From Death to Life

Pastoral visit in 2006

In 2001, Dr. Rafael Maradiaga had a busy medical practice and was assistant pastor of his church. A recovering alcoholic since 1988, he had accepted Christ 1991.

On Thursday, June 21, he was providing free care at the John F. Kennedy School in Tegucigalpa, Honduras. This was part of a series of medical brigades in schools which he organized in cooperation with Roberto Granados, the superintendent of schools.

Suddenly he began to feel strange. He noticed his hands were shaking, then he started having severe chest pain. He felt dizzy, “foggy in the head.” Roberto noticed that his speech was funny and asked him what was wrong. “I’m tired,” he replied, “Can you take me home?” In his home medical office he had his nurse give him an injection of steroids and vitamin B12, and took an aspirin and said he was going tobed. But when he tried to walk, he fell towards the left.

Roberto took him to a clinic where they found his blood pressure to be sky-high. The next thing he remembers was being at the public hospital with his left side completely paralyzed. A CAT scan that day showed no abnormalities (typical with a stroke; the tissue damage can take up to a day to appear.) Patricia, his wife, paid 8000 lempiras (about $400) in cash for medicine and 9,000 lempiras (about $450) for the CAT scan.

On Friday the doctors recommended a second CAT scan. The Maradiagas had used up all their reserves. Patricia went out to her car (worth about 120,000 lempiras) and there was a man looking at it. “Do you want to buy it?” she asked, “I’ll sell it to you for 25,000 lempiras." The transaction was finalized the same afternoon. The Maradiagas haven’t had a car since.

The second CAT scan showed a half-dollar-sized area of stroke on the right side of the brain, affecting the muscles and the area that controls emotion. His blood pressure was still uncontrolled.

Rafael was sure he was dying, and everyone else agreed that he was done for. Only Patricia’s brother Oscar Manuel scoffed, “You’re not going to die! What you need is to go to the mall!

On Saturday he begged Patricia, “Please get me out of here, I don’t want to die in the hospital.” She was reluctant at first, but it wasn’t even clear that he had gotten the medicines she had paid for, and even if he had they weren’t working. She thought to herself, “They are not doing anything for him here that we can’t do at home,” and as respecting his last wishes, she agreed.

The doctors were aghast. They begged him, “Please, Doctor, don’t leave,” offered to transfer to a private hospital. Dr. Carlos Marenco, who had been Rafael’s senior resident in his internship, sketched horrific scenarios of what would happen if he left. But he remained firm and signed the form to leave against medical advice.

They took Patricia aside and tried to prepare her for the worst. Wheelchairs, hospital beds, he would need all the trappings of illness. When she got him home, she said, “I’m not going to believe the devil,” opened all the curtains to let in the light, started working with the paralyzed limbs, and told the whole family, ¨we don´t need any weeping and wailing here. Dad´s going to be fine.¨

Rafael was scheduled to lead a home group that night, and his sermon was already prepared. To everyone’s surprise, he still wanted to preach. “If I don’t preach the gospel, I will die.” So they put him in a wheelchair, and someone held the mike for him, and he preached the sermon. His speech was so distorted that no one could understand a word; they just wept to see him like that.

Dr. Marenco visited him at home and immediately changed all his medications. The blood pressure oscillated wildly, and it took a lot of time and effort to finally get it under control. What remained of the money from the sale of the car was soon eaten up by this. Dr. Marenco told him, “You will have to die to live,” meaning stop working as a doctor; he had been pretty much a workaholic since he stopped drinking.

He continued preaching the gospel, and twenty days later he was able to walk, even to go down stairs. Dr. Marenco was surprised by his progress and immediately sent him to rehabilitation. His friend, orthopedist Dr. Otoniel Molina, who had visited him in the hospital, called it a miracle.

Rafael had twice heard the call from God to be a pastor , and each time he had said, “No, I don’t want live on tithes and offerings.” Even Oscar Manuel had told him, ¨You´re the real pastor of this church, not him.¨

There’s a saying in Honduras, “What doesn’t get in through here (point to ear) has to get in through here (mime blow to head.)” Rafael now knew in his bones that he had to obey the call. To this day, he says, if he doesn’t preach the gospel he gets twisted up and mute.

