Ramblings: What is Wrong in Healthcare in America, One Facet, the Issue of the Dark Matter of Medicine

Conversations, either online or in person, are typically where my ramblings are conceived. I had such a conversation recently with someone who thought the COVID-19 closures of our society are ridiculous. His point was, we are all adults and therefore we should have the freedom to make our own decisions about our health. In a Darwinistic way, you could say what he says makes sense, that those who take the greatest risks are most likely to get sick and even die. I pointed out to this man, however, that if he gets sick, he will go to the hospital and then all these teams of caring frontline people will have to put their lives and the lives of their families at risk in order to save his. Not only that, he will be exposing a lot of people along the way, including his own family and the public. But his response took me by surprise. He said he did not care if he was responsible for killing everyone in the “healthcare industry,” because he hates them all (which, I guess, includes me).

The conversation above ended at that point, so I do not know what this man has experienced in his life that created this level of bitterness toward our entire healthcare system. But most people agree that there are problems within it, especially here in the US. Maybe, in these days of the COVID-19 global pandemic there is more benevolence toward our healthcare providers than in more typical times (save this one man I talked to), but we do know that there are problems and those problems will come to the surface once more when this is over.

There has been a copious amount of material written and views expressed about what is wrong with the healthcare system. These views come from the perspective of a variety of people including politicians, physician groups, patient groups, insurance companies, and others. They each carry a perspective and an agenda. It is like the proverbial story of the group of blindfolded people examining an elephant and describing what they feel.

Amazon.com: Healthcare Is Killing Us: The Power of Disruptive ...

I think I bring to the table a unique perspective as having a 38-year career in the practice of medicine as a PA, and now a high consumer of healthcare. Before I was sick, I rarely used the healthcare system as a patient and took no medications. The other thing I bring to the table is that I am very candid. I say things that are true, even if people do not want to talk about them. But with that said, the main point I am going to make in this article is not “The” problem with healthcare, but one of at least one hundred issues that could be raised.

The Dark Matter of Medicine

The brightest astrophysicists have no clue what dark matter (or dark energy) are, however, these entities make up 95% of the universe. But they do know it is there, mostly by its gravitational fingerprint on everything else. Modern medicine has its own version of dark matter, and that is the great complexities of our human body including the vast number of things we know and the humble admiration for the even greater things we do not.

The science of medicine was built on the shoulders (to loosely borrow an idea from Newton) of giants in the field of biomedical research. We have come so far in the past one hundred years that it is mind boggling. It was less than 100 years ago when penicillin was discovered, which revolutionized medicine at that time. However, seeing an area of bacterial clearing on a petri dish around mold (the essence of how penicillin was discovered) is at the level of a middle school science fair. We are light years beyond that now.

This profound knowledge of biological systems also exposes the vastness of the biological universe that we still do not understand and that is the real dark matter of medicine. As far as we have come, we are only standing waist-deep on the shores of the Pacific Ocean looking out into the vastness of the abyss. This has never been clearer to the public than during the COVID-19 pandemic, when there is frustration that we do not know more about this novel (new) virus, and yet, amazed about how much we do know about viruses in general.

We have long ago gathered the low-lying fruits of the apple tree (such as discovering penicillin) and the cost of discovery and the complexities there-of grow exponentially going forward. This is one of the major economic forces in medicine, where the cost of a medication, which requires a one-billion-dollar investment and a decade and a half of time to finally reach the market. Since insurance companies have to carry the brunt of this increased cost, they cut corners in other areas, such as paying for the time a provider spends with the patient. This indirect facet frustrates both the patient and the provider, but that’s another story.

I want to summarize how this issue of the dark matter of medicine directly impacts the practical application of medical care and the healthcare system from the provider’s and patients’ perspectives.

Providers Perspective. A high school friend’s uncle was a physician. This was 1973 and this uncle was still practicing, and I think he was well into his nineties. He started his medical practice around 1905, at the tender age of 20. In those days, premed and medical school could be abbreviated because the pool of knowledge in medicine was vastly smaller than today. Not only could he start his career without a residency (and without debt) but once in practice, making a diagnosis and treatment was relatively simple. He could see a patient in ten minutes and focus nine of those minutes on more social aspects of the visit such as asking the patient about their family, their work, and even hobbies.

It was also much easier for a provider to make a good living one hundred years ago than today because you could see forty or fifty patients per day as the diagnosis and treatments were so simple and the documentation of the visit, if any, were reduced to a one sentence scribble. The costs of running a practice were vastly lower than today as well. I will not diverge into another facet and that is the laborious problem of documentation in medicine, to satisfy the malpractice lawyers and the insurance companies. That is a facet within itself.

Even fifty years ago, seeing a patient was like someone coming in saying their bike was not working right and you have 15 minutes to figure it out and fix it. But now, it is more like a patient arriving in a very complex Boeing 747 and tell you that it isn’t working right, and you still have only 15 minutes to make the diagnosis and treatment plan. For example, in my area of medicine, fifty years ago a patient would go see their doctor and say they suffer from headaches and their doctor would say, “You are not handling your stress well. Here’s a stress pill.” However, we know vastly more about headaches today. A good headache clinician knows that there are about 110 different headache types and it takes time to go through the history very carefully and examination to arrive at a proper diagnosis and treatment plan. This plan will be based on the complex pathophysiology of headache that involve deep brain structures and a complex cascade of events that play out on the outer membranes of the brain.

