Reflection on Presence: Part 2

Once, on a flight, I met an elderly woman who had the misfortune of needing a liver transplant when she was in her early thirties. She had just gotten married. Her husband (sitting next to her) recounted how their attending nurse, in a hurry to move onto other patients, had brazenly told the couple to “clean up their own bedsheets.” Then there were the annoyingly bright lights, the constant whirring of the machines, and the frequent noise disruptions from the 5, 6 other neighbors who were crammed into their room, that made it almost impossible to sleep. 

Meanwhile:

“Research over the last 10 years has shown that burnout – the particular constellation of emotional exhaustion, detachment and a low sense of accomplishment – is widespread among medical students and doctors-in-training. Nearly half of these aspiring doctors end up becoming burned out over the course of their schooling, quickly losing their sense of empathy for others and succumbing to unprofessional behavior like lying and cheating.” “The Widespread Problem of Physician Burnout.”

If these stories of patients and physicians count for anything,  there seems to be something  awry with the picture of medicine nowadays. That is to say, there is very little healing in medicine.

The central question is, why are doctors so bad at being present? Why is there so little opportunity for relationship, a space that not only allows physicians to give patients human care (that is, a kind of care that fights against the mechanizing, fragmenting tendencies of the modern healthcare system), but also allows the doctors to receive from their patients, becoming, in the process, more human themselves?

I wonder, though, whether we’re setting ourselves up for just that failure. I wonder whether medical education (and even before that, the premedical environment) is a tremendous bait-and-switch, preparing students for one thing, only to leave them, decades later, to find that medicine is entirely another.

Browse through any brochure or marketing material from the top medical schools and you will quickly see what I mean. They are full of language that I find disingenuous – a language that points to a technological utopia in which human will no longer have to suffer or die.

That is not all. The entire preparation process for medical schools trains students to think of medicine not as an endeavor greater than themselves, but to subjugate the field to the confines of their private ambitions. To attract the attention of premedical students, medical schools must now offer ample research opportunities (backed up by endless stores of NIH grant money), opportunities for leadership activities, opportunities to see the greatest diversity or extremities of clinical cases, opportunities to be placed into the best residency programs (whatever “best” means).  It is a continuation of what premeds have done all of their lives, which is to push forward a carefully crafted, highly individualized story that makes them a unique candidate for the medical profession. I am not merely finger-pointing here, because I am guilty of the same. And when faced with the decisions on which schools to apply to, or which school to ultimately attend, I admit I have very little guidance other than something like the US News & World Report rankings. God help me.

This has consequences. I once eavesdropped on a conversation a premed student was having with a stranger while waiting for his flight home from a medical school interview. The stranger asked him what he might want to specialize in. He replied, “Surgery. Because I worked at an animal lab and I really liked dissecting.” This student may have been an extreme, but the sentiment underlining the comment is surprisingly representative of the premedical mindset – we are more driven by the process and the tools than people. Surgery is a very popular specialty among premeds. And at the end of medical school, the list of students who join the ranks of primary care is short, and the list of those entering care for the underserved, even shorter. I do not mean to elevate primary care or care for the underserved above all other specialties. I simply mean that the sickest and the poorest will pay for our moral wandering.

I’m not sure what can be done about this at a systemic level, or, for that matter, whether something can be done (largely because not everybody agrees this is something that needs addressing). For now, it will be the fight of individual students and doctors making the conscious choice for presence, and against what I call the ‘elevator mindset.’ Medicine is not an elevator that gets us somewhere; the end of medicine is embodied precisely in the stranger we so often ignore on our way to false goals. Christ’s call to ‘love your neighbor’ has never been so needed.

-jds

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Reflection on Presence: Part 1

My parents moved back to Korea 5 years ago. They live now with my grandparents (on my dad’s side) on a farm in a dinky little down called Chuncheon that has nothing going for itself besides maybe the fact that it now boasts a subway stop leading to the capital city. So now people don’t have to move out of that town for good.

