this problem in the ER if that’s where you work or moonlight or whatever. Now, very interesting enough, why don’t the residents or medical students want to see these patients? What do you think? Jason, why do you think residents and medical students don’t want to see “the psych patient?” (There’s no quick fix.) Absolutely! We want to intubate them; we want to pop the elbow back in, put the shoulder back in, right? High five, right? We want to fix it and get the satisfaction that we’ve helped someone, right? No quick fix. Why else do you think people don’t want to see these patients? Exactly! What are you going to say to someone who’s trying to kill themselves? Well feel better soon. How’s that going to help? That’s the frustration. Anyone else? Yes, exactly! The average ER wait time for mental health evaluation is 6 hours. Did you know that? more than chest pain, more than abdominal pain, it is the #1 time sucker in your ER and that is the last thing you need when you have a big ER. So you look at these patients, you roll your eyes, right? And you think oh, no another waste of a bed. I’ve heard people say that, right? Isn’t that true? They’re just going to sit there and waste the bed for 6 hours. Any other reasons why people don’t want to see these patients? I think that’s pretty good but I think the bottom line is—you guys kind of hit the nail on the head—is that what difference can you really make to these patients? What I’m going to tell you is going to absolutely blow your mind. It’s going to change how you look at people in the ER. It’s going to change how you look at depression and suicidal ideation. I hope forever. And I hope it will change even the way you look at your own relationship with God.  

10:48 This is a letter I got from a patient. I saw this young woman when she was 20. She had planned to kill herself and she had gone to her friend and kind of mentioned it in passing and now her friends are very concerned and they knew that she liked to party, she liked to use a lot of drugs, and so they said, hey there is going to be a big party here.  So she shows up and the friends had the ambulance and the police there waiting for her. So they had actually trapped her, forced her in and took her against her will into the ER. She had already overdosed at the time. She was already drunk and high and I can tell you, I walked into the room and it’s just like, I see this young woman and the impression that comes to my heart is this is just God’s child being flushed down the toilet and I was just so moved I said to her, I said, Do you realize you’re throwing your whole life away? You have your mom here so worried about you; you have your cousin, your sister, they’re hysterical. And you know, you have so much going for you; you’re young, you’ve dropped out of college, you have so much potential but you’re throwing it away. And I said, I’d really like to pray that God can help you turn your life around. Would you like me to do that? and so she’s all glazed over so she’s like this (laughter). She really can’t say no. So, it’s pretty convenient. And her mom is like, oh, please! Can you pray for my daughter? And that’s all I did. I spent 5 minutes praying for this young woman; but in those 5 minutes you’ll see that things can turn around. So this is the letter she wrote—now, how did she get the letter to me? She actually went online, found my name on the hospital website, then Google searched my name, found a school that I did a Week of Prayer at, sent this e-mail to that school, and then the school sent it to me. This is what it says: Please give this to Dr. Riesenberger.  

12:40 I don't know if you remember me I was 20—this is actually when she was 23, 3 years later—but I wanted to write to you to let you know how much you really did help me. I was brought to your hospital by an ambulance. I came in on an intentional drug and alcohol overdose. At the time, I was just trying to end my life. I want to thank you for sharing Christ with me and comforting my mother with your kind words. I truly believe God is using you and used you that night to impact my life forever. I would love to e-mail you again and share the entire story—so of course, I want to find this person and find out what happened. So I got back in contact with her. I found out what happened was that prayer began a cascade of events that changed her life. Now, it didn’t change right away. I put her on a 72- hour hold. You know 51-50 if you work in California or whatever. I put her in the hospital, forced treatment. And she actually escaped from the hospital twice and one time they tackled her on the way to the bridge. She was going to jump off. So it didn't, it wasn’t just roses right away. She said, but every person I kept coming in contact with wanted to pray with me. And I just thought, okay, why not? And what had happened was slowly over time, the Lord was actually able to change her heart. She went back to college, she quit sleeping around, she quit all the drugs, she went back to school to become a teacher, and by the time I saw her she was back in school, and I didn’t even recognize her when I saw her again. She was so messed up when I saw her like three years ago. When I contacted her again, it was like it was a totally different person. And here is the second letter. 