His premonition in the hospital, and Dr. Marenco’s words, were absolutely correct. He was dying and did have to die—to himself—so he could live in and for Christ. The stroke (= 'blow') hammered home for him how worthless, how death-dealing, had been everything he had been striving for before. He really did pass from death to life. He says that it was the mercy of God, because if he had had any more worldly successes he would never have accepted the call to be a pastor.

During his recovery, the house was always full of people, and he was continually preaching. Not being able to go out, he thought, ¨Why not take advantage of this? So he formed Ministerio Cristiano Jehová Rafah.

During this time, he received a call on his (disconnected) telephone. His friend Guillermo Giraldo, a messianic Jew, said ¨I´m coming over.¨ When he arrived, he asked for oil, and there being none, he took water from the reservoir and anointed Rafael as pastor. ¨I knew you were the real pastor of that church,¨ he said.

descending the mountain
after the visit

Oscar Manuel did take him to the mall, and even gave him a puppy. Life was not easy in the years after that, but God has been faithful to provide for his servants. He still does volunteer medical brigades as part of his pastoral work, despite almost constant pain in his feet. And I can testify to the fact that he still just can’t keep from preaching.

Organ Recital

March 15, 2005

Over the years I have noticed that people often come to the doctor with a list of problems. One-stop shopping, I’m sure they are thinking; let’s get everything taken care of at once. I can relate to that.

The trouble is, human beings can’t give full attention to multiple things at once (no, not even doctors!) There is actually a concept in learning theory that explains why the brain can’t work that way (although I can’t remember the term right now!)

And of course, folks don’t always mention the most important or serious thing first, or at all, even if they know which is most serious. I once treated a lady who was having a heart attack, but all she cared about was her headache!

During the medical brigade, the patients could access only one service a day. They had to choose between medical, dental and optical. If they wanted another service,they had to come back another day and wait in line again with no guarantee of getting in. So they had to decide which was most important.

Most of them had one or more of about 10 symptoms:

1. Loss of appetite and abdominal pain – diagnosis, parasites
2. Headache – diagnosis, chronic low grade dehydration and heavy physical work, including carrying heavy loads on the head
3. Sore throat, coughs and cold symptoms – mostly viruses and allergies.
4. Pain in the bones – ditto heavy physical work
5. Dizziness – ditto dehydration
6. White blotches on the skin – superficial fungal infection – unsightly, but harmless
7. Skin ‘allergy’ – a non-specific rash that I had no clue about
8. Acid stomach
9. Exertional chest pain and shortness of breath walking up the mountain that Villa Nueva sits on – angina pectoris. Take these baby aspirins until they run out in 30 days and be sure to sit down and rest until the pain goes away. (!!!)
10. Asthma. There’s a lot of wood smoke from cooking in addition to considerable smog.

It was pretty routine to see a mom and a ‘passel’ of kids, and 'laundry lists' of symptoms were the norm. I always started with the baby and worked up to the mom in order to minimize the confusion in my brain. One day I saw a family of 7 – mom, 4 kids, and 2 nephews. Each of them had at least three complaints – some had more. It was late in the afternoon, I was already tired, and the almost-equatorial sun was beating in on us. Fortunately, none of them was really sick. Anti-parasitics, Tylenol and vitamins for all, and they were on their way. Meanwhile, I was toast – cross-eyed with mental fatigue.

So on the next to last day in the afternoon I had already worked through a lot of these families, and another one was in my cubicle. I’d finished with the two or three kids, and mom was giving me her list. Headache, pain in the bones, parasites, dizziness – maybe there was more; it’s all kind of a blur.

And oh! by the way, is there any chance of seeing the dentist? I lost a molar recently and I have a lot of pain, I can’t sleep at night. It just broke off, leaving the root behind.

Believe me, it’s all too easy to tune out towards the end of the list. By the grace of God, that last snapped me out of my fog. Have you had fever? I asked. Yes, she had. I looked in her mouth and winced. The socket was full of pus and the gums red and swollen. We had stopped giving out tickets for the dentists (they pulled hundreds of teeth; the record was 29 from one person), but I was worried about the retained tooth fragment – a wound can’t heal properly with a foreign body in it.