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Bike Repair Shop

But I want to focus on the part of the dark matter which, like in the astrophysics counterpart, is the vastness of what we do not know about disease and treatment.

Patient’s Perspective

I first entered the world of healthcare when I took a job in a hospital while I was in college studying premed. One part of the healthcare provider (used in the broadest sense, including nurses, nurse assistants, and etc.) culture I observed was that patients are considered as not knowing much and have the tendency to be hysterical. This same attitude continued to be part of my own medical education, both in the PA program I was in and with the medical students that I shared space with. It is a running joke about how stupid and hysterical patients can be. This attitude made me feel uncomfortable even then.

The hysteria diagnosis: Freud, Charcot, Breuer and Anna O
A Doctor Explains the Diagnosis of Hysteria to a Group of Doctors

I had one professor during my PA school experience that was the exception to this culture. He was a psychiatrist and taught our psychiatry medicine lecture series. He was a nice guy and was the spitting image of John Denver. He started each class by telling a fascinating patient story to illustrate a diagnosis or issue that he wanted to discuss that morning.

One day he came in and sat on the front of his desk. He smiled and then started to speak, “The Internal Medicine Clinic (at the University of Kentucky) sent me a patient one day with the diagnosis of ‘delusions of being a cat.’ I scratched my head as I had never heard of such a thing, although I guess it is possible to have delusions about anything. This well-dressed lady came into my office and took a seat on my couch. I asked her, ‘So, what’s going on,’ to which she replied, ‘I’m coughing up hair balls.’ ‘Really?’ I asked. Then I asked her, ‘Can you cough up one for me?’ She answered, ‘Sure.’ I handed her a box of Kleenex and she started coughing and then spit out a wad of long red hair. It was incredible! I immediately sent her to our pulmonology clinic, where she was eventually diagnosed with a bronchial teratoma, which is a type of tumor that can grow hair, fingernails, or even teeth. Her doctor had never asked to see the hair balls but had assumed that she was hysterical.”

Mature cystic teratoma of the ovary (gross pathology) | Radiology ...
Teratoma with Hair

The point that this psychiatrist wanted to make was to treat patients with respect by listening to them and believing them, even if you can’t explain their complaint. While their self-diagnosis may not be correct, their observations of something being wrong is accurate. Because the patient is not medically trained, they may not know the right terminology or understand the biochemistry of our bodies, but most the time their observations are based on something real. He also pointed out that it is quite rare that a patient is truly hysterical and just makes up symptoms.

Personal Story

One of the rabbit holes I refuse to go down, when it comes to my own health, are the “what ifs.” What if I had gone to see my doctor two months earlier? I did go in four months before I became ill and asked specifically for a Multiple Myeloma work up, which was done and was negative. If I had gone in as soon as I had symptoms, I would still have Multiple Myeloma but probably not the degree of kidney failure. I will try to explain why I did not go in. But this is not about me and my story but the much broader point that I am trying to make about this one facet of health care.

March is Multiple Myeloma Awareness Month. I saw a sign one day point this out and then listing the ten signs and symptoms of Multiple Myeloma. Oddly, I have never had one of the ten. That is why this was so confusing for me, even as a medical provider. My early symptoms were all neurological, coincidentally the field I have spent my entire career in.

At first, I thought I must have ALS and I was in no hurry to see my doctor because I knew he would only send me to the neurologist. It would take three months to get in to see the neurologist and then he would end up telling me I was going to die and there was nothing he could do about it. So, I told Denise to prepare to become a widow and I continued my life the best I could, working as hard as I could in my own clinic and taking care of our house in case I was gone.

My neurological symptoms continued to spread from my motor system into my autonomic system. Besides twitching and myoclonus all over, I started having difficulty swallowing and defecating. But the strangest one, which I still have although less intense, is that if I coughed or sneezed I would have about 30-50 places in my body go into spasm. They are clearly visible to the observer. However, I never developed the muscle wasting that you typically see with ALS. This created a very confusing picture for me and for all my medical providers since.

I will be honest and say that my hesitation about going to my doctor at the early point was that I knew that these symptoms didn’t fit any neurological disease state and I was afraid I would be labeled hysterical or some kind of whiner. Then I developed a new symptom, a sudden onset of severe neck pain and numbness down my arm. For that reason, I went to see my doctor.

When I saw my doctor, I told him about my neck pain, but also talked about my bigger problem of the neurological symptoms. I told him that if I forced a cough my entire body goes into spasms and asked if he wanted to see it. He said no. Then he focused on my neck pain and told me that my neurological symptoms were “stress” related to my neck pain. I knew better, but it was what I had feared.

To make a long story short, he did order a CT scan for my neck and to get a CT scan, over the age of 60, you must get renal function tests. My renal function tests came back extremely abnormal and I was sent from radiology directly to the ER and then to a telemetry unit at Peace Health in Bellingham.

