Yesterday the family and I trekked to Chattanooga to the gorgeous Tivoli Theater to watch Max McLean perform in "The Screwtape Letters." He did an admirable job of bringing C.S. Lewis's devil to life. Screwtape, the experienced temptor, advises an apprentice devil on techniques to bring a young Christian back into the pathway of the damned.
I read the book first when I was a teenager, and it make a lasting impression on me. Since then I've seen exactly how accurate Lewis's take on tempation has been. The enemy has literally tried every one in the book on me personally, especially the tempation to pride.
Watching Screwtape come to life made me ponder, from whence come temptations? Are they of external origin, or internal? The Biblical answer is yes, or both, because both are presented to us. Jesus was tempted in the wilderness by Satan, but James tells us we are led astray by our own evil desires (check James 1:13-14). Satan is not just a fairy-tale personification of badness, but a genuine, pernicious force. His influence on us comes by exploiting those persisting propensities to evil that remain within despite our new birth.
Lewis would need to add a new technique to Screwtape's bag of tricks if he were writing today. The magazines of pulp science, Discover in particular, make much these days of the technique of functional magnetic resonance imaging of the brain. This probing technique shows activity inside the cranium as thoughts flash here and there. A lustful thought, a racy picture causes flashes in one area, hatred in another. From this, we are told that our brains are built to perform these functions, and they're just manifestations of evolutionary biology. Thus, persistent pridefulness is actually good for us. I'm the best hunter in the forest.... I'll bring down that mastodon and feed the tribe single-handedly. We're just poor creatures who must follow the pathways of our neurons, and thus we're not really responsible for the destruction our sin produces.
To really understand what's going on, we have to go back. The problem is not our neural pathways, the problem is sin. Sin, brought forward through the ages from our original parents, has corrupted our bodies and brain, such that sin, which should immediately cause pain, instead causes pleasure. This aberration is, thankfully, subject to divine intervention in our lives today. A Christian's goal is to one day find that his thoughts are so controlled by the will of our Heavenly Father that even the remembrance of sin causes immediate recoil. Then Screwtape and his minions will be defeated.
Sunday, November 22, 2009
Tuesday, November 17, 2009
Adventures in surgery
This morning I entered the world of major surgery in a big way. My patient, named Andy, needed a major overhaul of his internal organs. In fact, his vital organs were all in need of replacement. I and my assistants, all second grade students, had to identify all the parts and put them back in Andy the doll. This was my job at a local elementary school health fair that I was invited to attend as a guest instructor. It was actually a lot of fun in that second graders are not spoiled yet and got pretty enthusiastic in our surgical undertaking. One delicate matter was explaining the function of intestines and kidneys and why we make trips to the bathroom on a regular basis.
This is probably as close as I'll ever get to being a real surgeon. In medical school, I felt very uncomfortable when asked to cut and sew. One determined surgeon tried to teach me how to fix hernias, which took me about two hours to complete. A good surgeon, such as the one who fixed my hernia a few years back, can do it in fifteen minutes. Since then, I've limited myself to skin-deep procedures, the "lumps and bumps."
This afternoon got a little more serious as I went out for house calls. One patient was a man of my same age who lives in a dilapidated mobile home a few miles from my comfortable home. I had met him at a health fair a week ago and had promised to visit him to address his high blood pressure. A lack of a job and health insurance had kept him away from medical care. As I examined him today, his wife was busy flattening out flour tortillas in their cramped but clean kitchen. My patient's blood pressure was about 30 points over the limit for both systolic and diastolic. More worrisome, he had an episode of one-sided facial drooping and muscular weakness last month that had resolved over several days. Although his muscles were strong today, abnormal reflexes on one side gave me the idea he had suffered a stroke. I pray that the two medicines I prescribed for him for his hypertension and an aspirin pill a day will keep him out of serious trouble. As I was leaving, his wife promised me some tortillas when I came back next week.
When I encounter a patient my same age with so many problems, it causes me to think about what Dr. Luke reports Jesus saying, "Everyone to whom much was given, of him much will be required." Why is that I have my health, many comforts, and employment doing something I enjoy, when my patient, who was created in God's image as much as I was, has not? I should be more diligent to use the talents that I have, not for fear that they will be withdrawn from me if I don't use them, but rather in gratitude for the grace that I have enjoyed.
This is probably as close as I'll ever get to being a real surgeon. In medical school, I felt very uncomfortable when asked to cut and sew. One determined surgeon tried to teach me how to fix hernias, which took me about two hours to complete. A good surgeon, such as the one who fixed my hernia a few years back, can do it in fifteen minutes. Since then, I've limited myself to skin-deep procedures, the "lumps and bumps."
