This material was developed to share information on the subjects of embryo adoption and embryo donation. This venue is made possible by support from the U.S. Department of Health and Human Services under grant #1EAAPA091015-01-00. The statements expressed herein do not necessarily reflect the views of the Department.
Thank you for encouraging your patients to donate embryos. Sweet.
Currently in the U.S. there are more than 500,000 embryos in cryopreservation, with approximately 10,000-15,000 available for adoption at any given time. Help us give infertile couples a chance to become parents by encouraging your patients to donate their remaining embryos. To learn more, visit embryodonation.org
editorial by David Stevens, MD, MA (Ethics), CEO
A Piece of My Mind
I’m getting old. As this magazine hits your mailbox, I’m turning 60 years old. Okay, I admit that 60 is not as old as it used to be. Well, at least not for me! My life expectancy is an additional 20.42 years, so I guess that means I’ve lived three-quarters of my life . . . unless I’m in that 1.19 percent of 60-year-olds that will die this year. I hope not! I’ve got two grandbabies due this fall, a boy and a girl who will be born five weeks apart to my two daughters. That is going to be fun! Surrogate parenting. A “do over” from your own experiences as a parent, but you get to have all the fun and not too much of the responsibility! Yeah, I hope I’m not in that 1.19 percent because I really do have responsibility; it is just a different kind of responsibility. I want to invest my time and energy in those two precious lives — bounce them on my knee, teach them how to say “Grandpa,” hold their hands when they are learning to walk and buy them their first bicycle like my granddad did for me. But more than that . . . I want to help form their characters and teach them about Jesus before they say their bedtime prayers. I want to celebrate when they trust Christ as their Savior. I want to teach them to love people, to have a servant’s heart, to help the poor and to desire to become what God has designed them to be. At 60, you look forward and you look back. When you were younger, it was easy to think life was simply about excelling — making top grades, graduating AOA from medical school, being chief resident, savings lives . . . even saving the world. Those are all good things, important things, but time and experience have given me a much clearer perspective and refined my priorities. The thing that really matters is to invest in people. That is the only thing that will outlive you and continue to multiply as those people deposit their lives into others. I’ve met thousands and thousands of people during my life. Those that I cherish are the ones that invested in me. My mom and dad would be at the top of that list. They taught me to love the Lord and share Him with others. They instilled in me a desire to sacrifice in order to serve others. They said it and did it every day. Despite the fact that my dad died 25 years ago, I still continue to meet people even today that are still glowing from the outlays he made into their lives. Mr. Glatfelter taught me high school biology and was the toughest teacher in the school. In his classroom, only your excellent was considered to be good enough because learning was an act of worship. He took a special interest in mentoring me and even supported us when we went to the mission field 13 years after I was in his class. Dr. Hammond was my pre-med advisor in college, and he had known me since I started kindergarten. His wife taught me to make candles as a young boy in cub scouts. He gave traction to my desire to become a doctor and shepherded me into medical school using his wisdom and many contacts to open doors to go to Harvard, Wake Forest and a host of other schools. Just typing his name floods my mind with words such as Godly, faithful, influential and loved. I could list many other men and women who shaped my life. I know you could too, but here is the point I’ve been making to myself as I remember the past and consider the future. I want to do more shaping in the years I have left. I want to mentor more, spend more time with people, ask more questions, serve more, hear more stories, help with more problems and be more like Christ with people. I want to do it with my children and my grandchildren. I want to do it at church, in my community, at work and with people that God brings across my path. I want to do it in person, by phone, through email, in materials I write, as I do media interviews and on Facebook. Who are you influencing? Christ had three years. I may have 20 years left. You may have more or less but, when it is all over, the only thing that is really going to count is the investment you have made through relationships to reveal Jesus. It’s about time. And that is a piece of my mind. ✝ w w w. c m d a . o r g
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contents To d a y ’s C h r is t ia n D o c t o r I
VOLUM E 42, N O. 3 I
Fall
The Christian Medical & Dental Associations® Changing Hearts in Healthcare – since 1931.
