Tag Archives: Health

Medicine and Seeing

Lord, give me eyes to see…

I’ve been praying this prayer a lot recently, in the first few weeks of medical school. Sight is a gift. To see our lives, the lives of others, and the events of our world in the lens of truth and love – that spirit is something we cannot conjure up on our own. The God of truth and love must gift it to us.

Each morning, I wrestle for this sight, as Jacob had wrestled God for His blessing. Jacob had spent his entire life crafting his own blessing. There is the time when he steals his brother’s birthright with a well-timed meal. And the time he tricks his blind father into blessing him instead of Esau with a clever scheme. He amasses a vast amount of wealth as Laban’s shepherd, taking the strong of the flock for himself, and leaving his uncle the weak ones. Jacob then runs away with Laban’s two daughters and his massive herd to begin his own life – to look for his own paradise. That is the picture of Jacob before his encounter with God: he is always running.

He is still on the run when suddenly he is forced to account for his life. Esau, his long-estranged brother, is said to be approaching from the far side of the wilderness, likely to kill him. Jacob ‘runs’ one more time, trying to appease his brother with a series of gifts, and ultimately, dividing his camp into two so that if one is attacked, he is left with the other. As he sends his camps off, he is left by himself (Gen 32:24) – his first time in true solitude. Desperate, cornered, on the verge of calamity, and finally alone, he does what perhaps God had been trying to get him to do all along. He simply asks. “I will not let you go unless you bless me.

I will not let you go unless you bless me!” That is a holy prayer.

Lord, give me eyes to see…

‘Education’ is a misnomer for what happens in the four years of medical school. Becoming a doctor is about more than just the accumulation of medical knowledge. Medical school is assimilation – the inculcation of a set of values which is no less cultural because it’s scientific. Medical school is a foreign country, complete with its own language, and therefore, its own way of seeing.

Before anatomy class began, our professor told us his philosophy for teaching anatomy, which was to help us ‘see what doctors see.’ He told us that as we open our donors’ bodies and delve beneath their skin into their viscera, we will look, but not see, because we do not yet have the framework to make sense of what is in front of us. What is this intricate mesh of meat, fat, and bone? I do not know, and so the world of the body is still fresh. It is still sacred.

But when will that eternal light dim?

There’s a passage in Annie Dillard’s ‘Pilgrim at Tinker Creek’ that I often reread. Apparently, when physicians first discovered how to perform safe cataracts operations, patients who had been blind all their lives were suddenly able to see. Having never associated words and meaning to visual stimuli, they saw the world differently than the already-sighted. They didn’t see chairs, tables, books, food, shadow, form, or size – they saw patches of light and dark, blobs of color, brushes of unencumbered, freeform marks.

“A twenty-two-old girl was dazzled by the world’s brightness and kept her eyes shut for two weeks. When at the end of that time she opened her eyes again, she did not recognize the objects, but, ‘the more she now directed her gaze upon everything about her, the more it could be seen how an expression of gratification and astonishment overspread her features; she repeatedly exclaimed: ‘Oh God! How beautiful!’”

It will be a tragic day when I stop exclaiming ‘Oh God! How beautiful!’ When, instead of the intricate mesh, I only speak of mediastinum, costal cartilage, inferior vena cava, ad infinitum…the babble (Babel?) of those of who know, but do not see.

Not long after that anatomy class, Dr. Lisa Sanders, who had started the New York Times column that inspired House, M.D., led a session for first year students on the topic of observation. ‘Writing is observing,’ she said, ‘and you must practice writing in order to keep observing.’ She then showed us a picture of a scene in the wards, in which a medical student was leaning over a patient to observe something on her shoulder. Dr. Sanders asked our class, “What do you see? What do you notice about the patient and the student?” Our class spent 5 minutes sharing our observations. We talked about how the patient looked afraid and how the student’s posture seemed to belie a certain eagerness. We noticed emotions and facial expressions, and imagined movements from the stillness of the photograph. At the end of the exercise, Dr. Sander turned to our class and warned, “What you see now, you will no longer be able to see 10 years later. You, still being laymen, notice things I no longer care to notice as a doctor. Medicine is a bridge you cross; there is no turning back, even when you wish so much to be back on the other side.”