I stepped out to consult with Joe, one of the dentists. He immediately offered to come and look at her. “Oh, yes, that definitely needs attention. I wish she had come earlier in the week so we could load her up with antibiotics beforehand. Give her two grams of ampicillin today and something for pain and have her come back first thing in the morning.”

I was grateful that he was willing to add her to an already full caseload. I begged a dental ticket from Bob and gave her a big bag of horse pills. Shortly thereafter, we finished for the day and I went home and passed out.

The last day was just as busy and exhausting, but when we were done I thought about her again and tracked Joe down to find out what had happened.

Oh yes, he said, it was a good thing she had come, because it wasn’t just an abscess in the soft tissues, but osteomyelitis – infection actually in the bone, from where it can easily get into the bloodstream and cause a catastrophic infection. She could have been dead in two weeks without treatment, he said.

Ay, carumba! It´s a good (God) thing that my numb brain woke up to pay attention to what she was telling me! Those kids definitely did not need to be losing their mama at such a young age.

For the Pleasure of her Company

March 13, 2005

For the pleasure of their company

British Medical Journal, August 2004

It was a normal day in the office, nothing exciting, the usual complaints. Patients came and went. On looking back, however, I find that three patients stand out.

One patient gave me a hug, another told me that I was the best doctor in the world, and the third played a song for me with great care and feeling. Such encounters are not common; in fact they are unique. The hug was given before I had time to anticipate it; the compliment was well meant without any hidden agenda; and the song—well, that was quite a treat on a gray winter morning.

It so happened that all three men had Down’s syndrome, and any concern about having a too familiar relationship with their doctor wouldn’t cross their minds. What they also had in common was their total dedication to and enjoyment of the moment, of an encounter with me. I know they will bring the same quality of human awareness and directness to the next person they meet, and the next doctor will be the best ever. These three men, with ages from 22 to 60, are all healthy, have a good lifestyle, don’t have many worries, and take pleasure in family and social life. In short, they are a delight to meet.

On reflection, I feel troubled. These are exactly the people whom we medics try with all our skills to prevent being born. What is so awful, so dreadful about their destiny that it is not worth living?

The likelihood that one of them will commit a crime or become a drug addict is quite slim. All three are in need of guidance, which will cost society less well spent than on the military or the new parliament building in Scotland? And I even refuse to believe they give their family so much heartache, after the initial shock at birth.

I am in the unusual situation of seeing patients with Down’s syndrome quite regularly in my office, as more than 3% of our practice population have this condition. And I can tell you, I don’t mind a bit.

Marga Hogenboom, general practitioner
Camphill Medical Practice, Aberdeen, UK

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As a doctor providing care to pregnant women, I have counseled many about the “standard of care” prenatal testing available for Down’s syndrome, spina bifida, and related condtions. The main purpose of such testing, of course, is to allow such children to be aborted at an early stage of pregnancy.

I saw Lesbia and Raquel on the second day of the brigade. Mama Lesbia was better dressed and better educated than most of those we were seeing. She was able to afford medication for her hyperactive thyroid. Little Raquel is about 4 and just exudes personality. She was smiling at everyone as they waited in line and hopping around on her little brace-clad legs with great enthusiasm, helping Mama keep track of little brother. Raquel has spina bifida, a congenital problem of the spinal cord that produces various degrees of paralysis in the legs. She has a 10-year visa to go to the US for medical treatment, and is scheduled to go to New York as soon as mom’s visa comes through.

I think I ordered some Tylenol and vitamins for various minor complaints. Then Lesbia asked me if I had anything for nerves. My antennae went up. She’d been having problems with anxiety ever since Hurricane Mitch. In my experience, the enemy likes to use emotionally traumatic events to implant death-dealing beliefs in our minds. These are often below the conscious level and anxiety symptoms are a frequent result.

I wanted to pray with them, but I wanted a native Spanish speaker to help me so as not to miss the nuances of Lesbia’s story. I asked Evelyn Klingler, one of the missionaries sponsoring the brigade, to step in and join me. I had already had opportunity to work with her and knew that she has great spiritual discernment.