Since that time, I have met countless medical providers who had no interest in seeing my twitching or spasms (which are impossible to fake) and have hinted over and over that either I’m making up the symptoms (hysterical) or they just shrug their shoulders and don’t want to talk about it. But these neurological symptoms are so severe, although slightly better now, that a year ago I was becoming suicidal (considering all the things I was facing, but these 24-7 neurological symptoms being the worst).

It wasn’t until I went to the Seattle Cancer Care Alliance did anyone ask to see the twitches. It was a PA in the bone marrow transplant unit. She was impressed and confused by the physical signs that no one could fake. But before that, and since, I’ve spoken to at least ten physicians who have no interest in seeing these twitches or talking about them, and if I keep bringing it up, they suggest I’m being hysterical.

I have read every study published anywhere in the world on neurological symptoms of renal failure. I found only one paper that presented three patients who had renal failure and this type of twitching all over their bodies, but all three also had seizures, so it was not the same syndrome. But that paper confessed that no one knows why neurological injuries can happen during renal failure and that it could manifest in ways that have not been reported.

My point here, is that there is a problem when you teach the medical providers that they know everything about medicine and anything that does not fit within that vast knowledge base, isn’t real. I hope that I knew better than this when I was a medical provider. I tried my best to listen to my patients and take what they were saying seriously. I even wrote an article for a national magazine back in the nineties on this very subject, titled, No Silly Symptoms.

I remember one of my patients who had a rather complex group of symptoms that I could not explain, nor could any of the doctors she had visited. However, I kept telling her that I think it is real, but it is something that has not been described yet in the medical literature. During this time, she visited the ER in Bellingham and there the physician told her (once again) that she was just hysterical, and she was not having the symptoms she was claiming to have. She told him, “Mike Jones believes they are real” to which she said that he replied, “Mike Jones is nothing but a PA and an idiot.”  I didn’t know the man, nor did he know anything about me.

But this attitude of out of sight out of mind, or if I didn’t study it in medical school, it isn’t real, creates a lot of dissatisfaction among patients. It would be so much better for a provider to say something like, “That must be terrible. I don’t know what it is, but I will do some reading to see if I can figure it out. If I can’t, I would be happy to send you to a specialist and see if they can figure it out.”

This change in our healthcare delivery culture requires the patient to not demand simple and certain answers but to understand the limit of our medical knowledge without thinking the provider is an idiot or does not care about them. It also requires the provider to understand their own limitations and to drop this preconceived idea that most patients are dumb and hysterical. It means listening. It means looking at the signs (the visible manifestation of symptoms) and taking the patient seriously and be honest enough to say, “I don’t know” and to be motivated enough to seek answers by study or referral.


Ramblings: On Mother’s Day, A Tribute to a Mother to None, but a Whole Village, My Aunt Helen

This morning my dear aunt, my father’s little sister, passed from this life. She was 93. She had lived with insulin dependent diabetes for fifty years. It is hard to do justice to describe this incredible woman. While she never bore children of her own, she became a mother to whole village, including my siblings and me.

As I describe in the video below, she suffered through incredible hardships, losing her mother to TB when she was two. She then lost her two older sisters to the same disease before she was in her teens. Then when she was 15 her father died from a heart attack in Sunday school. Then her brother, my father, was drafted to go fight on D Day.

Helen was married and (I think) it was her husband’s choice not to have children. Yet, she raised that husband’s niece and nephew as well as helped to raise my siblings and me. I’ve never seen anyone who was a better mom or loved children better than her. Later, like a bad novel, she discovered her husband had another wife in another city and, if I remember right, he did have a child with her. It was a very painful experience for Helen, as you can imagine.

Helen came to live in our home after she left her husband and the big old (built in early 1800s) log home where she had magical life far back in the hills of Tennessee. Her husband came looking for her with a gun and he and my dad had a stand off in our front yard, each man with a rifle. I was seven and hiding under my bed. But my dad was willing to give his life to protect his little sister.

With all these things said, Helen was the happiest person I’ve ever met. Her laugh was contagious and you could hear that laugh before you entered the room. She ran a beauty shop in a small Appalachian town (Fall Branch, Tennessee) for fifty years. It was the center of the town where news was shared and gossip abounded. If you read the book or saw the movie Steel Magnolias you will start to understand what that little beauty shop meant to our village. It wasn’t just for women as it would be the place for men to hang out too, if they wanted a good laugh or to know what was really happening in town.

When my dad became ill, aunt Helen moved back into our home to help care for him. When he was gone, she stayed and cared for my mom for the next thirty years. She stayed, based on a promise she had made to my dad on his deathbed.

Helen was cared for by our neighbor Billy for years, then in her last couple of years, my sister in Jacksonville. I can say that despite the isolation of COVID-19 (her having to go to the hospital alone) that Helen never had to live in the absence of love.

I must give up as there are not enough words to describe this incredible woman, the most loving, the most emphatic, the funniest woman I’ve ever met. Rest in peace dear Helen. Give my love to my dear mom and dad and your (and my) family that I never got to meet.