14:27 Tim, it was wonderful to see you again. Thank you for taking the time to come and visit and also for taking us to lunch—I took her and her whole family out—I would love to write my testimony and send it in. Also, thank you again for the book—I gave them a Steps to Christ, always have to follow up—I know that God is really using you in your line of work. You really touched my life and I know that you are touching so many more. I would love it if you would keep me in your prayers and I will do the same for you. I hope you're having a good week. Talk to you soon, Angela.

14:56 So I asked her cousin, tell me what happened to your cousin? And she said, It was like a dark cloud was over my cousin and now there's light. And that was from five minutes with a patient. You don't have to have a long drawn out contact with people. Just have genuine love for people. I know that at that moment the Lord was impelling me, you have to pray for my child you have to give me permission to intervene in the situation and sweep away the darkness from her life.

15:34 Now, I don't know exactly everything that happened to her. I know the last I followed-up she was engaged to marry a nice Christian guy and she was back involved with her friends, with a Christian group, who said basically, it was like night and day with her. That's her on the far right, by the way.

15:57 Now, I’m going to go back to the ER. Let's say one of your patients slips you this note, My soul is exceedingly sorrowful even unto death. Would that cause you concern? Would that cause you to perhaps be more vigilant? Maybe get a sitter for this patient, right, to be with them? But who said this? Jesus Christ said this. I’m going to change your whole paradigm about Jesus right now. And I hope to change your paradigm on how you view other people. Jesus Christ says this. Now, when Jesus was suffering the most intense agony, did He ask you to come to Him and say, Brother, how's your devotional life? or Sister, have you given up the dairy?  Sometimes we approach people like that. There having a hard time mentally and we try to offer solutions. Don't we? And there well meaning; but they are very, very wrong because what did Christ need at that time? What did he ask for? Do you know? Just be with me. Do you realize that? He said, stay here with me and pray for me.  

17:21 It’s interesting, the friends of Job, although they missed the actual whole point in the end, the first part of what they did was good. Do you realize they came to Job and what did they do, for how long? One week! Now, would you do that for your friend? If your friend was depressed, suffering would you just sit down there and just be with them? —Honey, what did you do with Job today?—we just sat—You what?—we just sat—Where? —in the ashes—What are you going to do tomorrow?—we’re going to sit—Where?—in the ashes—What did you say?—nothing.

17:53 Sometimes people don't need you to talk. They don’t need you to give them advice. They need you to be with them, to communicate to them that you care, that you love them, that’s what Jesus asked for. And I pray that that’s our answer. Now, here's a question, was He depressed? And now here’s another question, is it a sin to be depressed? Is it? Well, if Jesus had depression obviously it wasn’t a sin because Hebrews tells us that he had no sin. So that's an easy answer. But let's see if he had depression.

18:34 “The worlds unfallen and the Heavenly angels had watched with intense interest as the conflict drew to its close. Satan and his confederacy of evil, and the legions of apostasy, watched intently this great crisis in the work of redemption. The powers of good and evil waited to see what answer would come to Christ thrice repeated prayer. Angels had longed to bring relief to the divine sufferer, but this might not be. No way of escape was found for the Son of God.” (DA 73:693.3) Have you ever felt that way, that there's no way out?  Let me tell you, your patients feel that way.

19:14 “The angel came not to take the cup from Christ{s hand, but to strengthen Him to drink it, with the assurance of the Father’s love.” The angel told Him, “He would see a multitude of the human race saved, eternally saved. Christ's agony did not cease but”—what? Wow! Did you know that? Isn’t that powerful?—“His depression and discouragement left Him. The storm had in no wise abated but He who was its object was strengthened to meet its fury.” You realize Jesus was depressed? That’s powerful! What a comfort it would be to your patients if they knew that Jesus Christ was with one out of where every ten men are and two out of where every ten women are. This is popular, this is common stuff. Jesus knows what we go through by experience not just on the outside. He went through it. He was depressed. 

20:14 Now, how badly was he depressed? Well, let’s take a look. “And being in an agony he prayed more earnestly: and His sweat was as it were great drops of blood falling down to the ground.” Luke 22:44. What do great drops of blood symbolize?