Lesbia told us about attending a healing service with Raquel in her wheelchair. “Tell them what God said to you, Raquel,” she said. Little 4 year old Raquel, without any shyness, told how God had spoken to her, telling her to get up and walk, and she did. This gave me chills, of course!

Turns out Lesbia was pregnant with Raquel during Hurricane Mitch and she suffered a fall. I don’t know whether she misunderstood her doctors or what, but she had been believing all this time that she was responsible for Raquel’s condition. Her family also blamed her. Who wouldn’t be anxious believing that!

I had Evelyn explain to her that spina bifida is a congenital problem originating at conception, unrelated to trauma. More importantly, we prayed for God to show her the truth and deliver her from the spirit of culpability that had been tormenting her all these years.

While we were praying, I had a strong sense that Lesbia and Raquel are to have a ministry to women considering abortion in the United States, and that the enemy had been trying to frustrate this with his lies. I shared this with Lesbia and told her about children like Raquel being aborted, and she was shocked!

Seeing Raquel with her joyful heart and strong spiritual gifts, I thought of the other Raquels, the other Einsteins and Schweitzers and Ghandis and Beethovens and Mother Theresas that this world has been deprived of by abortion.

I’m just grateful that I get to have the pleasure of Raquel’s company on this earth.

Hope

March 12, 2005

The first day of the brigade a 40 year old woman came in with a chronic ulcer due to severe varicose veins on her right shin. It started as a bug bite, she said. Most patients with this kind of ulcer in the U.S. are in their 70´s and 80´s.

My first question was, How many kids do you have? Six. Pregnancy is the usual cause of severe varicose veins in younger women. (The other leg had no varicose veins at all, which is often the case.)

She’d had it for over a year, and had been treated with antibiotics several times to no avail. The ulcer was slightly inflamed because of the body´s efforts to heal it, but it wasn´t then, and probably hadn´t ever been infected, since she was otherwise healthy and not a diabetic. In any case, antibiotics would only be an adjunct, to clear up the infection, not to heal the ulcer.

The treatment this woman needed was not high tech. She needed a weekly leg wrap with a zinc oxide-impregnated bandage for several weeks to months. The ointment would keep hard scabs from forming and allow new cells to grow into the ulcer. The foot-to-knee wrap would keep blood from pooling in the swollen veins and causing fluid to leak out into the tissues, resulting in swelling that impedes the arterial inflow needed for healing.

At home, I have these patients come in once a week to have the bandage changed by the nurse. Not rocket science. The bandages themselves only cost a couple of bucks. But they do need to be wrapped carefully and they need to stay on continuously between visits.

My heart sank. Even if we could find the bandage and teach her how to wrap it properly, how was it going to stay in place during a week of walking the dusty dirt road up the mountain? Our elderly patients at home can watch TV with the leg up and drive to the office. This lady had to go and stand in the market every day to support her family. Furthermore, even a few bucks was beyond her reach. And even covered with something, that ointment would attract dirt like crazy. It seemed like such a tragedy that there were so many obstacles to something so fundamentally simple. It´s not a heart transplant, after all!

As we talked, she began to cry and express her fear that it would never heal. I was afraid of the same thing. I really felt discouraged and hopeless. I asked her if we could pray, because I felt we needed a miracle. I had tears in my eyes as I prayed that God would heal her body, mind and spirit. Then I was led to pray that he would provide whatever resources were necessary to heal her.

Well, this prayer changed me. The feeling of hopelessness left me, and I went out to confer with the team about what we had on hand. Nurse Ruth soaked the leg and did a beautiful job removing all the dead tissue (anesthetic provided by the dentists!) while I saw a few more patients. The wound was not as deep as I had feared, PTL! We had a small supply of antibiotic ointment in the pharmacy, and an ace bandage provided the means to counteract the elevated hydrostatic pressure in the leg that was preventing adequate blood flow from reaching the wound to heal it.

Since it was the first day, I told her to come back on the last day so we could re-dress it at least once. She left, smiling, with her return ticket in hand.

On the last day she returned and we re-dressed the wound. It was too soon to see any change, but at least the bandage had stayed on reasonably well.