Meet Helen:

Ramblings: A Troublesome Drumbeat of a New Pandemic Narrative

When out of the blue I start to hear a consistent narrative, remarkably similar, coming from a variety of people spread out across diverse geographical areas, I become suspicious. Over the past 10 days I’ve heard the following narrative coming from a spectrum of sources:

  1. The death rate for coronavirus infections is grossly overstated.
  2. The cost to America by having businesses closed, measured in deaths and ruined lives, will greatly exceed the pandemic if the society stays closed.
  3. Coronavirus infections are not much worse than a cold or the flu, just that the weak and sick are the ones to die. They are going to die anyway, even without coronavirus, so why punish all of society in our efforts to save these people who are going to die anyway?
  4. This whole hype over the coronavirus is being manufactured by those with a liberal agenda of government control of people.
Sacrifice the Weak - Re-Open TN" : iamatotalpieceofshit

Each morning I have a routine of finding out what’s happening in the world. My choice of information sources are based on the experts who evaluate media sources for accuracy and political balance. I start with NPR, listening through a smartphone app from my bed. Then I get up and listen to CNN on Hulu while I make and eat my breakfast. I recognize that CNN has an anti-Trump bias and I avoid several of their shows which are most biased, but they are mostly factual. I also tend to tune into the international version which is less Trump-centric. I stopped listening to MSNBC because of their bias. I eventually check out Fox News to see what they are saying and check out BBC and Al Jazeera (in the international and Arabic language news version) to see what’s happening in the world. I can do all of this information gathering within an hour. Additionally, about once a week I hold my nose and check out the far-right sources, Brietbart News Network, Judicial Watch, and Infowars. I believe that it is important to know what people are listening to, even if those latter news sources are so pathetically off the rails in their hateful agendas and pure bullshit.

After hearing this new narrative, I went back to look for the motherlode of misinformation about the pandemic and I found it within all those politically right sources, with the greatest exposure at Fox News. The fundamental narrative was not coming from public health or epidemiology researchers, but from the business world. After all, that makes the most sense because they have the most to lose (talking simply about money and wealth) by the societal shut down. They have almost nothing to lose from the disease itself because these are CEOs and owners who don’t work on the front lines and have minimal risk. They also have the funding to influence the public with this mis-information campaign. See: https://www.forbes.com/sites/jackbrewster/2020/04/09/a-fox-news-conspiracy-are-coronavirus-death-numbers-inflated-attacked-by-fauci-birx/#aff8ed816afe

Here is the factual narrative as expressed by the real experts, those who have spent their lives studying pandemics and the behavior of viruses.

  1. The death rate for coronavirus is being grossly under reported due to the lack of testing and a political pressure to keep the numbers as low as possible. (see https://www.nytimes.com/interactive/2020/04/28/us/coronavirus-death-toll-total.html)
  2. We are sitting on a time bomb. As bad as things are, they could mushroom into the deaths of millions without social distancing.
  3. Even with present numbers, we are more than 1 ½ times the death rate form coronavirus than from suicides (est 47K per year) and the uptick in suicides from social distancing is pale when compared to the deaths of coronavirus infections. If the infection takes off, then it will 100-fold worse.
  4. This novel coronavirus is much worse than the cold or flu both it is ability to spread and mortality.
  5. While there is a disproportionate number of deaths among the elderly and ill, it is killing people at all age groups from toddlers to those in their teens, to those in their youth and higher. Some of the deaths occur in very healthy young people and for reasons that are not clear. Still others come out of the infection with serious injury to their lungs and kidneys, from which they will never recover.
  6. There is no political agenda behind the information about the global pandemic but factual information from the real experts. There is no conspiracy behind this.

One of the most troublesome aspect of this new narrative is that I’ve heard it mostly from my evangelical friends. But that makes sense. As I’ve said many times, I spent 25 years of my life in the evangelical camp. During the later years of this time, before I came to my senses, I, like all of my evangelical peers, became a consumer of Fox News and even Rush Limbaugh. But eventually I realized I was being brain-washed with right wing pro Republican, pro big business bullshit and unfortunately, I like my evangelical peers were blending this right wing political agenda, in a very dark way, with our own Christianity.

Anti-vax 'Jesus wasn't vaccinated' shirt gets crucified on Twitter

But I want to look at what is being said from a philosophical viewpoint to try and unscramble this egg.

The Atheistic-Evolutionary Model

First, I want to look at the perspective from an atheistic, evolutionary view of humanity. I know many people who have an evolutionary viewpoint but as Christians, Muslims, or pantheists so it is an error to think that evolutionists and atheism are synonymous.

In this framework, and if you see the goal as the survival of our species (some would even argue with this goal, thinking that a human-less universe would be better), then there should be no social distancing and allow the viruses, as it did for millions of years, to take its full toil. This would “weed out” the weak and in the end, after possibly a loss of 10% of the population, that the genetic pool would be stronger and more resistant to future infections and have a herd immunity to this infection. This is so logical within that philosophical framework, that I call in to question those atheists, and there are many of compassionate atheists, who don’t think we should go this way but that we should intervene to save human lives and reduce suffering.