14 When Every Turn is Toward Death
29 Of Mice and Maggots
18 Has God Indeed Said . . . ?
33 A Biblical Foundation for Medicine
by Jim Ritchie, MD Facing ethical dilemmas on the war-torn battlefield
A Biblical Perspective on Sexuality, Part 1 by André Van Mol, MD Examining aspects of sexuality through biblical study
by J. Scott Ries, MD Transforming your spiritual fragrance to become the aroma of God
Part 1: Medicine Within a Christian Worldview by John Dunlop, MD, MA (Bioethics) The first installment in a three-part series
22 Suffering in Silence Pathways to Grace
by Sandy Christiansen, MD, FACOG Helping your patients find health and healing after abortion
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Excerpts from “Gray Matter” by David I. Levy, MD A close look at the impact of praying with patients
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Progress Notes Advertising Section
egional Ministries Northeast Region Scott Boyles, MDiv P.O. Box 7500 Bristol, TN 37621 Office: 423-844-1092 scott.boyles@cmda.org
Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Midwest Region Allan J. Harmer, ThM 9595 Whitley Dr. Suite 200 Indianapolis, IN 46240-1308 Office: 317-556-9040 cmdamw@cmda.org
Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 803-552-1950 west@cmda.org
Southern Region William D. Gunnels, MDiv 106 Fern Dr. Covington, LA 70433 Office: 985-502-7490 south@cmda.org
Interested in getting involved? Contact your regional director today!
TODAY’S CHRISTIAN DOCTOR® EDITOR Mandi Mooney
progress NOTES
Connections Conference Sets Record
EDITORIAL COMMITTEE Gregg Albers, MD John Crouch, MD William C. Forbes, DDS Autumn Dawn Galbreath, MD Curtis E. Harris, MD, JD Van Haywood, DMD Rebecca Klint-Townsend, MD Robert D. Orr, MD Debby Read, RN VP FOR COMMUNICATIONS Margie Shealy AD SALES Margie Shealy – 423-844-1000 DESIGN Judy Johnson PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). TODAY’S CHRISTIAN DOCTOR®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Fall 2011 Volume XLII, No. 3. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright © 2011, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tenn. Postmaster: Send address changes to: Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Undesignated Scripture references are taken from the Holy Bible, New International Version®, Copyright© 1973, 1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Scripture references marked (KJV) are taken from the King James Version. Scripture references marked (MSG) are taken from The Message. Copyright© 1993, 1994, 1995, 1996, 2000, 2001, 2002. Used by permission of NavPress Publishing Group. Scripture references marked (NASB) are taken from the New American Standard Bible®, Copyright© 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977, 1995 by The Lockman Foundation. Used by permission. Scripture references marked (NIV 2011) are taken from the Holy Bible, New International Version®, NIV® Copyright© 1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission. All rights reserved worldwide. Scripture references marked (NKJV) are taken from the New King James Version. Copyright© 1982 by Thomas Nelson, Inc. Used by permission. All rights reserved. Other versions are noted in the text.
For membership information, contact the Christian Medical & Dental Associations at: P.O. Box 7500, Bristol, TN 37621-7500; Telephone: 423-844-1000, or toll-free, 1-888-230-2637; Fax: 423-844-1005; E-mail: memberservices@cmda.org; Website: http://www.joincmda.org. If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product, or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice, or instruction.
The largest gathering of field staff in CMDA history was held in Bristol in May. A total of 55 people gathered at the CMDA headquarters to be inspired, equipped, encouraged and refreshed at the inaugural Connections Conference. This wonderful time of connecting was reported to be the “best field staff meeting ever!” CMDA’s valued ministry staff was presented a “State of the Ministry” update from Dr. David Stevens, and caught the vision for the “Future of Healthcare Ministries” from Dr. J. Scott Ries. In addition, the conference offered practical workshops including sessions on technology from Bill Reichart, Area Director for CMDA Atlanta, and legal matters on campus from Casey Mattox, Senior Counsel with the Alliance Defense Fund. Staff was also ministered to by America’s Family Coaches and CMDA partners, Dr. Gary and Barb Rosberg. Plans are already underway to continue this time of connecting at the 2012 Connections Conference.
