Addiction Medicine & Parity

It's late but I'm back and I just have to post something to let you all know I'm still here. The ASAM (American Society of Addiction Medicine) Scientific Conference in Miami was just awesome! I am so going into the right specialty, it's as if I was born for this stuff; I love it.

Two historic things took place while I was at the conference. One, it was decided that steps will be taken to form an independent specialty board in addiction medicine. Along the same lines as what Family Medicine did in 1969 when it formed the Board of Family Practice and became its own specialty.

Second, there was the decision to move ahead on pushing for parity legislation. There was significant discussion on the topic of parity; I learned a lot. Parity has to do with health insurance benefits covering addiction health problems the same as they would any other health problems. Most insurance plans exclude or severely limit coverage for addiction related medical care.

No other medical conditions are so universally discriminated against by third party payers in this country than are addiction disorders, followed by mental health disorders in general. My thinking on this issue was expanded at the conference. It is more than just addiction providers wanting to be paid more for what they do. Consider the messages that are conveyed to the addicted patient when there is a lack of parity:

1) The first message: "It's your fault."
Heath benefits for addicts are really just a tax against moral people.

2) Then, even if it might not all be your fault, you can at least: "Just snap out of it."

3) If not, then you can: "Just go to AA."
AA is cheap, available and open to anyone. Don't expect medicine to help.

4) OK, you might need help, but: "You're not worth it."
You're low life, you'll never amount to anything, you'll never get better.

Since this disease is characterized by shame, who is going to stand up against an assault like this? "You're not worth it." Certainly not those that are afflicted. Parity is really a struggle to rid the afflicted from the stigma of the disease of addiction. Parity is ultimately a human rights issue.

Addiction is a neurobiological disease, not a lifestyle choice. Patients who have this disease are just that, patients, ones who suffer. We will treat them, with compassion, to the best of our abilities, without discrimination. As humans, we are vulnerable to disease, all of us.

So here's to the new specialty of Addiction Medicine and to Parity. And it's good to be home.

Acceptance

Here is one of my favorite quotes. I memorized it fourteen years ago when I first ran across it. It was written by a physician and comes from Alcoholics Anonymous p. 417.

"And acceptance is the answer to all my problems today.

When I am disturbed, it is because I find some person, place, thing, or situation—some fact of my life—unacceptable to me, and I can find no serenity until I accept that person, place, thing, or situation as being exactly the way it is supposed to be at this moment.

Nothing, absolutely nothing, happens in God's world by mistake.

Until I could accept my alcoholism, I could not stay sober; unless I accept life completely on life's terms, I cannot be happy.

I need to concentrate not so much on what needs to be changed in the world as on what needs to be changed in me and in my attitudes."

Hopscotch Calamity

Hopscotch. It was the craze and I was obsessed. It wasn't enough to play every chance I could get at school, every recess, before school and after school until everyone was gone. I played at home with kids in the neighborhood too.

We used a crude hopscotch I scratched with chalk on the cement slab in my backyard. I played with kids that were good, kids I didn't typically play with, the ones that just liked playing hopscotch. Girls mostly.

I remember one girl particulary well who played hopscotch at my house. Her name was Veronica Zagarino and she lived several houses down the street. We were in the same grade at school, but except for hopscotch, we never crossed paths.

I never forgot Veronica Zagarino because of one noteworthy day. I had a new throwing chain, light, flexible, with just the right amount of slide to it, sticking just when it should, perfect for hopscotch. It was my best chain ever. Veronica Zagarino was good, one of the best. I wanted to beat her and I was determined.

It was her turn when something unexpected happened. While she was hopping, one foot to the next, as you do in hopscotch, she suddenly stopped with a sharp intake of breath, horror-struck. I didn't see what distressed her, but she was frozen in utter fear. Before I could do anything, she swooped down to the ground, scooped something up, spun around and in one swift movement made a mad dash for home. Without a word she was gone, her prized hopscotch chain still laying on the ground where she had tossed it, abandoned.

I was confused, terrified even. What just happened? I called after her as she ran off. She ignored me. She ran away as if the devil was at her heels. What was wrong with Veronica Zagarino? It was one of the scariest moments I remember as a child in my elementary school years. Veronica Zagarino panicked in such a way that it seemed to me she thought her life was threatened and I felt helpless. It was not a good feeling.