The Christian Model

Within this framework, there is a fundamental belief that all of creation is special because a personal and loving God created it. They also hold that humans are more special than all else because we, alone, are created in God’s image. Therefore humans, and all of creation, have intrinsic value and worth. The basic Christian philosophical viewpoint also states that evil and suffering entered the universe from the fall of Adam and the universe was not created with these flaws. Therefore, our struggle against suffering is not a struggle against God’s creative purpose.

The Christian message, as clearly stated by Jesus himself, is that one of our biggest problems is our love of money and wealth. Jesus was not pro big business, but was pro people, all people.

So it is odd that my compassionate atheist friends want to reduce suffering and save lives, while my evangelical friends are advocating this Darwinistic approach of sacrificing the elderly, the weak, the poor, the minorities, and those with underlying illnesses (like me) for the sake of money and wealth… and that money and wealth will mostly fall into the hands of the millionaires and billionaires.

To me, this is yet another example where American Evangelicalism as completely lost its way, where it was blended with right wing politics and now that politics have totally supplanted their original Christian ideals.

Update: 5/2/20

Someone made the comment that I had not done an “update” in a while and that they don’t read my ramblings. So, for the sake of those interested in my health and not these tangents I get off on, I will give an update.

I just finished my first three-week cycle of my new chemo (ninlaro). It is certainly much easier to use, swallowing one very expensive capsule per week rather than an infusion or injection. I think I can say that the terrible side effects I was experiencing are very slowly getting better. I mean I haven’t had diarrhea in three days and it was four or five times per day before. So, I’m optimistic. I just have to hope and pray that it is working on the cancer and we won’t know that for a couple of months.

My original symptom (cluster of symptoms), which are neurological are very, very slowly improving for the past 14 months. On good days I can go 20 minutes now and then without the twitching and other motor problems. On bad days, I still have multiple muscle groups jerking and twitching continuously. I’ve gone five weeks without any labs so I don’t have any information there. I do think my anemia is still better as my energy level reflects that. I have run three times now, each just a mile, but slowly picking up the pace.

As I mentioned in my previous Ramblings about navigating the crazies, we are all still in this same boat. I never knew how difficult it would be fore me having absolutely no contact with people would be. I did participate in a COVID-19 antibody study. I was hoping that I was positive, but I wasn’t. If I had been positive, it would allow me to be like other people where I could at least go to the grocery store with a mask on. But for now, I have to keep totally isolated as they predict that someone with my level of cancer, renal failure and age would have a 50% chance of death if I caught Covid.

Denise is still working long hours. Our marriage is stressed as I feel desperate to talk to someone. She has very hard days at the hospital and comes home talked out and does not want to talk to me but to watch a movie and go to bed (she gets up very early). But for the grace of God, I feel that I would be about ready to lose my mind. Again, I am thankful that I have a dog and I live on a lake where I can enjoy some space. But I think many of you can relate to these things.



Ramblings: The City of God—Revisited Part I

A long time ago in a galaxy far away, I was writing about the idea of the loss of truth. There is no question that we now live in an age when the classical sense of truth (or what I call TRUTH) has been lost being replaced by opinion. Then I became consumed in editing my manuscript for my novel Ristretto Rain, which I’ve now finished, and it is off to the editors. The original task of exploring this topic was so daunting that I have decided to take just one avenue of discussion and that’s how the Christian community (over time) has been engaged or disengaged in the pursuit of TRUTH. None of the things I share, I believe, are out of the mainstream and any professor of these histories would agree.

This article relates my general theme of the loss of TRUTH. I felt like I needed to explain the stance of the WEBB (white evangelical baby boomer) Christians within the historical context of the movement, and in the end, I will connect it to this loss of TRUTH. I will point out again that I was a WEBB for more than twenty years so my statements should be taken as from an insider.

The City of God (English translation of the original Latin, Dē cīvitāte Deī contrā pāgānōs) was one of the classic books of Christian theology, written in the early 5th century by Augustine of Hippo (aka, Saint Augustine). In the year 410 the city of Rome was sacked by the Germanic tribe called the Visigoths. This invasion and sacking were a profound shock felt throughout the Roman Empire. This shock was felt most intense by the Christian community within the Roman Empire. In the year 313, emperor Constantine had declared Christianity legal and then later the official religion of the Roman Empire, replacing—an often—antagonistic polytheistic religious system.

The City of God : Augustine of Hippo, St. : Free Download, Borrow ...

It didn’t take long for the Roman Empire to become blended (in a very unhealthy way, in my opinion) with Christianity. For one, the emperor, while knowing almost nothing about the Christian faith, placed himself as the head and authority of the church, shaping up until modern times. From that day forward, the “Roman Catholic Church” continued with these influences. The protestant faiths did their own unholy blending with secular culture, but that’s another story.

The Roman Christians made the huge assumption in the fourth century that the Roman Empire was the same as God’s Kingdom. That they were synonymous. They also assumed that God would protect this empire because it was special. Almost every Christian nation has made the same assertions throughout history including the “America First” evangelicals.

The Fall of Rome Depicted in Thomas Cole’s “Destruction”

Peter’s Great Sin

I am often a critic of the organized Church, while recognizing the Church’s great contribution to societies, it has also done many great mischiefs throughout its history. I believe that the root of most of the mischiefs was this mixing of earthly and spiritual kingdoms. Peter’s (upon whose faith Jesus said he would build his Church) did the original sin reflecting this confusion in the Garden of Gethsemane when he drew a sword. See John 18:10 (NIV): Then Simon Peter, who had a sword, drew it and struck the high priest’s servant, cutting off his right ear. (The servant’s name was Malchus.)