Ruth and I did our best to explain the how and why of the bandages. We strategized about some things she might use when our supply of two whole Ace bandages lost their stretch and the antibiotic ointment ran out. Petroleum jelly and strips of clean cloth would serve the same functions.

I don´t know how much she understood, or whether she could even afford Vaseline - oh, if only I knew how to find a parish nurse in this barrio! But we did our best with the resources we had. I know she felt greatly encouraged by our efforts and attention, and I am trusting that God will take care of the rest.

Medical Brigade

March 11, 2005

When I got to Honduras in January, I wanted to contact my friend Rick, but I didn’t have his phone number. So I emailed him and asked him to call me. The next day, feeling stir-crazy, I decided to take a walk around the neighborhood. As I came to the end of the street, I heard an American voice calling my name! Lo and behold, there was Rick! I accompanied him to the Internet café (he had yet to receive my email), where we ran into Sister Patricia, wife of Pastor Rafael whom I had heard of but not met on my previous trip.

Pastor Rafael is also a doctor, and a day or two later Rick introduced me to him. We talked about the medical needs in Honduras for a while, and then he said, about the brigades, “We serve much, but help little.” This articulates very well both my frustration and my commitment.

I’ve been on a couple of medical brigades in Honduras before now with the University of Cincinnati, but I had very mixed feelings about them. My Spanish wasn’t good enough to really understand what people were saying, and the translators were young teenagers from a different social class, so although they understood the words, I knew they were missing nuances. I didn’t feel I could really connect with the people, and from the medical standpoint, the needs were so great, and our resources so limited, that it was painful.

Anyway, Pastor Rafael invited me to join a brigade in February. This group was from Health Care Ministries of the Assemblies of God and was run by some very seasoned people. Bob McGurty, fresh from surviving the tsunami while on vacation in Thailand after many years in Bangladesh, was our fearless leader. (Basically, he and his family survived because they were visiting him in the hospital after he had had a motorcycle accident! When I met him, he was still moving slowly because of a fractured rib.)

“We’re field-driven,” he told me. “We only come in by invitation from local churches.”

This time they were invited by American missionaries Sam and Evelyn Klingler, who are part of a world-wide Assemblies of God ministry of evangelistic tent meetings. The medical brigade was planned with the evangelical churches of a poor barrio creatively named Villa Nueva (New Town), in conjunction with a two-evening revival at the host church, Gate of Heaven.

Bob and head nurse Peggy Johnson and the team of about 25 doctors, dentists, nurses and pharmacists from all over the US had been at the crematorio (city dump) for a few days before I hooked up with them. They had quite some stories to tell about ministering to the people who live there – like how the folks were in competition with the vultures for the garbage!

Bob oriented me to the system. Preprinted cards were used for charting. At the bottom of each one was a series of checkboxes:
• Under 5 years,
• Believer,
• Saved today,
• Healed, and
• Other.

After the medical evaluation, everyone was directed to the consejeria (counseling area) to talk with the volunteers from the local churches and to receive prayer if desired. Nobody could get their medicine from the pharmacy without passing through the consejeria! (Kind of a no-sparrow-shall-fall approach…)

It was gratifying to know that the whole team was on the same page in wanting not only to provide medical treatment to the best of our abilities and resources, but more importantly to offer the people the chance to get hooked up with Jesus, the only one who can shine light in our darkness and fill the big empty hole we all have inside.

So it was very easy to share the love of Jesus with the patients in words as well as in our actions. My Spanish is now good enough that I can usually understand what is going on, and I mostly worked without a translator. I asked everyone if they knew Jesus and checked the appropriate box. Most said they were believers, but I did pray with a few who were willing to receive Christ. (I know God will forgive the halting way I pray in Spanish – all those petitions are supposed to be in the subjunctive mode – arrrgh!) Others, who wanted prayer for healing, I prayed for in English - tongues, after all!

Our pharmacy consisted of anti-parasitic medications, various antibiotics, acetaminophen, ibuprofen, topical steroids and anti-fungals, vitamins, cold medications, a small supply of antihypertensive and antidiabetic medication, and not much else.