And that is why I pray for sight, with Jacob’s desperation. The battle for eternity happens in minutiae, and our souls soar or fall in trivialities we are prone to overlook amidst the comfortable humdrum of our lives. I pray before anatomy class that the God of healing may help me to know wholeness – that the ease with which the blade slits the skin does not dull me to the beauty of embodiment. I pray to see the weight of glory in people I pass by everyday. They are not merely ‘a nurse,’ or ‘a student,’ or ‘the person who takes care of your paperwork’; they are eternal, divine beings – imago dei – whom, as C.S. Lewis says, I’d be tempted to worship if I saw their true glory.

I pray, finally, that the Gospel would remain news. Too many times I let the Gospel become familiar, which also means that it becomes comfortable. It is not. I have to encounter the person of Christ daily and come to terms with its truth, and the demands and costs that truth makes on my life. There is no easy way out. He is calling for me (“Remember your first love!), and it means my death. The scales must daily be taken off from my eyes.

And with this I plunge into this medical world. I will learn its language, but I refuse to let that language define what is real and what is true, for I am afraid to be in a world I can box, devoid of mystery and beauty, where everything I see I can shatter in a thousand classifiable, knowable shards, and piece them back together to fit my convenience. So I worship, pray, and wrestle.

Lord, give me eyes to see…

Then Elisha prayed and said, “O LORD, please open his eyes that he may see.” So the LORD opened the eyes of the young man, and he saw, and behold, the mountain was full of horses and chariots of fire all around Elisha.” (2 Kings 6:17)


The passage on ‘Seeing’ from Dillard’s ‘Pilgrim at Tinker Creek,’ which I quote from, and which I highly recommend, can be found here: http://dcrit.sva.edu/wp-content/uploads/1974/01/Seeing.pdf

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Should We Pray With Patients?

The patient was abruptly, unexpectedly, and neurologically devastated, leaving his family stunned and grief stricken.  There was little else for the ICU team to offer, even as we worked to do everything physiologically possible to sustain life.  It was late at night and as we stood in the room listening to beeping monitors and the running motors of IV pumps, the family mentioned in passing that many people were praying for him.  So I asked them two simple questions: Are you Christian? Would you like me to pray for you?  They answered yes to both.  I led them in a short prayer, expressing no more in terms of medical prognosis or aspirations for therapy than had already been offered, but also asking for strength, wisdom, and a clearer understanding and experience with God himself.  The family was marginally but visibly relieved and calmed by it, and we continued on with the grueling task of caring for the patient.

As anticipated, the patient passed away several days later.  After the family left, their nurse told me, “They could not stop talking about that prayer.  They said that of the dozens of physicians they have interacted with over many years, not a single one ever offered to pray with them.  It meant a lot.”

Modern healthcare is conflicted about how to approach faith and illness.  On the one hand, rising pressure to improve patient satisfaction must recognize the importance of faith in the lives of patients; in one small family practice study, 48% percent of patients wanted a physician to pray with them (even though 68% never had a physician discuss religious beliefs with them).   On the other hand, the secularization and humanism-ization of medicine can use the ethical mandate to respect patient autonomy as an excuse not to engage in matters that could be controversial (such as faith).  Fear of “abuse of paternalistic power” in the physician-patient relationship or fear of invoking religious ritual and methodologies that are virtually impossible to hypothesis-test can create a “chilling effect” on the inquiry and expression of religious belief by healthcare workers even when no hostility or indifference is there.  It is as if medical practitioners find it hard to believe that faith not only exists, but that it could possibly matter more to patients than the field of medical therapeutics itself.

The earliest practitioners of medicine were clergy members.  In virtually every culture, ministers of medicine began as… well, ministers.  After all, what can be a more compelling reason to drive us to our knees than helplessness in the face of suffering?  Though modern medicine can explain the physiology of how we decay and die in excruciating detail, it is certainly not equipped to answer the question of why we do.  This observation alone should explain why questions of faith contend to occupy the center of a patient’s attention and not simply the periphery.

The next time you are in a small group or a prayer gathering, try to count how many times health-related concerns come up for prayer.  Illness afflicts our minds, hearts, and souls as readily as our bodies.  Healthcare workers are compelled to take hours of training in cultural sensitivity, mindfulness, and meditation; shouldn’t we be similarly compelled to attain and encourage proficiency in spiritual need assessment, willing to offer prayer when requested instead of retreating in indifference?  Shouldn’t this be true in all the “helping professions”?