In the fifth century, as the visible kingdom of the Roman Empire started to crumble, it didn’t make sense to the Roman citizens who didn’t believed that the very powerful and world-wide (the then known world) empire could fall but it was eternal. The Roman Christians had theological reasons to believe the Roman Empire could not fail. They believed that either God was going to come in at the last minute to save the empire, so they thought, or Christianity itself was going to fail. They had this position because they had confused the earthly empire of the Romans with God’s spiritual kingdom.

Peter Cutting off Malchus’ Ear

Augustine of Hippo was concerned about this discouragement and fear. So, while covering many topics in his book, his major thesis was proving, correctly, that God’s kingdom was not of this world and was not synonymous with any human institution.

In the eighteenth chapter of the book of John Jesus had the following conversation:

33 Pilate then went back inside the palace, summoned Jesus and asked him, “Are you the king of the Jews?”

34 “Is that your own idea,” Jesus asked, “or did others talk to you about me?”

35 “Am I a Jew?” Pilate replied. “Your own people and chief priests handed you over to me. What is it you have done?”

36 Jesus said, “My kingdom is not of this world. If it were, my servants would fight to prevent my arrest by the Jewish leaders. But now my kingdom is from another place.”

37 “You are a king, then!” said Pilate.

Jesus answered, “You say that I am a king. In fact, the reason I was born and came into the world is to testify to the truth. Everyone on the side of truth listens to me.”

The German Churches and the Nazi State | The Holocaust Encyclopedia
German Clergy Giving the Heil Hitler Salute

Like I said, throughout the Church’s 2000-year history, most of its greatest mistakes continued in this vein of Peter’s original misconception. The Church blended with the Roman Empire, the monarchs of Europe (even evil Kings), all the way down to the German Lutheran Church, at large, got right in bed with the Nazis and now the WEBBS in bed with the Republican Party. Peter and the Church since (not all churches of course) fall for this corruption because of the enticement of wealth and power.

Pope Leo III crowning Charlemagne emperor, December 25, 800.
The Pope Crowning Charlemagne as Emperor of the Romans on Christmas day and Later was made a Saint

Next time, I want to jump ahead to a phenomenon of the American church of the twentieth century and the historical story of how it has tried to create a worldly empire.

Pro-Trump evangelical leaders condemn Democrats' impeachment vote ...
Evangelicals Praying with Donald Trump, many of Whom have Declared him God’s Anointed or Some, the Messiah.

Ramblings: Navigating the Pit of the Crazies

We are all in this together. That is one thing that is different about the COVID-19 global pandemic and my myeloma “solodemic.” When I was first diagnosed with myeloma, it was hard to find anyone who could relate. Then I found the myeloma “support” group. It was fantastic… at first. But then, each day my FB page (where I connected with them) was filled with horrible stories of extreme suffering and prolonged death. I could not bear it any longer and had to leave before I got too depressed. But now, in this facet of life of social isolation, we can all relate. We all speak the same language of loneliness.

John the Dwarf, Who Left Egypt to Live Alone in the Desert in the Fourth Century

In the early days of COVID-19, I received a letter from the Seattle Cancer Care Alliance, warning me that leukemia and myeloma patients are at highest risk of catching COVID-19 and if they get it, they are most likely to die. The warning advised that I practice extreme social distancing. That I do not go out for any reason, even canceling many of our medical appointments and worst of all, have no contacts with anyone that does not live in my house.

About three weeks ago I was asked to participate in a study. The premise was, because there were virtually no myeloma patients in Asia who were COVID-19 positive, there is a theory that somehow, either having myeloma or taking myeloma chemo protects you from the infection. I had enough renewed (but false) confidence that I went to a hardware store while wearing gloves and a mask. It was my first outing. In the study, they hope to check the antibodies against COVID-19 in 1000 myeloma patients. I was able to join the study and will receive my test kit soon.

But then I wake up this morning to the news that “blood cancer patients such as leukemia, lymphoma and myeloma are the most vulnerable to COVID-19 and in Asia, they died at an alarming rate.” What? But this confusing information what we all face and will continue to face until we understand this virus better. But once again, it warned about the need for us blood cancer patients to take extreme measures.

Wilson Cast Away Volleyball

Sometimes I see the human psyche as very fragile. I know when I was raising my kids, at times, I felt like if I made one mistake, say I forgot and left them in time-out a bit too long, they would grow up and become sociopathic killers. But then, at other times I am amazed how resilient the human psyche really is. My dear aunt Helen, who practically raised me and is on her last leg as I type this, endured the slow deaths of her two sisters and mother from TB, then her father from a heart attack, then her brother (my dad) went off to WWII, all while she was a young girl. Helen was the happiest and most balanced person I’ve ever known. I don’t know any holocaust survivors personally but knowing what they went through is incredible that they did not go insane.

I want to share a little about my struggle, but this is not looking for any kind of pity. The stories that we know the best are our own and that’s all I’m trying to do.

