Saturday, January 31, 2009

On Evangelism and Coercion

I spoke with a Christian classmate and they said that their stomach turns when they hear the word “Evangelical”. I asked them why, and they explained that feelings of coercion and pride were at the root of the feeling. I suppose that the person felt like “evangelism” was tantamount (at least connotatively) to the Inquisition: Believe or die!

This is a common perception on my sociological category. And perhaps my ancestors were indeed inquisitors and I have to deal with that true legacy. Or it’s propaganda. In either case, I’ve got a strike (or three) against me in starting any conversation because I’m an “Evangelical”. So every once in a while, I am compelled to give a defense for the word with which I am stereotyped.

Evangelism is for me simply the attempt to convince another to believe in a theory about God and the universe. This theory has brought me great joy and peace, and because I love my neighbor, I wish to share the joy and peace.

My motivation hinges on changing belief. But the interesting thing about belief is that it’s not voluntarily changeable. No matter how much money I offered to pay you, you could not believe that the tooth fairy is sitting on top of your monitor right now. Even if you stood to make $1 million, you could not actually believe in something that you believed to be false. And no matter what I threatened you with, you couldn’t change your beliefs. You could say you believe something, but clearly you can’t change your own mind this way. Coercive “belief”, isn’t belief.

The next point is one of Christian doctrine. Christians believe that salvation comes through belief (at least…). So if no one can ‘coerce’ anyone else into believing a thing and if my religion teaches that belief is required for salvation, what then is evangelism? Whatever it is, it logically cannot be coercive. What is it then?

If you want to change someone else’s mind (say, on the team that will win on Sunday), you need to use evidence. Everything from a qualitative statement like “The Cardinals have such a great offense,” to a quantitative one: “Kurt Warner threw 4583 yards in the 2008 season.” This is the way you can change a mind: present compelling evidence. The mind’s evaluates evidence: “For the ear trieth words, as the mouth tasteth meat” (Job 34:3). So give it evidence!

Do I have the truth? I think I do, as I hope everyone thinks they do. Or at least a part of it.

Isn’t it arrogant to claim that your way is the only way? It would be if I claimed that the human institution of Christianity was the only way, it would indeed be arrogant; we are humans who built it, after all. This is the incredible thing about Christianity: we don’t have a monopoly on the truth. You don’t have to go to a Christian church to be saved. You don’t have to call Jesus “Jesus.” You just have to believe in the truth. Those Christians who do this will be saved; those who don’t, won’t. Jesus actually says that many will profess to be his followers but in the end “…I profess unto them, I never knew you: depart from me, ye that work iniquity.” The same goes for every human on the planet: if you have right belief, you will be saved.

It’s not about Christianity; it’s about the truth. Just like nature, gravity doesn’t care if you’re calculating where a cannonball lands from Newton’s laws or from lots of practice. Gravity is gravity, and its rewards are not exclusive to Newtonians. We can say that Newton has perhaps the most effective and elegant way to analyze gravity on a macro scale, but a man need not know the name of Newton to use gravity effectively. The same is true for Christianity. It’s the most effective and elegant way to analyze the spiritual world, but a man need not know the name of Jesus to attain salvation.

So I am an Evangelist for Christianity as Newton was an Evangelist for physics. Did Newton coerce people into believing his theories? No. He convinced them. One piece of evidence at a time. Because his view was true, people who believed in it were better off because of their belief. And belief in Newtonian physics spread.

We consider it an obligation and an honor for a scientist to make his findings known. We look at respect on the evangelical scientist, he who tries to better the world by his revelation of truth. And this is what I aim to do: to share what I believe I understand. If my reasons and evidence are compelling, believe. If not, don’t. I am an Evangelical Christian as Newton was an Evangelical Scientist.

Matter is a Literary Device

I was talking with a friend explaining the purpose of Creation, and it occurred to me that matter might be like a literary device.

There are several types that leaped to mind. Firstly, it’s a metaphor. The stars are a metaphor for wonder. The sun is a metaphor for glory. They all symbolize and teach some truth which is deeper than themselves.

Matter becomes allegory. Jesus uses this material literary device extensively in the parables. The field becomes the world; the mustard seed becomes the Kingdom of Heaven.

Because of the Resurrection (I’m thinking of NT Wright’s description of it; you can find it on, the trees and hills will themselves be remade into something greater than trees and hills. The material world foreshadows the one to come.

Church for Atheists

Along the lines of the entry earlier this week, I have been thinking about the spiritual health of non-Christians. They have the same needs as any Christian has. They need community. They need opportunities for service. They need places to express joy and thanksgiving (even if it’s directed to the universe in general). I think it’s clearly biblical to try to bring them to church. Unfortunately, all the talk about Jesus and miracles is terrifying for a staunch materialist.