Journey: The Path of CMDA Residents The journey through residency can be one of isolation, fatigue and loneliness. Our CMDA students that enter residency are not immune from the toils and hardships encountered during these challenging years. However, the challenges they encounter are not unique, but rather are shared by many Christians on the same path. CMDA is introducing a new window into these training years through the eyes of two residents, Dr. Allie Dailey (PGY-1 General Surgery) and Dr. Erik Lystad (PGY-1 Family Medicine). Drs. Dailey and Lystad recently began blogging their experiences as they travel along the road God has called them through their residency training. Offering a glimpse into their thoughts, struggles and victories, this blog is sure to be an encouragement for other residents and students who can also comment on their experiences and thoughts. Get a glimpse of their journey at www.cmdaresident.blogspot.com.
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progress NOTES
e c i Updates from Washington, D.C. o V r u Yo For More InForMatIon
CMDA Staff Physician Briefs Congressional Leaders CMDA Richmond area director Dr. Ed Read (pictured at center, with H.R. 3 bill sponsor Rep. Chris Smith) traveled to Washington, D.C., to brief members of Congress on aspects of the No Taxpayer Funding for Abortions Act. Dr. Read presented medical information to representatives who had previously served in healthcare professions. CMA Vice President for Government Relations Jonathan Imbody also made a presentation on conscience rights and the poll results to U.S. senators and staff at a meeting at the Capitol, chaired by Senators Kelly Ayotte, Marco Rubio and Roy Blunt. Senate support is required for the legislation to continue to move forward.
and
Updates, VIsIt
www . FreedoM 2 care . org
On the heels of the poll’s release, the U.S. House of Representatives passed legislation — the No Taxpayer Funding for Abortion Act (H.R. 3) — that includes the conscience protections reflected in the poll. The House of Representatives passed the bill by a vote of 251-175. Shortly before the vote, Mr. Imbody briefed key members of Congress with an analysis of the conscience poll results. The nationwide scientific poll, conducted by the polling company, inc., found strong public support across partisan and ideological lines for the conscience protections included in the bill. Poll results found that 50 percent of the survey respondents voiced support for “a law under which federal agencies and other government bodies that receive federal funds could not discriminate against hospitals and health care professionals who decline to participate in abortions.” Only 35 percent voiced opposition. The poll also found that 77 percent of Americans said it is important to them “to make sure that healthcare professionals in America are not forced to participate in procedures or practices to which they have moral objections.”
Conscience Protections Extend to Patients Dr. Ed Read (center) and Jonathan Imbody (right) briefed Rep. Chris Smith (left) and other Congressional leaders at the U.S. Capitol on abortion and conscience rights.
CMA Provides Poll, Expert Consultation to Advance Pro-life Legislation A national scientific poll conducted in May for CMA and the CMA-managed Freedom2Care coalition (www.Freedom2Care.org) demonstrated that a majority of the public supports conscience protections for healthcare professionals.
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A nationwide poll commissioned in 2009 by Freedom2Care found that 88 percent of the American adults surveyed said it is either “very” or “somewhat” important to them that they share a similar set of morals as their doctors, nurses and other healthcare providers. More than nine out of every 10 faith-based physicians who were also polled indicated they would leave the practice of medicine if denied the ability to practice according to their moral beliefs. Kellyanne Conway, CEO of the polling company, inc., noted, “Conscience protections for health professionals enjoy broad support, spanning gender, age, race, geographic region, political party affiliation and even position on abortion. Every major demographic group proved more likely to support than oppose conscience protection laws for healthcare professionals. Congress has an easy path to do the will of the people.”