Besides surviving this past year’s unbearable stress and doing so, I think by God’s grace, without any major depression. I was suicidal at times only to escape the suffering, but not frank depression. But now, the loneliness is one of the biggest challenges I’ve ever had to face.

Mountain man - Wikipedia
Fur Trappers Lived for Years in Solitude

Denise leaves for work around 6:45. I’m awake but not up. I am then completely alone at home for the next 12 hours. I do not leave my property, unless I sneak out with Greta (my dog) for a hike on an isolated trail… if I can find one. Then, Denise comes home completely exhausted and stress out. In case you don’t know, she is the nursing administrator at a hospital with COVID-19 patients and her job is intense and never-ending. While she is with people all day, the only words I’ve spoken are words to Greta. She has her own difficulties to deal with and I wish I could support her better.

When Denise comes home, she is completely “peopled out,” and does not want to talk to me, except for essential words, but prefers to be alone or to watch a movie.

I will end with my story here, except to say, you get the drift. I also know that I don’t have a monopoly on loneliness right now. I know many of you, like me, want to scream at times. I do have the fortunate situation of living on three acres and on a lake. I can go kayaking and work on my property. My son Ramsey lives alone in Seattle and works from home. He tells me that this kind of loneliness has haunted him for years. No, it is not healthy but sometimes there is nothing you can do about it.

I remember a classic scene from an old miniseries that was on network TV in the 1980s about the western expansion. The story followed a fur trader in the Rocky Mountains in the 1700s. The only other people west of the Mississippi were Indians and he had to do everything possible to avoid them. Once a year, this trapper would gather all his beaver pelts and float down the Missouri River to a trading post in Kansas. But in one scene, after being alone for almost a year, he comes out of his sod house he was living in and ran to the top of the mountain in his dirty red long johns and started screaming that he’s going crazy from loneliness. His cries were met with complete silence, save the wind blowing down the Tetons. I get it now.

It is always a good thing to try and make lemonade out of lemons. I want to study the old Christian hermits, those who left society and lived alone in the deserts or mountains (this was the precursor to monasteries) for decades. While I don’t agree with their reasons for leaving society (a dualistic view that this world was dirty and evil) I do want to learn how they coped and flourished. Then I think of others who had to remain alone, like the Tom Hanks character in the movie Castaway. I guess Greta is my “Wilson.” By the way, I am so grateful for Jean and Diane’s phone calls today. I’m sorry I spoke too long.

So I pray to God that this nightmare will end, that somehow the virus will vanish or an unexpected treatment would arise (I bet it won’t be  hydroxychloroquine or drinking Lysol) or, if the lemons remain that we can make lemonade and we all find nourishment in our solitude.


Ramblings: Ristretto Rain, off to the Editors!

Please put a bookmark in your COVID-19 reading schedule for June as that will be the estimated release of my new novel Ristretto Rain. I am very excited about this book that got its start way back in 2018. Then there were interruptions such as life-threatening cancer, bone marrow transplants, oh. . . then a pandemic. You know, just the ordinary kinds of things. The book is in the genre of drama with romance overtones written with the backdrop of San Juan Island living, fine coffee making, wooden boats and exploring the secret places of villagers’ hearts. Someone asked me if the book is G rated, like a Hallmark movie. No. Life is at least R rated and this book imitates life, not a fake world without conflicts and disappointments.

This morning the Ristretto Rain manuscript went off to the profession editor (Max) who is an editor for McGraw-Hill (education publisher) but is a freelancer for Mount Erie Press. I’ve worked with Max for two other book projects and he is very good. He does not hesitate to say something is crap or needs re-writing or that somethings is very good.

This will be my third novel and my seventh book. Between each book I’ve worked hard in fine tuning my writing skills by reading the classics and more recent Pulitzer Prize winning books.

Here is a summary of the story:

Halem was one of Seattle’s finest coffee roasters and baristas. Sandra, a wealthy divorcee rescued her from an abusive relationship and took her away to create a world-class coffee shop in a very remote village in Washington state’s San Juan Islands. The Rock Harbor Coffee Roasters, her little shop, was perched on a bluff overlooking a remarkably beautiful marina. She had her regular customers, mostly commercial fishermen and eccentrics who, each, had their own reasons for escaping mainstream society. She also served a host of transient tourists arriving by personal boats each day.

One morning, a mysterious and handsome man named Winston came rowing in from the Pacific Ocean in a little wooden boat. He was the most remarkable man Halem had ever met. He had the uncanny ability to look directly into her, and her customer’s souls and put his finger on their greatest emotional conflicts. Halem had her own personal labyrinth, which was far more convoluted than just her abusive Seattle boyfriend but stretched back into unresolved grief as a child.

During his short stay in the harbor, Winston became involved in helping several people navigate out of their personal quagmires. About this time, Sandra discovers that Winston is really a liar had swindled people in other harbor towns out of money. She chases him out of their little village. But it was too late for Halem as her heart was already lost to this man and was broken with his departure. But was Sandra correct? Could Halem find the truth? Was Winston the greatest man she had ever met… or the most conniving fraud? Would her world finally find peace or an unbearable heartbreak?