Most of what we see is either so minor as to not really need much treatment, or so major as to be beyond our resources. Although I passed out a lot of antibiotics, probably less than five of the hundred and fifty patients I saw actually needed them. (A really nasty tonsillitis and an infected jawbone are the ones that come to mind.)

The anti-parasitics were probably more widely needed, although of course we didn’t have any diagnostic testing available.

Then there was the diabetic who hadn’t been able to afford insulin for the past six months… not much to do for her, our supplies of medication would only last her a few weeks at most. That’s not going to make much of a dent in a life-long condition…

These folks buy Tylenols one at a time, so they are eager to have the opportunity to receive medications and vitamins. I was very willing to oblige, under the ‘serve much’ principle, but I was relieved on this brigade to be able to routinely and openly access the unlimited healing available through Jesus Christ. It’s easy to forget him when we see our medical treatment working effectively, but for those who are more worried than sick, and those for whom we can do nothing medically, the need is more evident.

Listening to his Heart

December 27, 2004
I’ve been a member of a group that meets for prayer, fellowship and study for over a year now. This fall we were studying a book on healing and I was working at a rural Veteran´s Administration primary care clinic. I was telling the group about performing evaluations for the Agent Orange registry, and how so many of the vets are wounded – mentally, physically and spiritually. After the discussion, Lynn really had a burden to pray for me and my ministry, and who was I to say no? I couldn´t recall anyone else in 18 years of practice ever asking to come alongside me in my ministry of healing as a doctor.

I had shared a couple of the most striking stories with the group, but I was not surprised that after they laid hands on me the patient care was incredibly ordinary, mundane, and unexceptionable. I finished up my main stint at the VA and came back home for Thanksgiving. I was scheduled to work a few extra days in December to help with the vacation coverage. The first week back I was able to clean up a large backlog of charts AND preview all the computer records for the first day of the second week.

So as I drove up the second week I was feeling pretty good that I wouldn’t be missing anything important due to a backlog of charting. As I drove I was remembering the group’s laying-on of hands and smiling to myself about how nothing unusual had seemed to happen afterward. I arrived at the clinic just as they brought the first patient back. After I had seen a couple of guys, my nurse came by to inform me that the next guy was having trouble breathing. (I knew what that meant – an at-least-60-minute visit in a 20-minute slot and therefore a significant derailment of the schedule. I rolled my eyes but I wasn’t really upset; I’d already had to admit 2 or 3 supposedly stable “routine follow-up” patients directly to the hospital from the clinic during the earlier stint and I knew it was always a possibility.) So, even before I saw him, experience was telling me that I’d be admitting him as well because he likely was having a heart attack.

I walked over to the treatment room to start evaluating the patient. “Fred” was lying on the gurney with his eyes closed. He was in his late 70’s, and I knew from my previous chart review that he, like the majority of the patients there, had a personal medical history that put him at high risk for heart attacks – diabetes, elevated cholesterol, age, etc. He was accompanied by a daughter-in-law who appeared to be in her early thirties and a granddaughter who couldn’t have been much over five. I started taking the history from Fred. He’d come back to his son´s house the night before after taking refuge with other relatives when the power went out during the ice storm. The daughter in law had noticed he seemed short of breath. The day of the visit he barely made it in from the parking lot up the stairs, and finally gave out in the hall before he got to the reception desk. And by the way, he was having pain in his neck.

Fred kept his eyes closed while I talked to him, and he kept saying “I’m sorry” and “Don’t be mad at me.” Whenever he said that, his daughter-in-law would reassure him that no one was mad at him. This must have happened at least 25 times during about 30 minutes. I began to get curious about what was behind it.

After I got the history, I put on my stethoscope to listen to Fred’s heart. Just as I touched his chest he began to sob loudly. Alarmed, I pulled back, thinking perhaps I had startled him by touching him without warning. No, that wasn’t it, but he couldn’t tell me what it was. “I just feel like bawling lately! Help me, help me, Jesus,” he said. I asked him if he would like me to pray with him. “Yes,” he said, and so I took his hand and prayed that Jesus would bring him peace and healing.