Anyway, my grandfather has something like Alzheimer’s disease. His debilitating stroke a few years back left him with such a compromised memory function that he can remember my name and not much else. Not being able to remember can be lonely. So when I go back home for vacations, and when my mom sees me doing nothing, she cuts up some fruit, puts it on a table and tells me go eat some fruit with my grandfather.

grandfather1

I sit there, talk about myself, eat some fruit. Silence for maybe 5 minutes, whereby my grandfather has forgot everything I just said. So I say it again, eat some fruit, and if I feel especially loving that day, maybe ask him a few questions about his life. He’ll mutter something – but nothing I don’t already know. I return the plates to my mom, and I ask myself, ‘what was the point of that?’ Nothing happened.

“When Job’s three friends, Eliphaz the Temanite, Bildad the Shuhite and Zophar the Naamathite, heard about all the troubles that had come upon him, they set out from their homes and met together by agreement to go and sympathize with him and comfort him. When they saw him from a distance, they could hardly recognize him; they began to weep aloud, and they tore their robes and sprinkled dust on their heads. Then they sat on the ground with him for seven days and seven nights. No one said a word to him, because they saw how great his suffering was.” (Job 2:11-13).

In ‘Salvation and Healing; why medicine needs the church,’ Hauerwas talks about the idea of presence, and how we have so little of it, both in medicine and the church. Consider Job’s friends, he says. You may think whatever you want about their well-meaning but vacuous consolations, but at least they stayed with Job for 7 days. And no one said a word.

That’s exactly what makes people uncomfortable. Everybody loves to help – everybody shows up when they have a chance to be a hero, no matter how small that heroism may be. But how many are willing to be present when not just the helped are helpless, but they are as well? Will you show up, even when there’s nothing you can actually do?

So then we return to my grandfather. Medically, the doctors have done everything in their power to fix him up, but where’s the healing? If what Wendell Berry says is true, then disease is not just the presence of a pathological condition; disease is fundamentally alienation – alienation from our bodies (we are no longer ourselves), alienation from other people (people don’t like to be around other people that might get them sick, or worse, remind them of their own mortality), and alienation from God (as in, Oh God, I’m sick as hell, where are you?).

If that is true, than healing is much more than what modern medicine is. If that is true, modern medicine is not only ‘missing the point,’ but predicated on an illusion, operating in a universe that lacks real moral meaning (which one can say is a universe that doesn’t exist). My grandfather can walk, talk, and live in ways he couldn’t in the days immediately following the stroke – and at that point modern medicine waves its banners high and declares success!, but I am left with a feeling that that is not all there is…

In the world of medical technology, the illusion of control prevails, and with that, the urge to fix. What if all of the medical shindig is but a cloud that blinds us from seeing the truth, which is simply that we belong to each other? And what if the greatest thing we could do (physicians and others) for sick people was simply to be present with them, rather than suggest a million cures for their physical and psychological condition. It’s hard to sit still when there’s all these toys we could tinker with.

In the end, though, being present is what we will all have to do. Because some day my grandfather will die. So will I. In death, we can do little but to hold the hands of the dying, and then, we no longer wear the masks of power, but become who we were meant to be: the recipients of a beautiful gift that we neither understand, or control.

Politics in the Ordinary

Read an amazing article about “Making Citizenship Personal” which calls us to engage in politics by first and foremost starting with our own hearts and the institutions near and dear to us – our families, our neighborhoods, our schools, etc. In a way, this is a call that should not be too unfamiliar, for just as Jesus proclaimed the kingdom of God — implying that he was somehow in competition with the kingdom of Caesar — and without taking up arms, so we who are his followers ought to think differently about what it means for us to engage in politics today. It’s not only about “renewing” politics by sending forth politicians armed with “a gospel worldview of politics”. It’s about reorganizing our own lives and relationships in accordance with what makes sense in God’s kingdom. Jesus didn’t cause a ruckus by gathering an army. Instead, he upended the traditional institution of the family and reorganized it around himself.