20:29 Well, I’ll tell you this. I was on my OB rotation—true story—one of the fellow residents was telling me about this very complicated delivery, where this lady, she was a prime up, she was trying to push this baby out, 12 hours, 14 hours, 20 hours, 30 hours. It was horrible. Why someone didn’t do a c-section? I’m not sure.  Anyway, it was going on a long time, and then the baby started having late D-cell, after late D-cell, after late D-cell, and the nurses came over to the mother and said, Look, your baby is in trouble. You need to push like you’ve never pushed or we’re going to have to open you up. And so she screams, and screams, and screams, and the baby pops out. And then she collapses back into the bed, wipes her face, and then she goes, Ahhh! because her hand is bloody and she says to the nurse, what does this mean? And she says, It means you pushed well. (laughter) It is not symbolic!

21:34 Hematohidrosis is an actual real phenomenon. Did you know that? When you are under extreme stress there are several case reports that show that you WILL sweat blood either under great mental anguish—usually it involves fear of death—usually described as far back as Leonardo da Vinci. He observed some people, who were getting ready to be executed, experience this phenomenon. When the bloody sweat is forced from the pores of Christ, you know that He was suffering to the utmost for you and me.  

22:10 There is an unpublished study done by Hans Selye, the stress doctor, and what he does, is that he has twin lambs and he splits them into two groups. He puts one in one cage, one in another cage. And the only difference is that one cage has the mother, the other cage the lamb is alone. Now, whenever these lambs go over to the feeding trough that's in the cage, they go to eat and they get zapped. It’s not enough to kill them. And it’s not even enough to cause any permanent harm but it definitely scares them. So what do you think the lamb did that has the mother in the cage when it got zapped? Ran to the mother. Now the other lamb just runs around. And what happens was the lamb goes to another spot and never goes back to that spot at the feeding trough. So eventually what happens is they shock them over and over and over and over again. Every time they get near the feeding trough they shock them. Now the one with the mother eventually ignores the shocks. Did you know that? It just continues feeding. The one without the mother, what do you think happens? Well, yeah, you’d think it dies eventually but it actually doesn’t. In the study, it is just totally paralyzed; has a nervous breakdown. It doesn’t get up off the floor; it just shakes and twitches, and doesn’t do anything. Now the only difference in those two studies, is what? the mother. And that's where this psalm comes in.

23:45 What do you think is the most recognized Psalm in the Bible? (Psalm 23) Why do you suppose that is? Well listen to the words. The Lord is my shepherd; I shall not want. He maketh me to lie down in green pastures; he leadeath me beside the still waters. He restoreth my soul: he leadeath me in the paths of righteousness for his name’s sake. Yea, though I walk through the valley of—what?—the shadow of death,—are some of you walking through that valley? Are some of your patients walking through that valley? Now you don't walk around the valley of the shadow of death. Notice you go through the valley of the shadow of death—I will fear no evil—why?—because thou art with me;—There is so much power in having the Lord with you, and knowing that he's with you, and not even just the Lord; but even a friend. That's why it's important to just know that there's someone with you. And that lamb knew that it had “someone with you” its mother, and just that knowledge was enough to change the outcomes; but what about Jesus? How did Jesus feel? Mark 15:29-34, “And they that passed by railed on him, wagging their heads, saying, Ah, thou that destroyest the temple, and buildest it in three days, Save thyself and come down from the cross. Likewise also the chief priests mocking said among themselves with the scribes, He saved others; himself he cannot save. Let Christ the King of Israel descend now from the cross, that we may see and believe. And they that were crucified with him reviled him. And when the 6th hour was come, there was darkness over the whole land until the 9th hour. And at the 9th hour Jesus cried with a loud voice, saying, ‘Eloi, Eloi, lama sabachthani?’ Which is being interpreted, My God, My God, why hast thou forsaken me?” 

25:42 People sometimes get this advice, you know you shouldn’t want to know why or shouldn’t ask why. Did Jesus ask, why? He asked, why?!  Let the person ask “why?” Okay? Because Jesus understands; he did the same. Did he feel forsaken? He wasn’t an actor in a play. This is how He felt from the core of His being. However, what did He do with those feelings? How did He manage to stay up there? He could actually come down, right? That´s the difference between Jesus and me. Jesus, you and I, people sometimes compare and say, well it was easier for Jesus because He was the Son of God. No! It was actually harder for Jesus because He WAS the Son of God? Do you realize that? You nail me to the cross and I'm not going anywhere, right? But if they say, Jesus come down (snap of a finger) and He can come down. Desire of Ages tells us that “by the flashing forth of His divine power, He could lay his cruel tormentors in the dust.” (DA 74:700.3) Isn’t that amazing? It would be like allowing someone to beat you up when you know you can take them with one hand. That’s what Jesus did. He had the power to come down from the cross but He didn't. That’s what made 

his life even harder than yours and mine, not easier; even harder. 

