BILL WATSON FLEW into town to interview for a management position at the manufacturing headquarters near the hospital where I was moonlighting. He went out to dinner with six others from the senior staff and enjoyed both the people and the conversation. When his hosts dropped him off at his hotel around 9: 30, he called his wife to tell her how well the process was going. He got ready for bed, brushed his teeth, and then hit a snag: he couldn’t empty his bladder. After dinner, two glasses of wine, two glasses of water, and a cup of coffee, his bladder was full. The problem was his prostate.
The prostate is a gland that lives under a man’s bladder. There it bides its time, quietly going about its business for decades, all the while growing like the national debt. The 50-50 rule applies to this gland: by the time men reach their fifties, half will have an enlarged prostate— a condition known as benign prostatic hypertrophy, or BPH. Certain substances make the prostate swell acutely. The alcohol Bill had with dinner caused his prostate to go into overdrive and contract around the tube that drains the bladder. This wasn’t the first time something like this had happened. On two occasions before, he’d experienced a similar although much less dramatic effect after a glass of wine. In those instances, it had caused a traffic jam, not a complete gridlock.
Once the alcohol wore off, he had been able to empty his bladder without any further problems. Bill said he’d hesitated to have a drink, but he didn’t want to seem prudish when his hosts were obviously enjoying themselves. What he had not figured into the equation was the cold medicine he’d taken before his flight. Together, they had brought his bladder’s drainage system to a complete standstill. Bill ignored his expanding bladder in hopes that it would soon right itself. He turned on the television. One show finished, and another went by. As the late news ended and The Tonight Show began, Bill once again tested the plumbing to see if it was working— but to no avail. He was getting really uncomfortable. Bill checked the system during every commercial break throughout the Late Late Show. When the infomercials began, Bill knew he was in big trouble, but he was in too much agony to drive to the hospital and too embarrassed to call 911.
What would he say when they asked about the nature of his problem? That he was about to explode? Fortunately, Bill had an old friend at his prospective employer. He called and explained the situation. It took another half hour for the friend to arrive at the hotel. After the drive to the hospital, Bill could hardly stand, and he definitely could not sit. I didn’t know Bill Watson existed until the night-shift nurse rang the phone in the call room. The clock numbers glowed 3: 47. “This is Lois,” announced the nurse in the ER. “I’ve got a fifty-seven-year-old man here who just needs his bladder cathed and I’ve got two BP cuffs that aren’t working. I won’t be able do the chart until I go out on the floor and get another blood pressure machine. I’ll call you when I’m finished.” Lois was a new nurse to me, but she seemed to be on top of things. In the old days, the night nurse would have just cathed a patient like this and wouldn’t have even bothered calling the doctor unless the patient needed to be admitted.
Now, it was all about the paperwork. I’d need to chat with the patient and make sure he had follow-up care and then sign his chart, but really it was the nurse who was the hero in these cases. I got out of the narrow bed, went to the bathroom, washed up, and headed to the ER. I detoured by the cafeteria to get a soda and poured it into a large coffee cup. (Hint to new doctors: nobody is reassured by a doctor sipping from a soda can, but drinking what appears to be black coffee is perfectly legit.) When I sauntered into the deserted ER, Lois and the patient were nowhere to be found. They must be up front in the procedure room. I took a gulp of my soda, walked to the procedure room, knocked, and opened the door. Bill Watson was a tough man, yet when I opened the door and saw him rocking and shifting back and forth by the exam table with tears rolling silently down his face, I saw a man ready to give up. Two blood pressure machines were parked in disarray beside the patient bed. The chart was on the end of the bed, waiting to be filled out. My eyes must have gone wide when I realized that Lois had left this suffering man without putting a catheter in him so she could wander around looking for a machine to record his blood pressure. Get a catheter in a man like Bill, drain his bladder, and you’ve got a friend for life. I like having friends. So that is exactly what I did. The bladder wants to empty once it is filled with twelve ounces of fluid or less— about one soda can’s worth.
I drained eight soda cans’ worth of fluid from Bill’s bladder and was well on the way to a twelve pack when Lois finally walked back into the room triumphantly pushing a blood pressure machine. “Can you believe there weren’t any working machines in the department? It was like pulling teeth to get the floor to give me one!” she crowed. Looking for a portable blood pressure machine when what Bill needed was a catheter? Talk about not seeing the forest for the trees! Later, when Lois explained her thinking, she said she was taught not to initiate treatment without getting vital signs first. That makes sense, but the purpose of vital signs is to know what to treat, which in this case was excruciatingly obvious. “If you didn’t want to cath him without the vitals, why didn’t you just call me to do it?” I asked. “Because I knew you would want the vital signs.” She was just doing her job— even if it killed Bill. Lois’s logic is an example of concrete thinking. The reasoning of a concrete thinker is locked in, rigid, and inflexible. We have all known people who seem to have a knack for not getting the point.
They take the letter of the law and lose sight of the intent behind it. The Bible is replete with stories that illustrate this all-too-human propensity. In 24/ 6, we are looking for the intent behind the law. What is the objective of the Fourth Commandment? And can we learn something by reading about its origin? We don’t need to go far into the Bible to discover the origin of the Sabbath: it’s right there on the first page. How the Fourth Commandment Got Added “Thus the heavens and the earth were finished, and all the host of them. And on the seventh day God finished his work that he had done, and he rested on the seventh day from all his work that he had done. So God blessed the seventh day and made it holy, because on it God rested from all his work that he had done in creation” (Genesis 2: 1-3, ESV).
In the beginning of the greatest story ever told, we find the inventor of everything taking a rest and enjoying his creation. And like most of the first few chapters of Genesis, this isn’t so much an explanation of how, but of who. The who, of course, is God.
Sleeth, Matthew (2012-10-18). 24/6: A Prescription for a Healthier, Happier Life (pp. 31-32). Tyndale House Publishers. Kindle Edition.