How ought we to respond to the problems of racism in society? Is it by expressing social solidarity and anger at certain symbolic representations of the problem (i.e. Trayvon Martin) by posting and sharing articles to such effect on social media? Is that how we can register our “protest” against the injustice of the world, to show that we’re on the side of justice, the side that will eventually be vindicated in the end? I cannot help but wonder whether the problem that Paul’s doctrine of justification by faith (N.T. Wright’s version) is yet alive and twitching with us today in the attitude of the young intelligentsia towards hot social issues of the day. Red equals signs, the right likes on the right articles, the right shares, the right tweets, and the sense of smug self-satisfaction that comes from unmasking privilege, are these but the new “works of the law” to mark out one’s membership among the righteous?

But as the prophet Habakkuk writes: the righteous shall live by faith. Just as Jesus was vindicated by his resurrection, so those who work and wait for God will be vindicated. It is not the hearers of the law who are justified, but the doers.

In a world with shrill cries and catcalls for justice all around, let us be those who do justice and not merely hear it. This means trying to embody it in our own relationships. Hate racism? Let’s start with our own hearts, for we might be surprised to see what we find or what we might end up being called to do. It might mean changing our lifestyle to try to force ourselves beyond our accustomed patterns. It might mean some hard talks. Some discomfort. Some damaged relationships.

It might mean different things for different people. But one thing is certain. It means something.

The gchat that started it all…

Daniel:  did you see my article on calvin’s wall?
me:  yeah, reading it now
i love wendell berry
haha
one of the st modules this year was actually supposed to be an introduction to environmental justice via an introduction to wendell berry, but it got removed when Sam had to leave
Daniel:  ah…
that’s sad
wendell berry is a prophet
me:  when I read him, I became a Marxist, haha
which 3 long years with Jon Lin could not do, haha
Daniel:  lolll
me:  he is able to espouse Marx’s principles in a way that is very concrete
Daniel:  this is the only thing I read by him
me:  oh really?
Daniel:  so far
but i’m sure more are to come
I’m reading “life is a miracle” next
me:  i’ve read an essay collection
Daniel:  which is a response to a Harvard academic about reductionism
me:  and a few other things
but I’d love to read more
Daniel:  he has suprsingly a lot to say about health
me:  do you have a lot of time to read at your job?
Daniel:  well
it’s outside of my job that i read
it’s only a 40hr workweek
so yea
lots of free time outside
i’ve already read lots of things
finished ‘habits of the heart’
read this book called ‘medicine as ministry’
then ‘reclaiming the body’
all very nice books
me:  jeremy just recommended me this book called “Ecstatic Existance” which is trying to articulate a new foundation for theological anthropology
maybe you’ll find it interesting, too?
 Sent at 10:06 PM on Tuesday
Daniel:  maybe
what does it mean
by theological anthropology
me:  roughly speaking = “what does it mean to be human”?
the central thesis is that to be human is to be in relationship with God
Daniel:  ah
me:  he uses three primary categories to talk about that relationship: Creation, Redemption, and Reconciliation
that’s about the extent of what I got from the Amazon review, haha
Daniel:  hahaha icic
i like berry’s take
me:  man, we should totally make a Manna Gospel Worldview blog
Daniel:  as defining being human as being whole
we should…
me:  for alumni to be able to post in
and to share books and whatnot
Daniel:  isn’t that what revisions is supposed to be haha?
me:  haha, it’s not mainly for alumni
it’s mainly for reaching the campus
I’m thinking more of a community blog
that lets us talk amongst ourselves
Daniel:  ah ic
me:  like, pseudo-private
Daniel:  that sounds cool
but then…
idk
i would love
people like calvin
to have access to this stuff too
nahm saying?
there’s a lot of things we’re talking about here that needs to see the light
me:  well, it could be good for undergrads to be able to listen into the discussions of working ppl
Daniel:  right
they don’t need contributing capacity
necessarily
greg would love to contribute to something like this too…
greg lee ’00 that is
me:  Greg Lee?
oh, do you see him often?
 Sent at 7:00 PM on Wednesday
Daniel:  yea
and for sure jack gang
all though i’m not sure how he theologically ties his work
every now and then yea
i love berry’s jab at efficiency in that article
somebody once told me
very insightfully
if God valued efficiency, he wouldn’t have given us freewill
me:  berry bashes HARD on efficiency
in his works on the economy
and on farming
Daniel:  yea
more and more
i’m starting to think efficiency is a value that works against the Kingdom
me:  man, this blog idea was just random
but I’m starting to think it would be a really good idea, hahacropped-mustardseed1.jpg
Daniel:  dude for sure
me:  maybe we could just informally start one
and invite everyone we think would be interested
Daniel:  yea i think just us two
and yea
snowball as we go
or people will read it
and they’ll want to say something about it
so we’ll tell them
instead of going to the comments section
write a response
me:  b/c the questions we are asking are BIG QUESTIONS, which will need lots of people working together on
 Sent at 10:16 PM on Tuesday
me:  well… gospelworldview.wordpress.com is available, haha
Daniel:  haha
can we buy that domain?
i’m just curious
not actually saying we should
it’s available!!
haha
me:  $18 bucks a year
Daniel:  maybe later
me:  I’ll just reserve the spot for now
Daniel:  kk
although
idk…
the term gospel worldview
sounds too tame
me:  oh, got another idea?
Daniel:  it just seems like another intellectual framework alongside a shelf full of other frameworks like marxism
i mean this is the truth man
me:  well, I thought it would just highlight the Manna connection
Daniel:  and the kingdom is doing battle against evil
i was telling sam this
last year
sam chez
i told him manna’s buzzword
shouldn’t be gospel worldview
but ‘Jesus blowing up in your face’
me:  hahah
that could mean… a lot of different things, haha
Daniel:  hahaha yea
but you see what I’m getting at
anyway
that was more of a rant
than an actual suggestions
me:  well, i’m open to suggestions if you can think of one
FrontlinesoftheKingdom?
Daniel:  too long…
what is latin for kingdom?
me:  regnum
Daniel:  you know what let’s just go with Gospel Worldview haha
me:  latin is sort of pretentious, though, haha