Why You Must Die, Before You Die

I’ve been thinking about death some – how it happens, what people think.

My clinic recently faced tragedy. Dr. Jerry Umanos was shot and killed at a hospital in Kabul, Afghanistan.  He had worked for the past 25 years as pediatrician at Lawndale Christian Health Center (located in inner-city Chicago), and for the past 10 years, had been volunteering part of his time training pediatric residents in Kabul. He had gone, against all warning,  to seek the poorest of the poor, and the neediest of the needy. LCHC saw him last this past January, when he gave a testimony before our whole staff about his work, and explained why he was going back once again to that war-torn land.

Keep Dr. Umanos in mind for a moment and consider end-of-life care in America. Most Americans will die a slow death, maybe brought on by cancer, maybe brought on by organ failure. There are two options when you are faced with a diagnosis that signals the end: aggressive (often experimental) treatment that probably won’t work and if it does, will leave you barely alive; or hospice, where physicians ease the pain for those who’ve already accepted death (hospice can occur either at home or in hospital).  According to articles like this one, more Americans are opting for the former, and saving the latter for when the former has failed. Interestingly, Christians (or those who identify as more religious) are even more likely to pursue aggressive end-of-life treatments. Simply put, our healthcare system (and our society) is teeming with people eeking out nanodrops of life with every last effort and dollar. We are hanging onto life with the very tip of our nails.

I hope the juxtaposition is as jarring to you as it as to me. On one hand is a man who shuns his life (perhaps even foolishly so) to serve in Afghanistan, and on the other hand are people (especially religious people) trying to live some more.

Obviously, end-of-life situations are incredibly complex, and it’s difficult to know what to do in the mire of emotions, tensions, and false hopes. I don’t pretend to know how to navigate through those situations, so this article won’t be about the ethics of end-of-life care. Instead, I want to point out how much the death of Dr. Umanos and the deaths of others in the American healthcare system reveal a sad truth about Americans: we are not ready to die.

This is bad news, at least for Christians, because death is one of the biggest things Christ stresses to his fledgling disciples: ‘You must pick up your cross daily and follow me’; ‘Whoever wants to save their life will lose it; whoever loses his life for me will find it.’ If they didn’t understand when he was speaking this to them in person, then surely they understood when their Lord hung before them on the cross, shamefully bloodied and scarred.

Paul eventually reiterates this theme in his epistles, telling the Philippian church, for example, that ‘to die is gain, and to live is Christ. If I am to go on living in the body, this will mean fruitful labor for me. Yet what shall I choose? I do not know!’ Only a man who dies daily could utter such words.

I think what Jesus (and Paul) was trying to point out is that life is a gift, not an ultimate good that should be pursued at all costs. And of course, this goes against everything in the dominant narrative in America. Lacking greater purpose, we live to feel alive: to travel and see the world, to engorge food with our bodies and take pictures of them on our phones, to drink and be merry with loud music beating in our ears, to pursue power and influence, to be intoxicated in love. I am not saying we should not enjoy these things. I am only saying that it becomes dangerous when these things mark life itself – when we jump from thrill to thrill seeking ways to adorn an otherwise vapid and listless trajectory.

If we do not die now, it will be too late when death really comes. Death should catch us in the act of dying, not in the act of living. Christ’s call to the cross is a very serious charge, and we would do well to pray over His words daily and to search the ways He is urging us to die today.

Shalom in medicine

Hello! My name is Stephanie; I graduated Princeton in 2010 with a WWS degree and am now a fourth-year medical student going into psychiatry residency (i.e. more years of training to become a psychiatrist) starting this July. I recently married my wonderful husband, who is also a fourth-year medical school student.

One (of the many) joys of being in medicine with my husband is that he is able to also think through and provide a different perspective about the field – all of the posts I will be writing on this blog are the product of and/or influenced by conversations I have with him, so I wanted to explicitly acknowledge (and thank!) him from the beginning.

