One summer apon a time, I used to do agency shifts in this little, rinky-dink, lousy ER near the neighborhood I grew up in. I don't think the equipment had been replaced since my mother worked there in the early 60's. So one night, I went out to the waiting room to discharge this homeless guy who had come in with some minor complaint. We used to get a fair share of homeless patients. I was a little apprehensive. I wasn't sure if maybe he had a psych history or rotten smelling feet or some other issue that would make me want to keep my distance. I shouldn't have worried. With a dignity that I've seldom seen on anyone, rich or poor, we discussed his care. When the discharge instructions were finished, I told him to come back if things got worse and to take care of himself. He looked straight at me and said, "I will and I shall." For a second it was like looking into the eyes of God. Then he shook my hand and left. If Jesus ever returns, you'll find him in an ER waiting room. I will and I shall. It echoes still in my mind.

I have a patient currently who is mentally ill. When she was still in hospital she became very paranoid, telling me that the nurses were keeping her in bed and wouldn't let her go to the bathroom, among other things. (Not true, I checked). Her discharge instructions included several interruptions by her boyfriend to argue with her, when he wasn't looking at me like I was a total waste of his time. I thought, "Hoo, boy, this one's going to have trouble with the follow up." I mean, our clinic schedule isn't rocket science, but it does take getting used to and there is a big onus on the patient to be responsible for frequent medication changes and repeat blood work and keeping track of their daily blood pressure, temperature and fluid intake and output. Trust me, it challenges those firing on all cylinders, as it were. I might even have projected that this one would be screaming at me on the phone every time her creatinine jumped or she had to adjust her prograf.

Instead, I find her to be one of our more pleasant patients. She keeps track, so far, of everything she's supposed to and shows up when she has to. If I think back now to how she was in the hospital, I think of how stressful it must have been to be helpless in a hospital bed, just recovering from major surgery, with lots of noise and little sleep or privacy. Now, she's taking all her meds, she's cut back to 2 cigarettes a day, one in the morning and one at night-which I think is a major accomplishment for her. Have we changed her whole life? I don't think so-she's still dating Mr. Douchebag and she still has whatever issues she had before the transplant. But she's doing well for her. Optimizing the patient's potential, or some such nursing theory stuff like that.

Just for the record, I don't really believe that Jesus is coming back to take the faithful up in a big rapture (although if he does, I am SO upgrading my car). But if you look for it, the Almighty Big-Whatever shows up from time to time in endless, little ways. The question is, how will you react to it?