When we see a man who has been beaten by robbers and left for dead, what ought we to do? Put him on our own donkey. Sure. But what if he refuses our help on the grounds that he is terrified of donkeys? He will not accept the best thing for him: to be carried to a place of rest. So do we throw up our hands and give up? After all, he had his chance and he blew it. Or do we try to pull he and the donkey together, much to the protestation of both man and beast? We know for a fact that his riding the donkey will be for his own good; coercion may be the most merciful thing.

Moreover, when we offer him wine, and he refuses, saying he doesn’t believe in the power of alcohol to dull pain. Do we force the wine upon him?

In my little rip-off of Jesus great parable, the robbers are Humanism and Materialism, the man is the atheist, and we’re in the role of the good Samaritan. Our donkey is church and the wine is prayer. For many of us, we can think of nothing else but the donkey and the wine. And in part it’s right; the church is indeed the best community on Earth and prayer is the best way man can commune with God. But the man has a deathly fear of the donkey and will not ride it; he does not believe in the wine, and will not drink it.

I propose that we consider another approach: give him all he is willing to take. He’s hurting, so let’s let him lean on us and walk towards the inn, albeit it at an excruciatingly slow pace. He won’t take wine; let’s offer him water. There is no question that he’s thirsty, almost to death for any liquid.

What is the leaning and what is the water? I’m not quite sure, because Christians haven’t quite figured out what spiritual practices are tolerable for Atheists. An Atheist would not come to a prayer meeting; would he come to a lesser communion of God by quiet meditation? Or perhaps stargazing? An atheist would not sing about Jesus; would he sing about the beauty of nature?

I am not thinking about this in typical Evangelical terms (though I think those approaches also are valid). What first motivated this was the question: how do I heal the spirits of my atheist patients? Even assuming that total spiritual healing would never come through Christ, did I not still have an obligation to heal as much as I could? So how can an atheist who is starving to death for community and parched for spiritual practice be healed in part?

I am also not talking about watering down the Gospel. The Gospel must be preached with power and authority at Church; the effort to seek and save the lost must continue unabated. But just like international work, long-term solutions are ideal, but people are starving to death today. Evangelicals have done a superb job at the long-term (eternal even) solution for the soul, but what keeps the soul of an Atheist from starving today?

I pose this question particularly to church people. I don’t know the answer. I see terrible spiritual affliction, and though the church is fighting it systemically, there are too many suffering without relief today who feel too uncomfortable to come to church. Should we have 'church' for atheists?

How can we be a Good Samaritan and give relief to the soul of the bruised and beaten Atheist today?

Friday, January 30, 2009

The Fountain of Youth?

Medicine isn’t a fountain of youth. In America, we spend more and more and more on medicine and it’s not making us any healthier.

Scholars evaluating ‘health outcomes’ have begun to see this and are getting scared. After all, what will they have to do when more medicine amounts to giving people sugar pills. I read a paper by a scholar I respected on the availability of MRIs. The conclusion was we use them more when they’re available (in a direct linear relationship), but there is a considerable question as to whether we are any better because of it. He suggests that we may need to start looking for non-health based outcomes. In other words, we need to ask how it made people feel.

We saw another study that showed that doctors in New York visit a certain population of their hospital patients three times as many times as doctors in San Francisco. They also keep them for thrice as many days in the hospitals. “Good for them!” you may say. But when you compare outcomes, there is no difference. Those who stayed 10 days in San Francisco had the same outcome as those who stayed 30 in New York. Zero difference.

“You get what you pay for,” we say to ourselves. If we pay more for healthcare, we get more life out of it. But we’ve maxed out on medicine. There’s no more life that can be purchased for most of us. There are certainly some people who need new breakthroughs to live as long as everybody else. But for most of us, throwing more money at body scans and vitamins is just like throwing money down a toilet. Staying an extra day in the hospital. Getting that X-ray for a rib you knew was broken. Will that make us healthier? Will that add years to our lives? No.

Why do we? Because we think it will. Somewhere in our psyche is the thought that we can buy eternal life. Like Simon the Sorcerer who when he “…saw that through laying on of the apostles' hands the Holy Ghost was given, he offered them money, Saying, Give me also this power…” (Acts 8:18-19a). We think life is for sale, and doctors are the vendors. I’ll let you in on a secret that, if everyone knew about it, would save us from financial ruin: Doctors don’t hold the keys of the kingdom of heaven. Giving us money just makes us rich. Save your money. Or better yet, use it to save others. Extension of your life cannot be purchased; but that’s not true for at least a billion people around the world. Buy for them the health you already enjoy.

Alternative to Universal Healthcare

Explore the possibility of having “universal healthcare” through universal access to government loans instead of limitless insurance. These loans would cover the cost of medical procedures and thus allowing everyone to get care that they needed. They would function like student loans: the payments would be reasonable for all incomes (payments max out at a certain percentage of income), deferrable under extreme economic hardship, and they don’t go away after bankruptcy.