Ramblings: “Jesus is my COVID-19 Vaccine,” Metaphysical Considerations.

Most of us have seen the videos of either right-wing protestors at state capitals, taking no social distancing precautions, and demanding to have all the restrictions lifted or evangelical pastors who insist on continuing to hold in-person church services. Both the evangelicals that take part in the protest and the pastors who insist on big church gatherings say things like, “Jesus is my vaccine,” or “I don’t need precautions because I’m covered in the blood of Jesus.” They spout these clichés with a big dose of spiritual pride (in my opinion) and not faith.

WATCH: Harrisburg Coronavirus Quarantine Protest, 'Jesus Is My ...

So, this begs the question, will God determine if you get COVID-19 and possibly die from it? If so, there is nothing you can do to stop God, including social distancing. I have already address this indirectly. I have also addressed, many times and in many ways, the question does God gives cancer and does He then direct the cancer to cause you to suffer and die from it?

But back to this simple question that is a hot topic at this present time. It really comes down to some fundamental metaphysical questions. Now, if the word metaphysical makes your feel uncomfortable feel free to think of it in theological terms. As I said before, Francis Schaeffer used to say that the only differences between philosophy (which deals with metaphysical concepts) and theology are not in the questions asked but, in the answers given.

It is woven deeply within colloquial (meaning common or everyday) Christianity, not just in American Evangelical circles but in many other types of Christian, and many Islamic sects, around the world, that for God to be God, He has to have absolute control of granular fate. What I mean by “granular fate” is the everyday things, even smaller of getting a disease, things like God controls if we blink or if we eat an banana, or if a particular raindrop will fall from 30,000 and hit me in the head… or not.

I will make a bold statement, and you are welcome to prove me wrong (in comments), that nowhere in the Bible does it say that God is control of the granular things of our life. That these things are predestine or controlled by His power. There are many passages that we used and I hear other using now to support their position that God controls these detailed things such as Luke chapter 12 (https://www.biblegateway.com/passage/?search=Luke+12&version=NIV). But read this passage if you want without the cultural glasses that automatically interpret this for you. Listen to what it is really saying. It is saying that for those people not to worry about their housing, their clothing, or their food because worrying does not help. It says, in a general way, God will provide the basics.

It is my opinion (based on my study) that this problem of the God intervening in the small things stems from the adoption of non-Christian philosophies into Christianity, those which dismissed this material world as insignificant. Therefore reason, cause and effect, physics, chemistry, and so on are meaningless and therefore everything is controlled by God, the puppeteer’s hands.

Instead, I say that God created this wonderful world and all the laws that control it. Consistent with the long history of Christian teachings, these wonderful laws that govern life have been fouled, in places—not everywhere—but in spots, which we call the fall. Therefore, viruses exist and cause horrible havoc. So, in the case of this novel coronavirus follow the laws of biology. You will get it if you are exposed and are in the right circumstances. It is not based on how much faith you have or if God loves you or not. It has nothing to do if you are “covered in the blood” or if you believe Jesus is your vaccine. I could write a book on the abundance of historical examples of very devout Christians that were 100% certain God would save them in a situation… and yet they perished in the end. If you hold to their God model, then He failed. But when we liberate God to be the great other, then it has no implications. But if you insist on God controlling granular fate, then you better deal with the example where that kind of god seems to fail.

When I discuss this with evangelicals, almost invariantly they assume that I am saying God is too small to control the small things and the larger things such as if I get COVID-19 or not. I will no be surprised if someone writes me a private e-mail from this post telling me how concerned they are about my soul and that I’m not walking with God. I’m used to it. I am not saying God is too small to control these things,but simply he chooses not to. In ways, I am saying almost the opposite. That for us to insist that God must control the details of our life in order to be God, I am shrinking God down and putting Him in the box I’ve crafted for Him.

If you take historical Christianity as it was, then it is clear that God is in control of the really big picture and in the end, the very end of everything, all will be well. On that point, the major monotheistic belief systems agree and even the pantheistic (although we disagree in other areas).

Note: I hope to get back to posting here. I just finished my 10th round of editing of my novel Ristretto Rain and tomorrow it goes off to the professional editors. If you read an early version, the final is much better. The book should by out by June.

Milestones: A & B

Sorry about a defunct post earlier. It was in a video format and this site would not allow it.


A. I took my first capsule of Ixazomib today, the new chemo. I hope it is a new path.

B. I used to be a modest runner, 3 miles twice a week then 7 miles on Saturday. I ran last the week before I got sick in Jan, 2019. I was so ill and quite anemic for much of the year, that there were even times I could hardly walk to the car. My hemoglobin bounced between 7 and 12 (normal is 13.5 or greater).

For some reason, I have felt stronger in the past 3-4 weeks and my hemoglobin was going up. I told Denise, before my labs were drawn this week, that I felt like it reached 13. Well, it is 13.7 and in the normal range. I couldn’t believe it!

While I have been walking faithfully, today (after I finished my 2 mile walk with Greta) I donned my running clothes and ran a mile. It brought tears of joy to my eyes as I never, ever thought I would run again. It felt great. I had to share this with someone. Mike