I went ahead and finished the physical exam, then was moving back and forth between charting and writing in the computer and asking additional questions of Fred and his daughter-in-law. Fred continued to say “I’m sorry, don’t be mad, help me Jesus” at frequent intervals, as well as to tear up and contort his face with emotion.

I asked his daughter-in-law if he’d always done that. “I’m sorry” was frequent, she said, but the crying was something completely new. She continued to reassure him when he said “I’m sorry,” but I started using some reflective listening each time he said it. “You’re sorry?” “You’re worried that someone will be mad?” His responses when I checked things out in that way were only marginally more communicative – nothing that gave me any clue about what the crying and all was about, but I kept reflecting back everything he said.

I finished my charting and orders and checked back with Fred about the pain in his neck, which I thought was angina because a lot of times diabetics don’t get actual chest pain with a heart attack. Six out of ten, he said. I asked the nurse to get a nitroglycerin tablet and I stood by the gurney to wait for her to bring it.

Fred teared up again and I had a sudden thought. (Three months at the VA had sensitized me to the prevalence of post-traumatic stress disorder in World War II vets.) I looked over to the daughter-in-law. “Where did he serve?” I asked. Just at that moment, he began sobbing and pouring out this story:

He had been in Okinawa, and the Japanese troops were trapped by the Allied forces. Rather than be killed by the Allies, they committed hare kiri (suicide). Fred felt responsible for their deaths and was now sobbing out his grief and guilt for the first time in over 50 years. (His daughter-in-law said he had never spoken of it before.)

I reminded him that the Bible says “if we confess our sins, he is faithful and just to forgive us our sins.” I led him in a prayer of confession and then asked him if he could forgive himself (he was having a hard time with this) for the sake of showing his granddaughter the way.

At this point another nurse came in preparatory to transferring him to the inpatient ward. She saw what was going on and came right over to help. “It’s all been covered by the Blood – it’s all taken care of," she told him. We continued to pray and talk to him for a minute or two.

Finally the first nurse returned with the nitroglycerine tablet. “How’s your pain now?” I asked. “Two,” he said, appearing more relaxed than he had previously. He took the nitro and 5 minutes later the pain was gone.

I looked over at his daughter-in-law and she was dissolved in tears. The first nurse was hugging and comforting her. The granddaughter was standing stiff and staring straight ahead. I went over and asked the little girl if she was worried. She didn’t speak or look at me. “You know how you feel better after you cry? Mom and Grandpa feel better just the same way.”

The transport team came and took Fred out on the gurney. The daughter-in-law said to me, “He’s never talked to us about any of that. How did you do that?”

“Well,” I said, “I used active listening to hear what was in his heart. You’ve probably noticed that when you tell him no one is mad at him, it doesn’t really stop him saying it?”

“Yes, that’s true.”

“When people keep saying things like that, there’s something behind it. I got curious and started reflecting back what I was hearing so he would know I was really listening. It’s not that complicated, but it’s not something we get taught in school, and it’s especially hard with family members. I can show you how to do it, though, if you want.”

“Oh, yes!”

“Well, there are three parts. First, you use a tentative opening, because you’re checking to see if you heard correctly what the person is saying. You say something like, ‘so, are you saying’ or ‘am I hearing you say…”

I got a paper towel and a pen and wrote down
1. tentative opening
2. thought content
3. feeling content.

“The second part, thought content, means “what the person is thinking.” For example, ‘someone will be mad’ would be an example of thought content. Then the feeling content is the person’s emotions about that. Sometimes they don’t say them out loud and you have to guess, like ‘you’re worried that someone will be mad at you.’ When you use all three parts, the person knows that you’re really listening and he feels safe to tell you more.”

I handed her the paper towel and said with a smile, “It works really well with husbands and children. I’m a little worried that your daughter may have been upset by all this. You might want to use this to talk to her.”

She got up to go. “Thanks so much,” she said. “You’re welcome, and God bless you,” I replied.

I left the treatment room asked my nurse about the rest of my patients. “You had two more scheduled,” she said. “One called to cancel and the other is a no-show.” It was 11:30 am, and I had finished up exactly on time. God had answered my prayer for Fred to experience peace and healing and I was privileged to be His instrument in fulfillment of the prayers of my small group.