I later learned that she had just had her ears pierced and when she was hopping one of the earrings fell out. Apparently, she was told, or she was given the impression that an earring falling out would be a very bad thing. When she saw the earring lying on the ground, she thought time was of the essence. She was afraid they wouldn't be able to get it back in again, or something. So, she ran home for help as fast as she could. Unfortunately, she left me thinking she was going to die.

Oh well, such is the imagination of a child. Veronica Zagarino never came over to play again but she is forever indelibly inscribed in my memory, associated as well of course with the silly game of hopscotch.

The human mind is a fascinating thing. If or when I develop my dementia, I will progressively loose my memories. I will loose the most recent memories of my life first, retaining the memories of my distant past the longest. Memories will peel away until one day, I fear, all I will remember is Veronica Zagarino. I will be blathering her name repeatedly, "Veronica Zagarino... Veronica Zagarino..." and no one will know who she is. She will be my "Rosebud."

So now, at least, you know.

Old Obituary

This is a photograph of the grandparents of Cindie's grandmother, J. D. and Rebecca K. Wirt. One of their sons was Cindie's great-grandfather, his name was Socia Wirt, you don't see that name everyday, Socia. They had a daughter they named Mary Elizabeth who apparently died when she was 23 years 23 days old. It is said, live one day at a time, I guess.

Cindie recently started working again on her genealogy hobby. She showed me the old family bible she inherited, the one that the couple in the photograph owned. Its date of publication is 1840 and its condition is remarkable. The sale price is written on the inside cover in pencil, $4.50, which must have been a small fortune back then, the bible most likely was a prized possession.

A small scrape of paper, tucked away between two pages, caught my eye. It seemed a bit out of place, it looked too new. I pulled it out for a closer look. It was a newspaper clipping, small, 2 inches by 4 inches, the paper was stiff, tan colored, but not faded, the print was strong and easy to read, but had and old look to it. I was surprised to see the date, 1875; I really expected it to be more like 1925, the way it looked.

The clipping was an Obituary for Mary Elizabeth. It struck me as so unusual and so unique that I just had to share it. First of all the content, I think it is funnier than heck, consider the line, "Peace to her mouldering (sic) dust."

Second, people don't write like this anymore and I so much like the writing style of that period, formal, proper and eloquent. They really could design a sentence and use words and say things in, well, in unusual ways. I love it. Like in this short piece even, words or phrases like "solemn truth" "fortitude" or "composure" would not likely appear in an obituary today.

Third, it does not really seem to say anything. It's incredibly short. Did the writer even know her? Is this a typical style for an obituary back then? It struck me as just kind of odd.

Hey kids, this is a relative of yours. Mary Elizabeth, she lived 23 years and 23 days. It was written by "E." I don't know out of what paper this was clipped.

Obituary

Died, near Harrisonville, Cass county, Mo., Nov. 18, 1875, Mary Elizabeth daughter of J. D. and Rebecca K. Wirt, aged 23 years and 23 days.

Feeling assured of the solemn truth that eulogies or lengthy obituaries upon the departure of our friends can neither benefit us or advance their interest on the other shore, suffice it to say that she bore her affliction with more than ordinary fortitude and composure, leaving as a legacy to her bereaved friends and relatives, unmistakable evidences of her acceptance with God, through the merits of a crucified Redeemer. Write, "Blessed are the dead, that die in the Lord." Peace to her mouldering (sic) dust.

Asleep in Jesus! Oh how sweet--From whence none ever wake to weep. E.

Pretty Much My Life

Autobiography
in Five
Short Chapters

by Portia Nelson

One
I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost . . . I am helpless.
It isn't my fault.
It takes forever to find a way out.

Two
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in the same place
but it isn’t my fault.
It still takes a long time to get out.

Three
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in . . . it’s a habit.
My eyes are open.
I know where I am.
It is my fault.
I get out immediately.

Four
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.

Five
I walk down another street.

Home Visit Code Blue

It was a quintessential moment, fitting for a rural medical practice. I was on my hands and knees in the dark cramped kitchen of a patient's home. The patient was sprawled across the floor in front of me. CPR was in progress.

I looked down at her face. It was devoid of even a vestige of color. Thin electric wires fastened to her chest made their way to an automatic defibrillator. A disembodied robotic voice from the device intoned, "Continue CPR." I prepared to provide her with an airway.

Moments before I was in my clinic seeing routine patients when my typically busy Friday morning was interrupted by the urgent call, "Code blue, patient down." I answered the call.

It wasn't far; she lived only a few blocks from the clinic. But then, in a small town, everyone lives only a few blocks from the clinic. I arrived at her house with the airway equipment in less than a minute.