Media Training The annual “Voice of Christian Doctors” Media Training was held in May, and offered hands-on studio practice to equip medical professionals to be a voice for righteousness in our culture. The training is designed to help physicians and dentists speak with confidence when being interviewed by the media. During the two-day workshop, each participant got the chance to sharpen their skills in one-on-one training in the CMDA radio and television studios. During the workshop, speakers focused on tips to remember when giving radio interviews, preparing for a live television conference and tips to help improve persuasive writing. Here are a few testimonies from recent media participants to help illustrate the effectiveness of the training:
2011 Media Training participants (from left to right) Rosemary Stein, MD; David Stein, MD; David Levy, MD; Marlene Jean; C. Brent Boles, MD; Margaret Cottle, MD and William Bicket, MD with Dr. David Stevens
• “(The training was) just fantastic! So supportive and encouraging. Everyone should do this! I was nervous before I came but was supported so well that I was excited to participate. I even had fun!” – Margaret Cottle, MD • “I got to use the training you provided to interact with the media by being a guest on a local conservative talk radio station discussing ObamaCare. I had the opportunity to defend right of conscience and the pro-life position. The host invited me for 30 minutes, and kept me on for 90 minutes (until the show ended). He commented on how
comfortable I was and on my use of “sound-byte” phrases — all taught to me by you guys. I hope to be invited back at a later date. Thanks again for all you do for all the members and what you have done for me.” – J. Grady Crosland, MD Media training aims to send you out prepared to represent Him effectively to the world. If you are interested in participating in next year’s media training on June 11-12, 2012, visit www.cmda.org/mediatraining for additional information.
61,000 Petitions Delivered
Graduate Chapters Hit 100!
Meanwhile, CMDA has been delivering mail-in petitions signed by individual CMDA members to Senate offices urging passage of the Protect Life Act, another conscience-protecting bill. Through Freedom2Care, more than 61,000 petitions have been sent to President Obama urging strong conscience protections for healthcare professionals. Each bill is profiled and updated at the new CMA/Freedom2Care Legislative Action Center (www.capwiz.com/f2c/home). The site includes ready-made forms to communicate with senators urging co-sponsorship and support for the bills. Poll details are included at www.freedom2care.org/learn/page/surveys.
The number of CMDA graduate chapter local ministry groups has reached a milestone! The recently approved CMDA-Orlando group brought our number of graduate chapters to 100. Under the organizing leadership of Dr. and Mrs. Steve Corbett, Dr. Mari Sanchez and others, the group is preparing to minister to their colleagues, as well as to reach into the newly formed medical school at the University of Central Florida. Congratulations to our Orlando members! In addition to these 100 graduate chapter local ministry groups, CMDA also has 219 campus chapters, representing a presence on 90 percent of the medical and dental schools in the United States and Puerto Rico. With more medical schools opening in the next year, we continue to press toward our goal of CMDA ministering on every medical school in the country! If you are interested in starting a local CMDA ministry with colleagues in your community or medical or dental school, please contact us at ccm@cmda.org.
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progress NOTES
From the Reading Room Grasping Heaven:
by Annelies and Einar Wilder-Smith
A Young Doctor’s Journey to China and Beyond At the age of nine, Tami Fisk told her grandmother she was going to be a missionary doctor when she grew up. Even as a child, she lived her life with that goal in mind. She finished college in only three years so she could begin medical school sooner, and she took every opportunity to study overseas, seeking the place God wanted her to serve. After working in Zambia and China, she felt called to spend her life with the Chinese people and began studying Mandarin. In the mid90s, she connected with Medical Services International (MSI), which was co-founded by Dr. James Hudson Taylor, the great-grandson of the famous founder of China Inland Mission. Tami was accepted by MSI as the first doctor to be sent to the area of the Great Cold Mountains since 1951 when Dr. A.J. Broomhall and all other foreigners were forced to leave China. It was decided that she should minister in that area for three years, and then return to the United States for further training. All went as planned until Tami returned to the U.S. After three months back in the states, melanoma was discovered in her left earlobe. After so much anticipation and preparation, what did the Lord have in store for her? Could she face this part of His plan with as much passion and obedience as she did the first part? Paperback. 263 pages. $13.99 Available from CMDA Life & Health Resources at 888-230-2637 or www.shopcmda.org
Recent Ethics Statements Passed by the CMDA House of Representatives by Nick Yates, MD – Member of the Ethics Committee At the April 2011 Annual Meeting, the CMDA House of Representatives approved two ethics statements that had been prepared and presented by the Ethics Commission. This provides a brief discussion of each of these statements. CMDA Overview on Human Organ Transplantation This statement provides a very simple and introductory documentation of the transplantation issue. The primary purpose of this statement is to provide a framework for future more-detailed statements that will deal in much more specific detail regarding various aspects of the transplantation issue such as medical tourism, living donors, allocation and distribution issues, donation after cardiac death and organ procurement. In this introductory statement, CMDA affirms the ethical use of human organs for transplantation and recommends that CMDA engage in educational efforts to inform the public of all aspects of organ donation and transplantation. A Christian Response to Adverse Outcomes Arising from Medical Error Primary Author – John Dunlop, MD, MA (Bioethics) This statement deals with the issue of medical error, and how the physician should respond. It suggests that the medical professional should recognize and identify the error, thereby offering a sympathetic response and the provision of sympathetic appropriate medical care that is necessary following the error. The statement recognizes three categories of error: 1) errors for which the physician in not responsible, 2) errors for which the physician is responsible, but not morally culpable, and 3) errors for which the physician is both responsible and culpable. The statement goes on to suggest steps that should be considered by the physician if the error results from moral failure; these are repentance, confession, restitution, forgiveness and thanksgiving. As healthcare professionals, we need God’s help to respond correctly to medical error, when it occurs.