27:08 “Jesus, suffering and dying, heard every word as the priests declared, ‘He saved others; himself He cannot save. Let Christ the King of Israel descend now from the cross, that we may see and believe? Christ could have come down from the cross. But it is because He would not save Himself that the sinner has hope of pardon and favor with God.” (DA 77:749.1) 

27:32 That unselfish love coming back again, right? Watch this: what was the motive that kept him there? Watch this, don’t miss it. “Three times He has uttered that prayer. Three times has humanity shrunk from the last, crowning sacrifice.”—this is an important point. Did Jesus want to go to the cross? What did He pray in the Garden of Gethsemane? Take it away! And I can tell you I have heard Adventist theologians say, if you’re on a diet and you really want a triple-decker hot fudge whipped cream sundae and you don't eat it, well that's just works ‘cuz you might as well just go ahead and eat it. Don’t eat it! Okay? Even if you feel like you want to do it. Did Jesus do what he felt? No. Remember, He says, take it away! I don’t want to go to the cross. I don’t want to be separated forever from you, my Father. He didn't feel like it. But praise God! He chose against his feelings. Don't you praise God? We wouldn’t have a chance if Jesus obeyed His feelings.—“Three times has humanity shrunk from the last, crowning sacrifice. But now”—watch this, this is the motive—“the history of the human race comes up before the world’s Redeemer. He sees that the transgressors of the law, if left to themselves, must perish. He sees the helplessness of man. He sees the power of sin. The woes and lamentations of a doomed world rise before Him. He beholds its impending fate and His decision is made.”—do you see what kept Him on the cross? It was you!!! And me!!! Jesus had the motive by focusing on others; focusing on the point of His sacrifice; focusing on the good that would come out of it. He left His feelings that were focused on Himself; that He didn't want to be separated from the Father; He didn’t want to be lost forever. He didn’t want to be out of heaven forever, separated eternally; but He took His feelings off Himself and what did He put them on? You!!! And me!!! And His decision is made—“He will save man at any cost to Himself. He accepts His baptism of blood, that through Him perishing millions may gain everlasting life. He has left the courts of heaven, where all is purity, happiness, and glory, to save the one lost sheep, the one world that has fallen by transgression. And He will not turn from His mission. He will become the propitiation of a race that has willed to sin. His prayer now breathes only submission: ‘If this cup may not pass away from Me, except I drink it, Thy will be done.’” (DA 73:690.3)

30:29 So that was His motive. Now, how did He take that motive and turn it into victory? I’ll show you. “Amid the awful darkness, apparently forsaken of God, Christ had drained the last dregs in the cup of human woe. In those dreadful hours He had relied upon”—what did He rely on?—“the evidence of His Father’s”—what?—“acceptance”—when?—“heretofore given Him.” He looked back to His baptism when God, the Father, said from heaven, what? This is my Beloved Son, in whom I am well pleased. He didn't have any evidence on the cross. So, what did He have to do? He had to look back to the evidence He had before, and that is what we can do, too. We may be going through the worst possible situation; but aren't there some good situations before? 

31:26 Same thing with your patients. You can have them look back to the evidence they have before and fix their faith there, not on the present, not on themselves. “In those dreadful hours He had relied upon the evidence of His Father’s acceptance heretofore given Him. He was acquainted with the character of His Father; He understood His justice, His mercy, and His great love. By faith”—not by sight, by faith—“He rested in Him whom it had ever been His joy to obey. And as in submission He committed Himself to God, the sense of the loss of His Father’s favor was withdrawn. By faith, Christ was victor.” (DA 77:756.3)

32:13 But what about John? Let’s come back: I'd intubated this guy. Actually, put in a central line, intubated him, sent him up, and I had expected by this time they had drained his lung, and he would be doing better. I went up to the ICU and John was dead, and I was just like, dude, he’s dead. 