While she was being ventilated and chest compressions were being delivered, I calmly prepared for what I needed. I checked the laryngoscope, inserted the batteries, attached the curved blade and checked the light bulb. Fourteen years ago, I was an ER doctor and I did this all the time. I was very good at it and fancy that I still am, even though I don't do it that much anymore.

I selected an ET tube, inserted the stylet, adjusted the stylet and shaped the curve of the ET tube just right, attached a ten cc syringe, inflated the balloon, checked it and then I was all set; I was ready.

I gently extended her head and inserted the blade of the laryngoscope along the side of her tongue, pushing the tongue out of the way. I was nearly laying flat on the floor, my head lowered down as low as I could go, to be at the best angle to see into the larynx.

Redundant folds of oral and pharyngeal structures obscured my view. I pulled up on the scope with my left hand and angled it to try to expose even just the smallest glimpse of the arytenoids or the vocal cords. I craned my neck. It was an awkward angle.

My bifocals couldn't quite bring into focus the minute area I needed to see, that particular teensy tiny little spot just beyond the tip of the epiglottis that I had to visualize in order to place the ET tube properly. I had to see it. I repositioned the blade and probed with the tip of the ET tube. I jiggled my glasses up and down.

For a flash of a moment it crossed my mind that maybe I wouldn't be able to do it. That it would be just too hard for me, that it had been too long since I had done this sort of thing and my eyesight was not good enough anymore. As I struggled within the diminutive space of my patient's gullet, stretched out as I was across the floor, it flickered through my mind for only a brief half of an instant that I should let the other doctor have a go.

Then I recalled that I am good at this. Really good. I used to do this all the time. I worked once in a busy ER full-time. I intubated people in code situations nearly every day. I am the best person for the job, I reminded myself. This patient needs me and by golly I am not giving up, I am doing what it takes to get this done.

So I pulled a little harder, angled a little bit more, got down a little closer to the floor, then I slid the tip of the ET tube up under the epiglottis and directed it anterior into the trachea. I removed the laryngoscope, inflated the balloon, attached the amboo bag, gave some breaths, watched the chest rise, fall and listened for breath sounds. It was a successful intubation.

Later on, ensconced again in my ordinary busy Friday clinic, I was still feeling warm inside from the glow of accomplishing something truly remarkable. I imagined that it might be like the feeling one might get from catching a game-winning touchdown pass or from winning a $10,000 Lottery Prize.

I wanted to share the feeling, so I said to my staff, to no one in particular, "You know, intubating somebody is always tricky, but it really is something doing it when you're in a cramped dark space laying flat on the floor."

No one in particular, replied, "Huh, huh, that's nice."

Hmmm, what do I expect? Anyway, I think I'll make an appointment to get my eyes checked. Maybe they can do something about that.

Kissing Salty Babies

He was bigger-than-life and big in true life with a loud Texas drawl that boomed in the distance before you even saw him. Ruddy, barrel-chested, thin greasy hair plastered carelessly across a mottled scalp, his face was adorned with a toothy grin spread perpetually wide from one haggard ear to the other.

His cylindrical girth was festooned with a long white lab coat embroidered with his name and title, and I dare say no one ever saw him bedecked in anything else. He was an icon at our institution, as close to god as anyone could be. He was Chief of Pediatrics of Children's Hospital, specialized as a Pediatric Pulmonologist. He was world famous as an authority on Cystic Fibrosis, making the hospital a foremost treatment facility for the disease.

He was an imposing figure, no he was an intimidating figure, no he was simply terrifying, at least from the perspective of a fledgling third year medical student. That is what I was when I encountered this paragon of a legend many moons ago.

I heard stories about him; everybody talked. I heard that he was brilliant and that he was awful, but I couldn't really tell in the end what to expect from him. Then, I didn't know what to expect from anything. I was fresh from two years in lecture halls, gross anatomy dissection labs, mountains of thick textbooks and all with never a patient in sight. Then finally, I was thrust onto the wards of the Pediatric Hospital and I didn't have the slightest clue as to what came next. I was overwhelmed.

It was the first assignment of my Pediatric rotation. I had morning rounds with the famous terrifying Pediatric Chief. Fortunately, I thought to myself, with some degree of comfort, the group making rounds that morning was big enough that I could fall back on the time tested strategy of making myself look real small, become invisible, blend in, disappear and survive by not being noticed.