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Steury Scholarship Awarded This year’s Steury Scholarship was awarded to Joshua Stake, a preacher’s kid who is now a first-year medical student at William Carey University College of Osteopathic Medicine in Hattiesburg, Miss. Growing up in Florida, Joshua accepted Christ at a young age and learned about the importance of following God’s call from his parents. “Both of my parents showed me that following Christ wasn’t just something that you do on Sunday, but that it’s about leveraging everything you have for the Gospel and letting Christ penetrate every area of your life.” While attending Florida State University in Tallahassee, Joshua felt that God was leading him to pursue medicine as a means of doing overseas missions. He graduated in 2009 with a bachelor of science in exercise science. “I’ve grown each day in my walk with Christ and it’s exciting to see how far He’s brought me. He’s becoming even more real and redeeming each and every part of my life as I let him. I can’t help but follow the call to go deeper with Him.” He has spent time in Bolivia, Kenya, India and Thailand. Throughout these trips, Josh felt that God was giving him confirmation to pursue medical missions. As a result, Joshua received his Associate’s Degree in biblical studies from Global Frontier Missions in 2010 and spent time working in
the organization’s missions program in Clarkston, Ga. “I’ve loved and thrived in every medical experience He’s given me and still pray that God will direct me in His timing to exactly where He wants me.” As he starts his first year of medical school, Joshua is looking forward to becoming a more active participant with CMDA. “God has given me a gift of encouragement and I love to build up the body of Christ. As the Lord takes me deeper, I’ve seen His desire for me to raise up disciples and leaders who will go and raise up other disciples and leaders.” The purpose of the “Dr. and Mrs. Ernest Steury Medical Scholarship Fund” is to assist with the tuition of medical students who are committed to a career in foreign or domestic missions. Applications are evaluated on the basis of academic record, spiritual maturity, cross-culture experience, leadership ability, the student’s sense of call, references and extracurricular activities/talents. For more information regarding the Steury Scholarship, contact the office of the Chief Executive Officer or download the application at www.cmda.org/scholarships.