This system would have the advantage of allowing patient-consumers to choose wisely with their own money, and not simply spend without discretion. This would likely need to be aided by mandating transparency in healthcare (Ala Herzlinger’s Healthcare SEC). Whatever a person spends on his health, he is responsible for. For a very sick poor person, they will pay a percentage of his income for the rest of his life, thereby sharing in the cost he is incurring on society.

This would solve the dual problems of medical expenses causing financial ruin and expenses rocketing to the stratosphere because we are not allowed to be consumers. It would cause problems in potential overspending for the very sick. It would also make insurance companies irrelevant, because the burden of risk is upon the government. In many cases, it would be an unequal burden on the rich; they would more often pay off their expensive loans while the poor would die with government medical debt (which would have to be forgiven).

Though I am always hesitant to give the government power, the exchange of a huge government program for a moderate one is palatable. The unequal burden on the rich already exists, and the cost savings by consumers driving the market (as in the RAND experiment) would more than make up for this inequity. Overall, the system would make a person’s health his own responsibility.


When you design a dam, you make it big enough to hold more water than you ever expect to encounter. When you screw up, and water starts flowing over the dam (usually causing the dam to fail), it’s called overtopping.

When you’re in medical school, you expect that you can do enough writing so as to record all ideas that you ever expect to encounter. When you screw up, and ideas start backing up, it’s called overtopping.

I started using Post It’s. A wonderful invention. I stick Yellow notes on the wall by my desk for “To Dos” and magenta for “Cool thought; should work out in writing”. At this present time, I have four yellow notes (three of them have all their items crossed off so that I can feel gratified at seeing that I do do things), and 14 magenta notes (none of them have been scratched off). Needless to say, I can’t write 14 pieces, and I don’t expect the flow of ideas will slow. So my only option is to write short, poorly edited pieces. I just want to get them off my wall and make more room for more ideas. Naturally, this give you my reader the wonderful opportunity to say which (if any) of these ideas you find interesting. I like to talk about what other people are interested in; your interest may reignite my own. So please comment!

And now, without further ado (what is ‘ado’ anyways?)…

Thursday, January 29, 2009

Living and Life

We confusing living for life. We attempt to keep on living for its own sake, and do not realize that in so doing, we fail to truly live.

It is prudent to preserve one's life, but not for it's own sake. I wear a helmet to prevent death by unworthy causes. It is not to maximize the number of years my heart beats. I have protected my life for 23 years so that I might have a chance to spend it on something worthwhile.

We should not flee from death. We err gravely When we equate senseless death with sacrificial death. If we look at soldiers who die and those who die in car crashes and say about both, "what a waste of life," we nullify the nobility of sacrificial death. The soldier gave his life for others; his death was meaningful (even if the war isn't). The car crash victim made no such sacrifice; his death was meaningless. We may justly oppose war because of justice or cost; we ought not oppose it simply because of death.

We can never make 'less death' the end of society. Living alone is not a virtue. Courage, honor and love are; we ought never to sacrifice these for the sake of living. In our decisions we must consider the bad and good that we are preventing.

There are certainly some policy decisions which are straightforward. No major virtue is lost by mandating seat belts. But we cannot take the argument developed in a realm without virtue and apply it to one with virtue.

There is often strong opposition to an organizations' members going to dangerous places. There is a fear that their 'lives will be lost'. On the contrary. Their lives will be saved. If they die for a noble cause, they will have experienced some life within their living. If they avoid all danger and risk, they may never see life, though they live.

Life is loving our neighbor, and true life sometimes requires that a person not live as long. Life is not a beating heart. It is a thriving soul. Making life all about prolonging the functioning of a pump is foolish.

Let us never exchange life for living.

Mar 8:35 "For whoever wishes to save his life will lose it, but whoever loses his life for My sake and the gospel's will save it."

Monday, January 26, 2009

Spiritual Health

What is spiritual health? I have long thought about this question, especially since my profession’s concern is with ‘health’. Spiritual health is certainly important for physical health. Many scientific articles have shown that things like church attendance and belief have measurable positive effects on physical health (one study showed that church attendance lowered mortality so significantly that a lifelong churchgoer would live seven additional years compared to the non-attendee). My first thought was, “Great! Everybody should go to church!” but this suggestion was vehemently opposed by those who are deathly allergic to religion (most of my classmates and professors). Even I, upon reflection, concluded that an Atheist who took my advice and went to church hating every last Sunday morning would likely not live seven years longer.

What then can I do? My job is to share whatever of God’s love and healing as I can with my patients, even those who are unwilling to go to church. Are there benefits of spiritual practice which are sharable with non-Christians? Or is it Divine intervention that gives churchgoers their extended lives? Though I can’t completely rule out God’s favor (I am, after all, a rational person who does not come to conclusions without evidence), it seems likely to me that if there were such an effect, it would at least be coupled with a natural one. That is, there is probably some positive psycho-socio-physical effect that could indeed be transferred to the heathen (גוי – literally “non-Jews”; figuratively “not God’s people”... no offense to the heathen).