The grand Pooh-Bah entered, his white coat flying, big belt buckle flashing, cowboy boots clomping, he swooped down on our ensemble, a huddled mass of unsuspecting learners waiting for his arrival. He wasted no time as he launched into a soliloquy, shooting questions right and left, attacking here, zinging there. There was no hiding; no one was safe, so much for my strategy. He was fast, loud; eyes darted everywhere and missed nothing. This was his turf, he was king and he relished asserting it. In a dervish, we were off, bed-by-bed, patient-by-patient, on "lightning" rounds.

I was a novice student, as green as they came, my first time in a hospital. At that stage of things I was prepared for doing little more than just tagging along. We came to the room of a mother tenderly holding a small, thin, almost emaciated child in her arms. She gently rocked him as the room filled from the onslaught of our Chief-following troupe. We crowded in until we surrounded the tiny patient and his mother. No one knew what the diagnosis was; we waited to hear the presentation.

The Chief boomed out, "Where's a student? You there!" He pointed directly at me and my eyes must have widened in response, I know my heart quickened. "Kiss that baby!" he commanded.

"Kiss the baby?" Nonplused, incredulous, I froze; I didn't move a muscle. "Am I missing something here? He can't really mean it, can he? 'Kiss the baby?' What part of Marcus Welby did I miss? Do doctors examine patients by kissing them? Is he making fun of me? Is this a joke? Am I going mad? Am I missing something here!"

During the brief moments that I hesitated, I noticed that no one in the group made a sound. This wasn't turning out to be a joke. The Chief persisted, this time more earnestly, "Come on, kiss the baby!" He was motioning me on. His imperative was not in my imagination.

I looked around. Everyone stared back at me. There were no smiles; no offers of any help. I looked at the mother. She looked like a normal everyday kind of mother. I looked at the baby. Nothing special there, just sleeping away. I looked back at the Chief. He didn't look happy. I shook my head. This just couldn't be right. I didn't want to kiss the baby. Right then, I wished that I was on another planet. I wished that a hole would open up in the floor and would just swallow me up. I didn't know what was going on and I didn't know what to do.

The Chief's face turned a scary red color. He jumped out, grabbed my arm, pulled me forward toward the patient and continued to insist that I "kiss the baby, kiss the baby!" Wanting to just end the disaster, I leaned over and quickly planted a peck on the child's arm, then returned to my place with the rest of the group. Seemingly satisfied, the Chief then turned to me triumphantly and asked, "Well, what did he taste like?"

"What did he taste like!!!? How the heck do I know what he tasted like!!? I didn't lickthe child!! What did he taste like!!? Is this guy stark raving mad!!? Does he think I French kissed the stupid baby's arm!!? What did he taste like!? Is this guy a moron!?"

Of course I didn't actually say any of this, instead, I just mumbled, "I don't know." With that response, thank God, in exasperation, he finally lost patience with me, gave up and moved on. It turns out that he never spoke another word to me again. Fine with me.

The point he was trying to make was that patients with Cystic Fibrosis have a genetic defect that prevents them from being able to keep salt out of their perspiration. Therefore, patients that have Cystic Fibrosis have salty tasting skin. It is so salty in fact, that it is virtually diagnostic for the disease.

There was a time once when physicians no doubt made the diagnosis of Cystic Fibrosis with their own tongues, but in our day, there is a lab test for measuring the amount of salt on a persons skin. Doctors do not have to go around licking their patients in order to make a diagnosis; we can save our tongues for other uses.

So, out of my fear and naiveté did I miss the chance of a lifetime to experience a great clinical teaching moment by not licking the child and actually tasting the salty skin of a Cystic Fibrosis patient?

Or, did my fear and naiveté lead me into being intimidated and browbeaten by a bully of a man who was ultimately just a poor teacher?

Something I do know. People like him do not scare me anymore and I don't let things like that day on rounds happen to me anymore.

I don't know where that unfortunate man is today, but I have to say, he sure was one strange cookie, ho boy. Sometimes I wonder -- if he had been a Pediatric Endocrinologist and if the patient had been a diabetic -- would I have been required to taste the patient's urine for sugar? Would I have done it? It boggles the mind.

Things I Have Done (in bold)

I couldn't resist. This list intrigued me. The things I have done are in bold.