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president from the CMDA
John R. Crouch, Jr., MD
A Passion for Faith
I am passionate about faith because I know I need faith to walk out this life as a Christian physician. Those of us who are Bible believing Christians know that “it is by grace you have been saved, through faith…” (Eph. 2:8). That is to say, we accept God’s grace in His free gift of salvation by an act of faith. Abraham’s faith in believing what God had promised despite circumstances to the contrary was counted to him as righteousness. But the gospel is not only for our salvation. Through it and by His grace, we are given our righteousness before God. So God’s grace is available to help us walk the daily walk. As it says in Scripture, “The righteous will live by faith” (Rom. 1:17). There lies my challenge! I live in the real world, and that real world presents me with many challenges as a result of “the fall.” From people who don’t understand to the great difficulties of life including job change, loss of income, injuries, disease and death. Some of these problems are due simply to the circumstances of life and some are related to a direct attack by Satan. Maybe you are like me; when these crises strike, they immediately cause fear! I have heard many teachers say fear is the opposite of faith, so I need faith to overcome fear. How do I have faith for the daily walk, especially for the Goliath problems that move in my direction? I recently heard a sermon focusing on Isaiah 6, where Isaiah began to give revelations to establish our faith in Jesus as the Messiah. This passage served to establish Isaiah as a prophetic voice for future generations. For many reasons, this was a time of great uncertainty, challenge and probably even fear for Israel. In verse 1, Isaiah says, “I saw the Lord sitting on a throne, high and lifted up, and the train of His robe filled the temple” (NKJV). In the midst of great challenges and attacks from Satan, it is important for me to see God as far more powerful than all of the circumstances I face, even those that provoke great fear. So how do I build that faith? Matthew 8 provides some instructions for us. In verse 10, Jesus tells the Roman centurion that “I have not found such great faith, not even in Israel!” (NKJV). This declaration served to exemplify the minimal faith of all who are following Jesus, including His disciples. As if to underscore the point, Jesus is awakened a short time later from sleeping in a boat that is nearly being capsized by the storm. The disciples implore Jesus as they awaken Him, “Lord, save us! We are perishing!” (Matt. 8:25, NKJV). Jesus’ response to His own disciples was “Why are you fearful, O you of little faith?” (Matt. 8:26, NKJV). How is it that a Roman centurion is described as having “great faith,” and the followers of Jesus are described as people of “little faith?” Despite being schooled in the discipline of Rome, the Roman centurion recognized Jesus’ authority. The disciples said, “Who can this be, that even the winds and the sea obey Him?” (Matt. 8:27, NKJV). They did NOT recognize the limitless authority that Jesus embodied. I must learn to function in the realms of authority in this real world so that it prepares me to recognize God’s authority in the unseen realm. It is this recognition of God’s authority that is the basis for faith! We need to recognize and submit to authority in our civil life, homes, church life and every place where we are under a hierarchy of authority. In doing so, we prepare ourselves to recognize God’s authority in the spiritual realm. As a result, we develop the faith to overcome the great challenges of this present life, whether that is completely changing the location of where you work or facing the diagnosis of cancer in someone very dear to you, which are my current problems. Seeing our God in all of his majesty and recognizing His authority over ALL THINGS is the basis of faith that will help us win the battle. ✝
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Global Health Outreach (GHO) For InForMatIon aboUt gHo opportUnItIes, VIsIt
www . cMda . org /gHo
Providing Hope in the Midst of Turmoil by Don Thompson, MD, MPH&TM Director, Global Health Outreach
Global Health Outreach teams make a difference in each country they visit by helping to meet both the basic physical and the spiritual needs of the local communities. A recent trip to Afghanistan was delightful for the participants, and brought hope to more than 1,600 patients by showing in deed our Lord’s loving compassion. All of our medical and dental work was in refugee camps, caring for people who have been repeatedly displaced by decades of violence and turmoil. Conditions were deplorable; yet, as a physician’s assistant noted, “I learned that God plants hope within the hearts of even the most destitute people. They may not know what or in whom they are hoping, but it’s there, even in the most hopeless situations. I think it then becomes our job as the hands and feet of God to give that hope a name, Jesus Christ! I am blessed by the new awareness I have of my freedom (in the United States) to worship and proclaim my salvation is Jesus Christ.” While we cannot verbally share our faith in the Muslim cultural context, we can still obey our Lord’s command to show His mercy to widows and orphans!