And so I must return to my original question: what is spiritual health? For a long time, my thoughts on this question were informed (and limited) by the traditional Christian answer: fellowship, prayer, service/evangelism and Bible study. These have certainly laid the foundations for my own spiritual health. But can these be generalized? Is there some part of the benefit of prayer which a Hindu could get by meditation (or conversely, what of spiritual health are Christians missing by ignoring God’s command to “be still and know that I am God”)?

In considering my own spiritual life, I identified seven areas which I believe are important for spiritual health (and I didn’t make it be seven on purpose… that’s something I’m liable to do but I didn’t). They are 1. Relationship with family 2. Relationship with friends 3. Sleep and rest 4. Spiritual exercise 5. Private spiritual expression 6. Confidential spiritual expression 7. Public spiritual expression. I’ll describe how I have seen the church engage these seven points, and then how it may be generalized.

1. Relationship with Family
A Christian is encouraged to have a good relationship with her literal family. Many places command respect for parents, love of wife/husband, and care for kids. My church in Temecula places a strong emphasis on this point.

Family and family responsibility is a large part of being human. From a crude biological sense, reproduction and child-rearing is our only important role. And the sensibilities of most people today and those throughout history have placed a special significance on having a good relationship with our families. Indeed marriage has been shown to extend lifespan (and my guess is that a good marriage does so more than a bad one).

2. Relationship with Friends
A Christian is encouraged to have friends to whom she can go. These are developed in ‘Small Groups’ or via Discipling (mentoring) relationships. There are many emphatic commands to love one another, and many incredible examples of such relationships in the New Testament.

Friendship and community is one of the most universally accepted human goods. It is certainly not the exclusive domain of the church (though the Church has often been the friend to the friendless historically). Psychological studies have started mapping this as a variable that is linked to mental health.

3. Sleep and Rest
God is quite concerned about rest. He talks about the Sabbath a whole lot more than Christians are comfortable with and themes of Rest are throughout the Bible. Christian generally rest at least 1½ hours on Sunday morning.

Rest is really important. We all know this. And even the idea of intentionally not working is important. I’ve heard an apocryphal story of the USSR switching to a 6 day work week because of productivity declines after they tried a 7 day work week. We need rest and we need sleep, be we Christian or Atheist.

4. Spiritual Exercise
There are lots of exercises we’re supposed to do: bible reading, fasting and service are a few, and the Bible is full of expositions on these. Widows and orphans, justice, and evangelism are things that God would like for us to care about (and the Church generally does care).

Many of these expressions are directly translatable (service), some of them are not (Evangelism), and I think the traditional Christian picture omits some important things. My most recent thinking on the spiritual aspect of a thing is: “that part of an experience which remains after subtracting its rational and emotional aspects.” Serving others, going to church, getting married, going to a funeral all have large spiritual components. But so do hiking and stargazing, art museums and drama performances. These experiences have something about them which is sublime. And I’m inclined to call it spiritual. Even if an Atheist doesn’t go to church, I bet he’d be a spiritually healthier person by stargazing. I don’t know of any studies that link these practices to health, but I think that’s because nobody’s ever looked. This category deserves more thinking, but for the moment is broad enough to be accommodating to everyone.

5-7. Private, confidential and public spiritual expression
A Christian ought to expresses her love for Christ, her hopes and fears, her praise and thankfulness, her sorrow and joy, she confesses her guilt and asks for forgiveness. And she has opportunity to do it through prayer (privately), in small group or accountability (confidential), and at the church building (publicly).

These expression of the human heart, mind and soul cannot only be the turf of the Church. I think the Church has worked out a very convenient way to regularly express them, but the need (and opportunity) is universal. A person may quietly reflect on his guilt without asking forgiveness from God; part of the benefit of prayerful confession will be maintained. Mentees can express their hope for the future just as well as disciple-ees. Joy can be expressed at a Dave Matthews Band concert as well as at one by Switchfoot.

What is spiritual health? I’m not sure entirely. But I think the traditional Christian framework, refined by two thousand years of spiritually health people and generalized, is an excellent way to think about spiritual health. I am very interested in further refinements and improvement, but I think even in its early stage, if a person made efforts to improve in these seven areas, he’d be better off. And that goes for Christians and non-Christians alike.

In a first step to help people improve their spiritual health, I have designed a Spiritual Health Self Assessment. It takes about 20-30 minutes and encourages participants to reflect on their spiritual health and includes a section for planning for self-improvement. The next step is to recruit and train Spiritual Healthcare Providers (SPHs). But more about that later.

I would love for you, my reader, to participate and improve your own spiritual health (and give me feedback, so I can better heal the spirit):

Take it once a week for better health, (future) Doctor’s orders.

Wednesday, January 21, 2009

On the Origin of Life

I recently had a discussion on an article published in Science on the Origin of Life. While it is a little unfortunate, some of you, my readers, won't be able to read the original article unless you're signing on from a university campus. Here is the link if you can use it.