01. Bought everyone in the bar a drink
02. Swam with wild dolphins
03. Climbed a mountain
04. Taken a Ferrari for a test drive
05. Been inside the Great Pyramid
06. Held a tarantula
07. Taken a candlelit bath with someone
08. Said “I love you” and meant it
09. Hugged a tree
10. Bungee jumped
11. Visited Paris
12. Watched a lightning storm at sea
13. Stayed up all night long and saw the sun rise
14. Seen the Northern Lights
15. Gone to a huge sports game
16. Walked the stairs to the top of the leaning Tower of Pisa
17. Grown and eaten your own vegetables
18. Touched an iceberg
19. Slept under the stars
20. Changed a baby’s diaper
21. Taken a trip in a hot air balloon
22. Watched a meteor shower
23. Gotten drunk on champagne
24. Given more than you can afford to charity
25. Looked up at the night sky through a telescope
26. Had an uncontrollable giggling fit at the worst possible moment
27. Had a food fight
28. Bet on a winning horse
29. Asked out a stranger
30. Had a snowball fight
31. Screamed as loudly as you possibly can
32. Held a lamb
33. Seen a total eclipse
34. Ridden a roller coaster
35. Hit a home run
36. Danced like a fool and not cared who was looking
37. Adopted an accent for an entire day
38. Actually felt happy about your life, even for just a moment
39. Had two hard drives for your computer
40. Visited all 50 states
41. Taken care of someone who was drunk
42. Had amazing friends
43. Danced with a stranger in a foreign country
44. Watched wild whales
45. Stolen a sign
46. Backpacked in Europe
47. Taken a road-trip
48. Gone rock climbing
49. Midnight walk on the beach
50. Gone sky diving
51. Visited Ireland
52. Been heartbroken longer than you were actually in love
53. In a restaurant, sat at a stranger’s table and had a meal with them
54. Visited Japan
55. Milked a cow
56. Alphabetized your CDs
57. Pretended to be a superhero
58. Sung karaoke
59. Lounged around in bed all day
60. Played touch football
61. Gone scuba diving
62. Kissed in the rain
63. Played in the mud
64. Played in the rain
65. Gone to a drive-in theater
66. Visited the Great Wall of China
67. Started a business
68. Fallen in love and not had your heart broken
69. Toured ancient sites
70. Taken a martial arts class
71. Played D&D for more than 6 hours straight
72. Gotten married
73. Been in a movie
74. Crashed a party
75. Gotten divorced
76. Gone without food for 5 days
77. Made cookies from scratch
78. Won first prize in a costume contest
79. Ridden a gondola in Venice
81. Rafted the Snake River
82. Been on television news programs as an “expert”
83. Got flowers for no reason
84. Performed on stage
85. Been to Las Vegas
86. Recorded music
87. Eaten shark
88. Kissed on the first date
89. Gone to Thailand
90. Bought a house
91. Been in a combat zone
92. Buried one/both of your parents
93. Been on a cruise ship
94. Spoken more than one language fluently
95. Performed in Rocky Horror
96. Raised children/currently raising child
97. Followed your favorite band/singer on tour
99. Taken an exotic bicycle tour in a foreign country
100. Picked up and moved to another city to just start over
101. Walked the Golden Gate Bridge
102. Sang loudly in the car, and didn’t stop when you knew someone was looking
103. Had plastic surgery
104. Survived an accident that you shouldn’t have survived
105. Wrote articles for a large publication
106. Lost 100 pounds
107. Held someone while they were having a flashback
108. Piloted an airplane
109. Touched a stingray
110. Broken someone’s heart
111. Helped an animal give birth
112. Won money on a T.V. game show
113. Broken a bone
114. Gone on an African photo safari
115. Had a facial part pierced other than your ears
116. Fired a rifle, shotgun, or pistol
117. Eaten mushrooms that were gathered in the wild
118. Ridden a horse
119. Had major surgery
120. Had a snake as a pet
121. Hiked to the bottom of the Grand Canyon
122. Slept for more than 30 hours over the course of 48 hours
123. Visited more foreign countries than U.S. states
124. Visited all 7 continents
125. Taken a canoe trip that lasted more than 2 days
126. Eaten kangaroo meat
127. Eaten sushi
128. Had your picture in the newspaper
129. Changed someone’s mind about something you care deeply about
130. Gone back to school
131. Parasailed
132. Touched a cockroach
133. Eaten fried green tomatoes
134. Read The Iliad - and the Odyssey
135. Selected one “important” author who you missed in school, and read
136. Killed and prepared an animal for eating
137. Skipped all your school reunions
138. Communicated with someone without sharing a common spoken language
139. Been elected to public office
140. Written your own computer language
141. Thought to yourself that you’re living your dream
142. Had to put someone you love into hospice care
143. Built your own PC from parts
144. Sold your own artwork to someone who didn’t know you
145. Had a booth at a street fair
146. Dyed your hair
147. Been a DJ
148. Shaved your head
149. Caused a car accident
150. Saved someone’s life