This afternoon got a little more serious as I went out for house calls. One patient was a man of my same age who lives in a dilapidated mobile home a few miles from my comfortable home. I had met him at a health fair a week ago and had promised to visit him to address his high blood pressure. A lack of a job and health insurance had kept him away from medical care. As I examined him today, his wife was busy flattening out flour tortillas in their cramped but clean kitchen. My patient's blood pressure was about 30 points over the limit for both systolic and diastolic. More worrisome, he had an episode of one-sided facial drooping and muscular weakness last month that had resolved over several days. Although his muscles were strong today, abnormal reflexes on one side gave me the idea he had suffered a stroke. I pray that the two medicines I prescribed for him for his hypertension and an aspirin pill a day will keep him out of serious trouble. As I was leaving, his wife promised me some tortillas when I came back next week.
When I encounter a patient my same age with so many problems, it causes me to think about what Dr. Luke reports Jesus saying, "Everyone to whom much was given, of him much will be required." Why is that I have my health, many comforts, and employment doing something I enjoy, when my patient, who was created in God's image as much as I was, has not? I should be more diligent to use the talents that I have, not for fear that they will be withdrawn from me if I don't use them, but rather in gratitude for the grace that I have enjoyed.
Wednesday, November 4, 2009
The Professional Worrier
What makes folks go to the doctor? Something's not right, or there's something that makes you worry. Sometimes it's a pain signal coming from the body. Or, the knowledge of the presence of a silent disease. Or, just the worry that there might be something wrong.
What happens when we talk to the doctor? We feel better. We can relax a bit, knowing that someone more knowledgeable is on the case. Our doctor will pick up the ball and see what needs to be done. We've transferred our worry to the doctor.
In every society, there's a process by which problems and worries are mentally transferred to others. In Belize, where my family and I spent eight years, the process is most visible when there's a death in the family. With each death, one female relative becomes the designated "hysterical mourner." The rest of the family doesn't need to display tears or sorrows, especially the men. But one young to middle aged woman is expected to cry uncontrollably, faint, and make a scene. Predictably the hysterical mourner ended up being brought to my clinic so as to be given something to "calm her down."
American society tends to hire its worriers. Got a problem with someone else? Someone did you wrong? Hire a lawyer. Kids aren't making good grades? Hire a tutor.
Speaking from the other side, being a professional worrier isn't what doctors want to be. We'd rather play detective, teasing out that rare diagnosis. It doesn't really matter if that diagnosis has no cure, but we feel much better if we know what's going on. I recall a patient of mine with a constellation of strange aches and pains that I could never figure out. Listening to her was stressful. One day she started having internal bleeding. At last, relief. Something I can get to. Order a test, find her incurable esophageal cancer.
Doctors think they have two choices. They can internalize their patients' anxieties. This can last for a while, but tends to lead to burnout, which translates to the patient's perception that the doctor doesn't care. Or, they can become good actors, pretending to care but leaving their concern folded up in the patient's chart for another day.
Is there another choice for doctors when it comes to bearing other's burdens? Jesus said, "Come to me, all you who are weary and burdened, and I will give you rest." Our Savior is the only one who can really bear our patients' anxieties. I would have given up on medicine a long time ago without Him.
What happens when we talk to the doctor? We feel better. We can relax a bit, knowing that someone more knowledgeable is on the case. Our doctor will pick up the ball and see what needs to be done. We've transferred our worry to the doctor.
In every society, there's a process by which problems and worries are mentally transferred to others. In Belize, where my family and I spent eight years, the process is most visible when there's a death in the family. With each death, one female relative becomes the designated "hysterical mourner." The rest of the family doesn't need to display tears or sorrows, especially the men. But one young to middle aged woman is expected to cry uncontrollably, faint, and make a scene. Predictably the hysterical mourner ended up being brought to my clinic so as to be given something to "calm her down."
American society tends to hire its worriers. Got a problem with someone else? Someone did you wrong? Hire a lawyer. Kids aren't making good grades? Hire a tutor.
Speaking from the other side, being a professional worrier isn't what doctors want to be. We'd rather play detective, teasing out that rare diagnosis. It doesn't really matter if that diagnosis has no cure, but we feel much better if we know what's going on. I recall a patient of mine with a constellation of strange aches and pains that I could never figure out. Listening to her was stressful. One day she started having internal bleeding. At last, relief. Something I can get to. Order a test, find her incurable esophageal cancer.
Doctors think they have two choices. They can internalize their patients' anxieties. This can last for a while, but tends to lead to burnout, which translates to the patient's perception that the doctor doesn't care. Or, they can become good actors, pretending to care but leaving their concern folded up in the patient's chart for another day.
Is there another choice for doctors when it comes to bearing other's burdens? Jesus said, "Come to me, all you who are weary and burdened, and I will give you rest." Our Savior is the only one who can really bear our patients' anxieties. I would have given up on medicine a long time ago without Him.
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