The article is very well written and very persuasive. It describes steps that are being taken in artificially creating life. Its tone is positive and hopeful, believing the breakthrough is just around the corner. The argument goes something like this: "Life as we know it is way to hard to have come about on its own. It must have worked its way up from RNA based life. And RNA is really hard to make, so it must have worked its way up from something else (lets call it 'PNA'). So, therefore, we think we're close to being able to assemble RNA. And we know that RNA can replicate itself spontaneously. And once it can do that, badaboom, we've got life." [Author's note: this is heavily satirized; please read the original article if you can].

All satire aside, I think the case for artificial life is drastically overstated.

Since there's no other acceptable theory (i.e. Theogenesis, Panspermia aren't allowed), we can pretty much speculate wildly and no one can say that it's unreasonable. We just have to be more reasonable than your totally unreasonable competition. RNA life seems likely when you compare it to existing life. And since even RNA can't be easily formed, we can entertain theories of PNA. We invent a new life form (RNA-based life), which we have never observed or have any evidence exists and then because they're so implausible, we invent a new biological molecule (PNA) which we've never observed or have any evidence exists. We've come to inventing two orders of new, unobservable things we just need to have faith in. It strikes me as ironic that this is mostly done out of a motivation to eliminate faith.

There is a computer image of what looks like a double helix assembling inside a membrane. On first glance, it's not artsy; I thought it was some sort of model. I read the caption. "Researchers at Harvard are trying to make simple life forms, shown here in a computer image." "Shown here"? You don't show molecular biology in anything but an artist's conception. But the caption and the art style makes it seem like they're showing the actual work.

There's too much bruhaa and not enough science (I'd like to read the papers they refer to). The author makes it seem like a simple 1,2,3 process, but my guess is that each step requires entirely different conditions, materials and special tinkering to make work. If it were simple, it's have been done by somebody (or discovered) sometime in the last two centuries.

That being said, I don't discourage the research in principle (though I think that curing TB might aid humanity more). I'd like to see people try to make life. And I don't doubt we will be successful at creating an artificial cell, and that in the near future. I am very skeptical of our being able to create an artificial cell under anything like natural circumstances.

Bone of my bones

[Rated R – Don’t read this while eating or if you have a weak stomach or if you’re a girl (in the middle-school sense of the word :)]

Today I sawed open a man’s head. First I had to scalp him, scraping the skin and muscle from his head pulling with my gloved fingers on one hand and cutting the tissue beneath with a scalpel wielded by my other. And then I had to saw open his head. I turned on the Stryker saw, a foot-long white handle and motor connected to a steel semi-circular toothed blade. I flipped the switch, and a high-pitched whir come from the motor as it drove the blade, rotating it an eighth inch back and forth in a blur.

I held the saw with both hands, held it perpendicular to the forehead, and the pressed it to the bone. The high pitch whirring lowered its pitch. Bone like sawdust shot from side to side by the now-invisible movement of the blade. The pitch lowered still and the saw labored; the blade was buried a quarter inch in the bone. The bone dust continued to flow out of the hole, and then above it rose white smoke. And I smelled it.

In four months of anatomy, I’ve smelled a lot of strange things. But this smell has haunted me all day. I have smelled burning flesh before and it turns the stomach. But burning bone turned my soul. It didn’t make my lip curl as the smell of flesh does, but it did make my soul writhe.

Inch by inch, I cut a circle around from forehead to back. Then I cut that dome in two pieces to more easily remove it from the brain it was stuck to. After prying off these two pieces of skull, I exposed the brain. Covered in blood vessels and pinky-purple, it was an incredible thing to behold. It showed evidence of my sloppiness, a few cuts where the saw slipped from the bone and cut a gash into the tender tissue below. It was to be expected in such a violent dissection.

I cut off another piece from the back of the skull to the brainstem and finally I turned off the saw. I looked at my clothes; I was covered in a white powder that used to be skull. Having finished this cut, my lab partner cut the brainstem, and handed me the three-pound piece of meat which once housed a man.

It should have been traumatic, but it wasn’t. A well adjusted person should not be able to do what I just did without having his stomach turn. I turned off my emotions as an unwanted accessory and did what I was supposed to. But the smell has lingered, outliving the image of the bone and brain-splattered table which I was able to leave behind in the anatomy lab. The smell followed me today. After class. At dinner. While reading. Even now.

I wonder if there is something in the bone beyond marrow. I wonder if there is a special holiness to a man’s bones. Have I somehow defiled something holy?

Friday, January 16, 2009

A Good Time for Thinking

The Doctor was pensive. Normally The Doctor never had time to think. Work was too busy, not a good place for thinking. And home was far too relaxing a place; also not a good place for thinking. So today was special, for he thought.