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When I went to medical school, it seemed like a fairly straightforward decision because there seemed to be such an explicit link to promoting shalom, which is perhaps just another way of saying “you get to help people.” The book of Revelation makes clear that in heaven there will be no more mourning, crying, or pain, so from my then-cursory understanding of medicine, of course becoming a doctor was a legitimate endeavor.

In medical school, psychiatry in particular captivated my attention because while the body was interesting intellectually, psychiatry deals with the profound mystery of patients’ minds and spirits, the restoration of shalom in situations where ultimate things are at stake. In friends and acquaintances who have struggled with eating disorders, depression, PTSD, schizophrenia, and bipolar disorder (to name a few), I have seen how necessary a foundation mental health is for establishing shalom, for “a man’s spirit sustains him in sickness, but a crushed spirit who can bear?” (Proverbs 18:14).

// as a side note, i feel like there’s a WORLD of redemption that needs to happen in the church’s understanding of psychiatry and mental illness; those who suffer from mental illnesses are unnecessarily shamed and hurt by the church’s ignorance of the realities of mental illness and casual dismissal of those who suffer as “needing to have more faith in God” etc.//

The journey through medical school has been one of the most challenging experiences of my life (academically, personally, spiritually etc) — and having a gospel worldview in medical school itself is probably worth 1000 posts (or rants) — but my journey has given me a glimpse into a more nuanced reality of the gospel worldview when applied to the practice of medicine. My hope is that those who are seeking to be in the medical profession (or even just want to understand it) will find this a useful adjunct to their own journeys.

A few things that come to mind and that I hope to address in future posts (although on some of these I may have more questions than answers):

  • How should a gospel worldview impact the attitude of a physician when treating patients?
  • What is medicine prepared to do, and where are its boundaries? (i.e. what are the expectations we can rightly have of medicine?)
  • How does promoting shalom translate into how a doctor practices? Beyond treating the individual’s disease, this includes (but is not limited to): 
    • addressing systems and policies that prevent patients from receiving proper treatment
    • addressing the patient’s context and community
  • In psychiatry:
    • How can a psychiatrist respond to both the organic and inorganic needs of the mind?
    • How does an understanding of sin and the fall help us conceptualize mental illness?

Not sure where I’ll start, but I’m glad this blog exists, as it encourages me to think a little more systematically through some of these issues (the unexamined life etcetc).

I’m always open for suggestions for topics, so let me know!

Why This Blog is Ultimately About Grace

I used to be shy. I saw little reason for talking when I didn’t believe in the interestingness of my own story. What had I to offer that the world had not already seen, or heard?

I grew up in the suburbs of San Diego, where buildings all took on a stucco-ed squareness, the most interesting foliage was desert brush, and even the weather, though nice, seemed drab in its consistent niceness. I had a vague idea of what I wanted to be in the future, but that dream seemed so damningly stereotypical: Korean guy with glasses pursues MD, wants to save lives.

Every now and then when I’m bored, I re-read my college application essays and laugh mockingly at my former self.  A sense of bemusement sets in – how did I get into Princeton? How did these jumble of letters and lackluster narrative get me into one of the most prestigious institutions in the country? I honestly don’t know.

College was somewhat of a personal crisis, simply because I was forced to confront my shyness with unexpected intimacy. My roommates freshman year included a former president of the National Junior Classical League (who had his own Facebook fan page), a gifted musician who learned to play the piano by ear and had more neckties in his closet than I had clothes, and an Indian guy who, I’m still convinced, was using his goofiness to hide his true identity as Indian royalty. I had friends who studied abroad in Oxford and walked its storied, Gothic halls. Then there was always that senior in precept who knew everything about everything. In retrospect, many of my pursuits in college was nothing but a relentless game of catch-up to an imaginary, better man. I learned Swahili, traveled to Kenya and Tanzania, took on the only competitive major at Princeton to study public policy, and wrote a thesis on HIV/AIDS, partly out of genuine interest for those things, but also partly, I confess, out of a subconscious desire to have better stories to tell.

This, of course, was a remarkably tiring way to go about life – and a lonely one, too. The problem was not that my story seemed uninteresting or typical, and needed some embellishment through the pursuit of some crazy vision or ideal. The real, deeper problem, the pig beneath the lipstick, was that my story is all I saw.