32:38 I just expected the parents to be so angry with me like, we’re going to sue you. I expected them to be so livid; but do you know they weren’t?  And I learned a lesson from John that I will never forget as long as life shall live because this is actually the letter that his parents sent to me. Dear Doctor Reisenberger, We wish to thank you for the special care you gave to John and us. We know that you are an answer to our prayer and need. Everyone we came into contact with at your hospital was kind and helpful, thank you. I'm sending you John’s memorial service program; perhaps, you'd like to get better acquainted with our dear son. Thank you again and God bless.

33:29 I was just like, I don’t get it. And I was just talking to the parents. I don’t understand. Why aren’t you upset? They said, yes, we’re very sad—this is as their son is dead, lying next to them in the ICU gurney—they said, yes, we’re very sad but don't you understand what you gave to our son? I said, tell me. They said, you gave him a window of time. You see, after you intubated our son, they took out the tube—he was able to breathe on his own for a little while.  While they were doing the procedure and while they were draining stuff and trying to figure out what it was. He was able to call his grandparents, call his sister, call his girlfriend, and make his peace with God during that time. And right about that time, they realized that this was not fluid but his whole mediastinum was solid tumor, and it was crushing the great vessels of his heart, and that there was no hope for their son. Within several minutes, actually hours, after they made that realization—our son died but he died a free man and for that we are always grateful to you. And I’m just like, wow. It didn't sink in until I went to the book of Daniel and discover the three most powerful words in the Bible.

35:01 Daniel 3:14-15 you know the story. Nebuchadnezzar has a dream, head of gold, chest of silver, waist of bronze, thighs of iron. The head of gold represented Babylon and then Medo-persia, etc. etc. Now very interestingly enough after he has this dream he builds something. He builds an image in the same likeness as the one in the dream, with one minor change: the entire image is made of solid gold to represent that Babylon will rule forever and his law says, the music plays, you fall down and worship; if you don't you're toast, very simple. And as the crowds bow down in adoration there are three figures bolt upright: Shadrach, Meshach and Abednego. I don’t know where Daniel was at this time. Maybe he was on a UN sort of journey for Babylon or whatever. I don’t know where he was but he probably would have done the same thing. Now it’s very interesting “Nebuchadnezzar spake and said unto them, Is it true, O Shadrach, Meshach, and Abednego, do not ye serve my gods?”—now how long had they been in service for the King? years, right? After three years they were ten times smarter. It’s like, dude, you know we don't serve your gods. You’ve known from like day one or day zero that we don't serve your gods. It wasn't that Nebuchadnezzar didn’t know this; he was mocking them. Don't you serve my gods or worship the golden image which I have set up?—“Now if your ready at what time you hear the music”—I’m going to give you another chance—“fall down and worship the image which I have made; but if you worship not”—Ellen White tells us that as he spoke, something happened—“you shall be cast the same hour into the midst of a burning fiery furnace and”—she says that he raised his hand in defiance to heaven and said—“who is that God who shall deliver you out of my hand?”—now what’s their answer?—“Shadrach, Meshach, and Abednego answered and said to the king, O Nebuchadnezzar we are not careful to answer you in this matter. If it be so”—if that’s your decision—“our God whom we serve is able to deliver us from the burning fiery furnace, and He will deliver us out of thine hand, O king.”—here's the three words BUT IF NOT—“But if not, let it be known unto thee, O king, we will not serve thy gods, nor worship the golden image which thou has set up.”  

37:59 You see, it's very easy to worship God when things go well. It’s very easy to have faith and confidence when all your patients do well; but when they die where is God?  Where is your faith? Shadrach, Meshach, and Abednego understood the three most powerful words in the Bible are not ‘God is love,’ ‘Jesus what ever,’ it’s: ‘but if not.’ 

38:28 If God saves us, He is God; but if we roast, He is still God! And we will still serve Him! That is power, and that shows that your faith is real, and that will show your patience that your faith is real. When God is still God when everything doesn't make sense, when everything falls apart, where's your faith? Where is your hope? Is God still love when your patient dies after all you did for him? And I can tell you, I learned that truth from John that day in the emergency department that sometimes life isn't about good outcomes, sometimes life is about a heart change. Sometimes you ask for life, but God allows death because sometimes that is the best outcome, because John died a free man. He made his peace with God in a few moments by God’s grace I was able give him. And that's all he needed. And sometimes in our lives we’re going to face disappointments. We’re going to face patients that don't make it. We’re going to get a lot of bad outcomes. But I can tell you with my whole heart I'll never forget the lesson from that young teenage boy that sometimes the things that seem the worst are really the best.