He was thinking particularly about what he was doing and why he was doing it. Money. Prestige. Sure, they’re involved; but the ideal is something more than that. Everyone thinks that there’s something special about doctors, something that sets doctoring on Olympus. Why did this ever enter into people’s minds? The answer would have to wait; Medical Student was presenting. Now was not a good time for thinking.

“Patient presenting with a supra clavicular four centimeter cyst. First noticed two weeks ago…” prattled Medical Student without a scrap of interest or life in the words that were flowing from his mouth, as oil dripping from a leaky pipeline. The Doctor paid attention and gave orders to the nurse to prepare to open the cyst, giving orders as a program running a subroutine.

The Doctor entered Cyst’s room. She was sitting as a patient patient, wearing the same gown as everyone who he ever saw. The Doctor thought about how the shape of the bodies changed. Some were tall, some were black, some had breasts. The problems that needed fixing changed. Some needed cutting, some needed drugging, some needed nothing. But the gown never did. It was always the threadbare material with the bland pattern. All individuality, all modesty, all humanity was stripped before the doctor’s “Hello.” As prisoners’ uniforms, the donning of the gown turned people into patients. And so thinking, The Doctor found himself with the patient. Now was not a good time for thinking.

“Hello! How are you today?” asked The Doctor with utmost politeness, spoken with the exaggerated volume and enthusiasm of a high school drama student.

“OK, except for this,” said Cyst, pointing at her cyst.

“I understand. We’ll get that taken care of right away!” said The Doctor with such a tone, one might have guessed he wore blue spandex with an ‘S’ under his white coat.

The Nurse had brought in all that would be needed for the operation. The Doctor moved swiftly, his hands moving with the efficiency of a martial artist. Anesthetize, cut, drain, pack, bill. He was a machine. A machine repairing a machine.

“Thank you, doctor,” said Cyst. But Cyst was not thankful. The pain was gone, but she did not feel better. Why not? It wasn’t coldness, for he sounded warm. It wasn’t incompetence, for he was efficient. Was it soullessness?

“You’re welcome,” replied The Doctor. But The Doctor was not gracious. He did not feel good. He did not feel bad. He did not feel. It was as if nothing at all had happened. He would have felt the same way about eating his lunch. The Doctor left the room and walked down the hallway, feeling particularly feelingless. And so he thought.

Cyst’s body was made whole. And maybe that’s all a doctor can do. But what if it wasn’t? What if he were more than a biochemical mechanic? What if medicine was more than fixing broken biological machines? What if it was ...

“BEEP!” shrieked The Doctor’s pager.

There is not time for such questions. Especially not with Chest Pain arriving. Now was not a good time for thinking.