I first heard about Lawndale Christian Health Center around the beginning of my senior year, and it waved like a checkered flag ushering the end of this futile race. I was in the midst of the run-of-the-mill Princeton senior activities then, applying for jobs and academic scholarships.  I can’t quite explain it, much as a moth can’t explain why it is so persistently drawn to a source of light. When I found out about Lawndale, I rescinded my outstanding applications that would have led me elsewhere. I left my nets.

In retrospect, I think it was how miraculous the Lawndale story seemed. Wayne Gordon, a graduate of Wheaton college, leaves his suburban Iowa home to become a high school wrestling and football coach in a marginalized neighborhood in Chicago. His students ask him to join, then lead, a Bible study. That Bible study snowballs into a church, and that church, driven by the students’ desire to love and serve their neighbors, begins a health center providing access to care for the poor and the uninsured. That was 1984 – when the health center was no more than a couple of idealistic doctors practicing in three decrepit exam rooms fashioned out of an abandoned car lot. Now, the health center has four sites on the West Side, and serves over 200,000 patients a year. It even has a state-of-the-art fitness center (for $15 a month!) and a cozy cafe.

Wayne Gordon (or, “Coach”) is still around, and I have the blessing of being a part of his weekly men’s Bible study. Some of the men there are students he used to coach nearly 40 years ago. Others are health center workers, like me. A majority of them are graduates of Lawndale Community Church’s Hope House, a rehabilitation center for formerly addicted or incarcerated men, and have persevered through unspeakable sorrow.

Here at Lawndale, I have had my most formative year to date. Much of what I learned here – about life, about justice, about healthcare, about God – I hope to share in my coming posts on this blog. For now, I want only to make this one point.

Lawndale was here long before I arrived, and it will continue to thrive long after I leave, this coming June. It is refreshing to feel small – to be part of a story I neither wrote nor foresaw. People here do not care what is on my resume. Now, after some months, I don’t either. Only love remains.

Of course, what I experience here at Lawndale is a microcosm of what is happening at large – that of which we get a glimpse in moments of intense joy and intense suffering. We inherited this world, this life, our stories – we do not control or deserve this. In an era where our Babels of social policy, medicine, and technology inch enticingly close to the heavens, we will do well to remember that the made is but a shadow of the given.

This blog, at its best, will be a collective of people trying to recover a vision of grace. Not much of what we say here will be new, but novelty is not the goal. It is remembrance. Blogging will become for us, I hope, a liturgy that brings us to the precipice – into a fuller view of His vast kingdom, and, consequently, a diminished view of our own selves. I understand more than ever before that grace is not only sufficient, it is inescapable. We pray only that He peel back the scales and let us see it anew.

Daniel works as an intern at a primary care center in the inner city, and plans to attend medical school this coming fall.

A Postscript

I wanted to say a few things about the blog itself that I couldn’t fit in the actual piece. Consider this post as an introduction to the blog for the first-time reader.

1) The idea for this blog began with a simple chat that Enoch and I had and we quickly realized we needed reinforcements. In the coming weeks, you will get to meet our regular contributors, discussing anything and everything in their respective fields. It is, simply put, an ongoing attempt to articulate and revise a Gospel Worldview as it applies to each field. New feature posts will appear every Monday and Wednesday. Unfortunately, a contributor’s name will not appear on the Contributors page until he or she has made his or her first post. We expect to have gone through the entire rotation in early March. As a sneak peak, we have Alice Su, the fierce freelance journalist (already published in multiple reputable publications!) writing about media and politics of the Middle East; Ed Zheng, a culinary mastermind trapped in a consultant’s body, speaking about food; and Jinju Pottenger, who famously traveled to North Korea, talking  about law and justice. Others, who I will not mention here solely for brevity’s sake, are just as amazing and I am honestly more excited about reading their posts than writing mine.  So stick with us.

2) You will notice the link to what we’re calling The Reading List. That is a list that our contributors will help us put together for anybody who is interested in how the Gospel Worldview applies to a particular topic/field. 1-2 works will compose the “Canon” for each category, and 5-10 works will compose the “Highly Recommended” section. As we put those up, please feel free to comment on the selection and give us input!

3) Please make sure to like our Facebook Page for updates and posts with interesting/relevant articles!

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.