we can change the title of the blog to “Jesus blows up in your face” lol

right now, I just have “the news that changes everything”
Daniel:  hahaha
sounds good

me: man, i have such a great idea for a gospel-worldview restaurant

I want to pitch it to ed and see what he thinks, lol
Daniel:  lol
you should write about it
that restaurant should also be at my hospital
per Berry’s opinions
me:  or rather, the hospital should have a farm, lol
haha, the basic idea behind the restaurant is to make it less a “commodity”-oriented business but a “community”-oriented service
Daniel:  wow
that’s awesome
me:  like, the underlying assumption behind all food industry right now is that chefs are delivering a “product”, a dish
what if we challenge that assumption?
 Sent at 10:50 PM on Tuesday
Daniel:  that sounds amazing
interestingly
atul gawande
do you know him?
new yorker contributor
me:  not off the top of my head
Daniel:  health policy expert
he’s the one that wrote “better”
and “complications”?
anyway
people listen to him
and interestingly, he wrote an article not long ago
saying how the healthcare system should deliver health more efficiently and with better standardization
just like how cheesecake factory delivers its cakes
exactly the way you want
every time
i say ‘interestingly’
because in our discussion
we both have a feeling that neither healthcare nor food should be described in those terms…
me:  yeah, it’s our wendell berry influence, haha
a move away from mechanistic metaphors to organicist metaphors
interestingly enough (philosophically) it’s what happened in the shift from the Enlightenment to Romanticism in 19th c. German philosophy, haha
Daniel:  huh
i wonder what happened…
we should just post this IM conversation
as our first post
me:  the industrial revolution happened, haha
Daniel:  true dat…
me:  the romantics already saw it coming and protested against it, but their solution was insufficient
they had a communitarian ideal, but it just does not hold up when faced with the forces of capitalism
the question of how to regain that ideal… is arguably still a live one
Kuyper, interestingly enough, has an interesting essay on this called “Our Instinctive Life” in which he tries to grapple with the realities of heading up a rapidly expanding political party that was now more democratic than aristocratic
haha, we totally should just post this convo
Daniel:  im not sure
if we can philosophically recover from the industrial revolution
me:  well, there’s no going back, that’s for sure
Daniel:  probably just Christians being faithful to their calling
and living out the Kingdom despite these worldly forces
me:  knowing that all power and authority has been given to Jesus
and God’s in the process of making all his enemies a footstool for his feet