Monday, January 12, 2009

If American Healthcare was a Burger Joint

Imagine you work up a mighty appetite. You consider to yourself, “Self, I have a mighty appetite. What shall I do?” Upon reflection, you come up with two revelations as if from on high, “McDonalds or In-N-Out.” You certainly like McDonalds’ fries, but the fresh ingredients at In-N-Out are very tasty too (and somewhat healthy, to boot). You weigh your options, but the double-double animal style wins out.
You walk in to the white-and-red themed eating establishment. You wait in the line (it’s 12:34pm, and it seems that everyone else had the same idea). You get to the counter. At the last minute you have a quick change of mind and with exuberance exclaim to the cashier, “I’ll have a three-by-three animal style!”
Then what’s next? Payment for your tasty burger, of course! You pull out your wallet, expecting to hear the price of what will be a much needed relief of your hunger.
“I’m sorry, we don’t take cash,” says the cheerful cashier whose nametag reads ‘Allison’. “We only accept food insurance. Also government Food-i-care.”
“Food insurance? That sounds awfully silly. Why would you need insurance for an everyday transaction between the burger-flipping establishment and yourself? It sounds especially silly since the cause of your being here is not exactly unexpected (you do get hungry about three times a day, every day). Why should you be forced to buy food insurance?” reasons your ever-alert mind. “I should be able to reason through this with a manager.”
“May I speak to the manager?” you ask Allison, with the utmost politeness.
“Certainly,” says now somewhat less cheery Allison, looking somewhat dejected that her services were not good enough for your rational inquiries.
A sharp looking manager wearing the white-and-red (and a nametag that says “Rob,” you wonder if his real name is Robert or if his legal name actually is what his nametag reads) comes out and greets you. “How can I help you, sir?” he asks.
“I’d like to pay for my cheeseburger,” you say in as straightforward a tone as you can muster in the face of all the shenanigans thus far.
“With money?!” asks Rob in disbelief. He begins howling with laugher.
“Yes, with money,” you say, the annoyance in your voice communicating to Rob that this, though apparently very funny, was not intended as a joke.
“You can’t do that! Who pays for goods and services with money?” exclaims the bewildered Rob, throwing his hands into the air.
“I do,” you say, crossing your arms.
Rob, looking very confused at never having encountered such an obstinate customer replies, “Well, you can’t. We’d love your business, but you see, we don’t have prices here.”
“You don’t have prices?” you ask.
“That’s right. We don’t have prices,” said Rob with a neener-neener tone in his voice.
“Well,” you retort, assured that the shenanigans surely could not have reached this far, surely. “Surely you could just tell me the price of my three-by-three and I could pay for it. You know the price of scrumptious burger meat, delectable cheese and sponge-dough buns; you know how much the rent and utilities cost for this spunky building; you know how much it costs to hire cheerful people to staff an In-N-Out; and you know how much profit you can make while staying competitive. Tell me how much one burger’s worth of that cost would be.”
“We actually don’t really know,” says Rob, in a matter-of-fact voice.
“You don’t know,” you say in disbelief.
“That’s right. We don’t know,” Rob explains flatly. “I’m sure somebody knew at some point. Maybe somebody has made some estimation. Maybe. All I know is that we don’t know. And that’s for sure. It’s not that we don’t take cash per say, it’s that we just wouldn’t know how to charge you.”
“But how do you normally get paid?” you ask in bewilderment.
Rob begins to explain the normal process, “We’ve negotiated contracts with food insurance companies. We wring ‘em for every cent that they’re worth. Sometimes we get a good deal. Sometimes we don’t. See that customer right there in the purple cardigan? His health insurance company is paying us $12 for his double double. But see that one over there in the pink t-shirt? She’s on food-i-care and that’s a bad deal for us. We’re only getting $3 for the same thing. We’re able to extort enough money out of the cardigan guy’s company to make up for it, though. So it works out. The problem for you is that we don’t actually know how much it costs.”
“Surely somebody does,” you say, as if trying to get an admission out of Rob.
“Nope,” says Rob with confidence. “Well somebody claims to, but nobody does. Every one of our deals is secret, and nobody wants to know how much we extort for our burgers, and no food insurance company wants the others to know how much they pay us. Otherwise the ones that we’re screwing would be upset. So since all these deals are secret, nobody knows.”
“Who claims to know?” you ask.
Rob’s eyebrows furrow; a black look comes across his face. “Food-i-care. They have interviewed hundreds of burger flippers, rated burger-flipping for how stressful a job it is, and how desirable it is to be employed in that manner. They’ve calculated the number of minutes to flip a burger. Then they calculate the national average cost for beef and cheese. And they figure out it should only cost $3 to make a burger. So that’s what they pay.”
You, being a big fan of the fresh ingredients and cheerful service at In-N-Out, and having seen the differences in price for fresh ingredients at the grocery store, ask, “Do they account for the fact that In-N-Out uses scrumptious burger meat, delectable cheese and sponge-dough buns? Surely this would make In-N-Out burgers more expensive than McDonalds.”
Rob shakes his head, “They do not account for such things. You’re probably right that our burgers actual cost is more than McDonalds’, but they don’t care. They’ve ruled that a burger is worth $3, so that is how much we get.”
“How do people decide where to eat?”
“Some of them are told where they can eat by their food insurance companies. Others just go to the most expensive burger joints they can find, since the food insurance is picking up the tab. Mr. Cardigan over there is usually at Le Burger Espensiv across the street every day; he comes here for a bit of variety.
“It sounds like there is no mechanism left for controlling rising burger costs,” you notice.
“You are right. Burger costs have been rocketing upwards and no matter how we adjust the wings, the rocket doesn’t slow down!” says Rob.
You get upset and say, “Shucks! I certainly wish there were some mechanism for controlling costs, improving quality and inspiring innovation in the fast food industry.” Your mind races. You once took an introduction course in economics. You remember that one of the turning points in the history of the world was the inventions of just such a mechanism. You remember that other ways of distributing goods and services had been tried and had failed throughout the centuries. But what was this miraculous system that, as an enchanted sword, slashed rising prices?
“The free market!” you exclaim, joy rushing in where there had only been despair.
Rob waxes poetic and crushes your optimism, “Alas, the food free market is dead! If only we had the wisdom and courage to bring it back!”

Sunday, January 11, 2009

Photography as Prophecy

Photography often feels like a hunt. I am always armed and will quickly pull my camera out and leap into a place where I can get a clean shot of my quarry. Sometimes it’s a bird on the wing. Sometimes it’s a sun that’s falling. Sometimes I’m driving home at seventy miles an hour and there happens to be the most beautiful scene ever on the left side of the road.

I remember once in the middle of conversation seeing a hawk or falcon (please tell me if you can ID the bird) begin to dive near me. I literally ran so I could see the valley into which it dove, drew my camera, and took my footing. Holding the camera like a pistol, steadying my right hand with my left, I tracked the bird, held my breath, squeezed the trigger and fired. It was a perfect shot.

Another time I was a distance from a beautiful field that would perfectly catch the sunset, if only I could get there in time. I was walking fast, but the sun was setting faster. I started running, being slowed by beautiful obstacles that would not permit me to pass without photographing them. The batteries of my camera died. Like a soldier reloading under heavy fire, I quickly dropped out the old batteries and reloaded new ones. I made it to the field just in time to catch the setting sun a beautiful grassy field.