40:07 You know, I had a young woman that I had been dating for over two years and I loved with all my heart and she loved me with all her heart—wait a minute, we weren't dependent on each other, that was the last lecture—So we loved each other very much, probably selfish love; but even so, I realized at about the two-year mark in our relationship that there was something there that the Bible and Spirit of Prophecy made very clear that I had to end the relationship and let me tell you this was the hardest decision I've ever made in my entire life to walk away from the woman I love. And I remember, this was a year later, I had a friend of mine she was down in Loma Linda, they had taken me out to dinner. Tim, would you ever love a woman more than you loved your girlfriend? and I said, I don’t feel it but by faith I say, yes, because God never will take away something good without giving you something better in return and I may have to wait until heaven for that something better. I may not ever have someone in this life but God, I believe, will give me something even better than that relationship and I can have faith that God knows what He's doing in the good times; but He’s still God in the bad times. 

41:33 I can tell you when that point is reached in your faith, you will be in Christ so solidly that it will affect everyone around you. It will affect your patients because the proof to them that God is real is not that you’re a Christian when things go well, the proof to them is when your life is swept away and you like Job can say, the Lord giveth and the Lord taketh away blessed be the name of the Lord. And mean it. That is more powerful than any evidence. Did you know that the greatest evangelistic tool in the Middle Ages was the martyrs’ pile? Did you know that? 

41:17 When these guys were roasting alive on these piles of wood and would be singing hymns to God dozens of people in the audience would give themselves to Christ right there because they knew it was real; because these young men, young women were dying for their faith. They knew that God was God even though they had to pay the ultimate price for their faith. And I pray that you would not only bring that faith to your patients but also embrace that for yourself that when times are tough that you would realize that that moment is the moment of greatest faith for you; that you can prove to all the on looking world that God is God in your life; ‘but if not,’ you serve Him anyway.

43:13 This is actually a poem that I’ll close with. This was written by a 15 year-old girl who went through a very devastating experience and heard this presentation. This is the poem that she wrote as a result. And I'll close with this and I’ll ask that you close your eyes and just meditate upon this for yourself, for your patients, for your life. It's called But If Not.

43:41 I'm trusting Lord, in You whatever is Your will to do
Send grief or pain or suffering; just send me a song to sing 
I know Your power to deliver in love; You rule all the universe above
I know all things will work for good; and yet, ‘but if not,’ 
By Thy grace I will serve Thee; by Thy love I will serve Thee. 
I cannot look to tomorrow; only today 
All things will work for good in Heaven, someday
My belief cannot be based on my trials; You're coming in just a little while 
Though the night may seem cold You know the way I take; I will come forth as gold
Until then, help my faith not to waiver in light of eternity, forever 
Help my belief to stay strong; even yet by Thy grace may I say, ‘but if not.’

43:42 Let’s kneel for prayer. Loving Father in Heaven, Lord, I just want to thank you for the great honor I had of being the last one to care for John before he closed this life Lord, thank you that the words that he taught me, his legacy will always live on in my heart and through all of the hearts of the people I touch as a physician, as a friend, as a brother, as a boyfriend, as a preacher; and Father, I pray that his death would not be in vain for any of us just as Christ’s  death would not be in vain; but that we would learn the lesson of the three powerful words in the Bible that you are God no matter what. May we be able to say that we love you in good times and say that we love you “but if not.” Lord, I pray that whatever my fellow colleagues are going through right now, may they know that you are in control of their life and you are in control of this whole world and universe and you ultimately will bring about what is best for their life. No matter how it looks to us Lord, give us strength, gives courage, give us inspiration when things happen well, like in the life of Angela let us rejoice; but when our patients die, like John let us still rejoice; because they can die in hope. We pray in Jesus’ name. Amen. 

This media was produced by AudioVerse for AMEN (Adventist Medical Evangelism Network) if you would like to learn more about AMEN please visit www.amensda.org or if you would to listen to more free online sermons please visit www.audioverse.org.

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