A Liver Mass

He was a small man, dark-skinned, sinewy, aged beyond his years from stifling heat and backbreaking work. He did not particularly stand out from any of the hundreds like him that I examined that week. Silent at his side sat his wife, not quite aloof, but reserved, cradling their sleeping infant in her arms. He complained simply of what he called a "hernia" of his stomach. A strange thing to say, I thought.

When we were finished, he looked away. I found myself waiting, as if I wanted something else to happen, an inspiration to appear, a comforting thought to materialize, anything. Instead, silence pervaded, palpable and dense. It was awkward and uncomfortable. I finally looked away as well. A feeling of hollow emptiness griped me.

With nothing left for it, I turned toward the mother and the infant child. We proceeded with baby's check-up as if father's encounter had not just occurred. It was surreal. Mother had listened to everything but had said nothing. Now we were acting as if everything was just fine. However, everything wasn't just fine, not really. I knew better. The smile was missing from mother's face, but more than that, mother's smile was missing from the inside as well, I could tell.

As I continued my conversation with mother, I could not help but notice father's subtle separation. Almost imperceptibly, he repositioned himself on the bench so that he and mother ended up sitting with a significant a space between them. He faced away at a slight angle, distracted from our conversation, he was lost in his own thoughts, pensive, stunned even.

This little family was in shock. They were reeling. I calmly and quietly delivered a nuclear blast in the middle of their existence and even though to the casual observer on the outside nothing looked amiss, this family was devastated.

Our family medical visit ended with a polite good bye, and then they left. The nurse prepared for the next family but I could not move on. Something about that man, in the way he reacted, the way he detached, troubled me. My heart was not letting me let this pass.

The nurse sensed this and asked me if I was all right. I looked at her and told her that I was not. I gazed across the room. The beleaguered man and his taciturn wife were asking for prayer at the prayer station. I considered them for a moment.

"36 years old with a rock hard mass the size of a melon in his liver. And there isn't a thing he can do about it. What good did I do him?"

The nurse said nothing. "You know something, I don't know what that mass is, but I think it will kill him and I also think he knows it."

I could not settle the issue in my mind. The question seemed clear. Did I travel all the way from my comfortable home in Iowa, to a remote isolated Peruvian jungle village, to tell that man he had a mass in his liver, only to go back home and leave him there to die? Is that why I went to Peru? As I watched him from across the room, in my heart I knew that it was not. I said to the nurse, "Wait here, I'll be back."

I crossed the room to the prayer station. The man sat with his wife, the baby still secure in her embrace. A translator and two of our team members were in conversation with them. "Excuse me," I interrupted, "but I need to know, have you asked him if he is a believer? Does he know the Lord Jesus Christ?"

"We asked him and he said yes, he is a believer. He is a member of the church here. Do you want to pray with him and his family?"

I did. We prayed together. When we parted ways the first time, his future seemed uncertain, after our final parting my sense was altogether different. His future, I came to understand, is entirely guaranteed, as is mine.

As Christian brothers, the apostle Peter tells us, "we live with a wonderful expectation because Jesus Christ rose from the dead. For God has reserved a priceless inheritance for His children. It is kept in heaven for us, pure and undefiled, beyond the reach of change and decay.

And God, in His mighty power, will protect us until we receive this salvation, because we are trusting Him. It will be revealed on the last day for all to see. So be truly glad! There is wonderful joy ahead, even though it is necessary for us to endure many trials for a while."

I'm glad he knew Jesus and that I had an opportunity to encourage him. But the thought nags at me, what if he hadn't known Jesus? I can't bear it that I would go to Peru to meet this man, or someone like him and then leave him there to die without telling him about Jesus, the reason for the hope that is within me. Jesus predicted that his followers would tell people about Him everywhere, even to the ends of the earth.

The apostle Paul said, "Anyone who calls on the name of the Lord will be saved. But how can they call on Him to save them unless they believe in Him? And how can they believe in Him if they have never heard about Him? And how can they hear about Him unless someone tells them?"

That is the real reason I went to Peru, to tell people about Him, everywhere. "How beautiful are the feet of those who bring good news!" That is a good motto.