What is the mission of a photographer? To capture beauty. It’s a simple yet profound task. The object itself has been created by God directly or secondarily through human hands; the talent of the photographer is to see it.

I think its primary goal, capturing beauty, has much the same purpose as prophecy. Photography, like all art, is a portal to eternity. As the prophets who shared their glimpses of heaven causing us to yearn for its glory, I aim to make visible that which is invisible to most. I have no ambitions to pass Isaiah, but I would like to share whatever of heaven that can be shared.

In “The Problem of Pain” C.S. Lewis describes his view of Heaven. Have you ever “…stood before some landscape, which seems to embody what you have been looking for all your life? All the things that have ever deeply possessed your soul have been but hints of it…but if it should really become manifest …you would know it. Beyond all possibility of doubt you would say ‘Here at last is the thing I was made for.’”

A great photograph is only ever a shadow of the Truth; it is to the real thing as a two-dimensional black shadow is to the three-dimensional object that cast it. I took the picture above on the I-5 on the north side of the grapevine. It may have been the most beautiful landscape I have ever seen, and stirred within me a yearning and homesickness for a place like it, a place I have never been but is my home.

I believe that the landscape was the rim of an eclipse. We’re in the shadow of the sun, its bland and natural light blocking the glory of heaven. It is complete, except in the few places and times where we glimpse the edge; in the photo above, snow, grass, shadow and light converge to offer a momentary flicker of the glory that is coming, a prelude to a song that will soon be sung. It can’t come soon enough!
Isa 49:13 Sing, O heavens; and be joyful, O earth; and break forth into singing, O mountains: for the LORD hath comforted his people, and will have mercy upon his afflicted.

Saturday, January 10, 2009

The Valley of the Shadow of Death

I was Atlas, bearing the weight of the world pressing down on me. Under the emotional exertion, my heart beat faster, also crushed by the heavy responsibility before me.

I walked down creaking pine floorboards to where I would take up my mantle as senior “Médico,” not that 22 years gave me any qualifications for such a title. I took my place in a bare, makeshift examination room. As it seemed with everything in this part of Tijuana, the furniture was being held together by sheer ingenuity that comes with poverty.

The quiet, black fear broke out into an active yellow terror, like a rat out of a cage. I began to think of any means of escape. My mind darted left and right. Could I pass it to another? Could I leave it undone? No and no. All escape was blocked. If I was to be anything but a coward, I had to do this. I clenched my teeth, preparing for what would be an anaesthetized vivisection of my emotions.

Señor G staggered in, leaning on a friend. I greeted him warmly. He was wearing a blue Chargers hat that he had received as a gift. I complimented him on the hat, and he beamed with joy. I yearned for this moment to stretch into eternity.

It did not. The moment came that I had feared, the moment I had run through a hundred times in my mind. I had to tell him he was going to die. Sr. G had been on heroin and cocaine for many years. That together with alcohol had destroyed his liver, and he did not have long to live. He was my patient, and I alone bore the weight of delivering the news. Everyone dies, but woe unto me, for I had to translate a fact into a reality.

I gathered up all the courage within me, but it was only sufficient to produce a euphemism: “You’re not going to live much longer.”

“I know,” he replied. But he didn’t. He talked about plans he had for years ahead. And now I had to crush them.

“You don’t have much longer to live,” I tried again to make the sting of death less sharp. But death’s sting cannot be dulled by soft words.

“I know,” he said again. But still he didn’t. His planning continued.

“You’re going to die soon.” I used the word. I said it. And I saw despair in his eyes. His spirit overflowed with sorrow and his eyes with tears.

Then something happened that I did not understand. I spoke without speaking, and a voice that was not my own asked if I could pray for him. He and I shared a common faith; the request would have been reasonable, but for the alien source. Laying my hand on his shoulder, I prayed, pouring out my heart to our God. I thanked God for his love to us in giving salvation; I prayed that we would have faith in the valley of the shadow of death; I prayed in the hope of eternity. Then his dirge entered a new movement, as if a light new flute melody danced atop the low and mournful chorus: he remembered hope. The blackness of his night was pierced as if by the morning star; black indeed, but not black complete.

My own terrible weight of fear was cast into a sea of sadness. But even in the darkness above the waters, there was a wind of hope that hovered there unseen. As he limped away, I realized it would be the last time I would see him this side of eternity.

What did I fear? I entered medicine to speak Life, and I had to declare Death. I learned that doctors do not only announce hope, wearing white coats and stethoscopes; we must also proclaim doom, taking up the black hood and sickle. We are not saviors, but guides. We may be angels, but sometimes we must be the Angel of Death. Though we always desire to lead our patients out of the valley of the shadow of death, not all leave the valley. For those who must stay, we must be faithful guides even unto the grave. And it was that grim task that I feared.