Medical Education International (MEI) For InForMatIon aboUt MeI opportUnItIes, VIsIt
www . cMda . org / MeI
New MEI Opportunity to Partner with Hospital Vozandes in Ecuador from the Director, Medical Education International
In recent years, the majority of MEI’s invitations to teach have originated from outside of the Americas. But this year, MEI has been asked to teach in Ecuador. This is MEI’s first year to be invited to teach at Hospital Vozandes’ academic conference “Jornadas Medicas.” The conference is a great way to positively impact physical and spiritual health in Ecuador. In 2011, a total of 540 people attended the conference on-site in Quito and another 500 people attended in 25 virtual classrooms in other locations! It is also an opportunity to rub shoulders with other Christian academics, experience Ecuador and see the largest colonial city in the Americas. The one-week conference is scheduled for February 1317, 2012, and it focuses on a wide variety of OB/Gyn topics including OB and Gyn diagnosis, pathology, and therapy and adolescent issues. Translation from English into
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Spanish will be provided for speakers not fluent in Spanish. Room and board will be provided for speakers, but all speakers are responsible for their own airfare. If you are experienced in any of these topics and would like to teach on this team, please contact MEI at mei.director@cmda.org. Hospital Vozandes is a highly respected mission hospital that has also had a family practice residency since 1988. It has graduated more than 120 professionals, who are now influencing the model of health for Ecuador. Many of the graduates have also started other family practice residencies. During residency, the residents are exposed to daily Bible readings and a weekly class called Spiritual Cardiology. Would you pray for this conference and prayerfully consider if God wants to use you to improve OB/Gyn care and to advance the gospel in Ecuador?
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cover story
When Every Turn is Toward Death by Jim Ritchie, MD Captain, Medical Corps, United States Navy Naval Medical Center, Portsmouth, VA
A military doctor shares his passion for serving in combat situations.
I have read a fiery Gospel writ in burnished rows of steel; “As ye deal with my contemners, so with you my grace shall deal; Let the Hero, born of woman, crush the serpent with his heel, Since God is marching on.” – Julia Ward Howe Battle Hymn of the Republic
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U.S. Navy Lt. Joseph Baugh, a physician assistant with the Ghazni Provincial Reconstruction Team, provides medical care for a sick child during a village medical outreach mission at the Janda Clinic in the Gelan district of Afghanistan on Feb. 13, 2010. Afghan, American and Polish medical providers from Forward Operating Base Ghazni treated 270 patients during the mission. DoD photo by Master Sgt. Sarah R. Webb, U.S. Air Force.
A war story
A
friend of mine found himself in the middle of a war. He was a general medical officer in the Navy, fresh from his internship. He was in a tent combat-support medical unit, far forward in the fight. Along with the help of four corpsmen, he was desperately trying to save the lives of three badly injured U.S. Marines. Their injuries were prodigious. Though the Marines might possibly be saved, there weren’t enough people to do all the work, and they were beginning to lose the battle against death. Just then, soldiers brought in an enemy combatant prisoner who was also very seriously wounded. His wounds appeared to be more serious, but he remained conscious. Knowing his obligation to the enemy as per the tenets of the Geneva Convention, my friend turned to treat the enemy soldier. The corpsmen and other conscious Marines were outraged, and called for him to return to treating the Marines. Just then, the enemy soldier caught sight of the injured Marines . . . and laughed at them. As he was in the same unit as the injured Marines and knew them personally, my friend was disgusted with the enemy soldier and returned to his Marines. But that wouldn’t do. The soldiers who had brought in the enemy belonged to a
Another story
What’s right? We want to do the right thing. But to do the right thing, you must first know what it is. In wartime medicine, the rules are different. Soldiers have been given the lawful right to kill. And, at least to some extent when necessary, they have given up their right to life to achieve the goal of victory. Your unit’s mission may dictate whether or not you can treat certain people and under what conditions. Your patient might be a hostile prisoner who has demonstrated his intent to harm you if given the chance. Even your role as a single-minded preserver of life may be questionable. If a hostile combatant is trying to kill both you and your patient, and deadly force is the only means of preventing that action, you are expected to use deadly force. Commonly used frameworks for discussing ethics are of little utility in such settings. The basic tenets of ethi-
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Another young doctor was stationed far out in the wilderness of a foreign land at war, supporting an expeditionary group. Long-distance transportation was only available by a specially requested helicopter. This transportation required many hours of transit time and was a perilous flight, risky to both the aircrew and craft. All ground transportation routes were thoroughly mined with enemy explosives. The doctor had been advised that ground evacuation was impossible. Then the casualties started to arrive. He did what he could. With each casualty, he decided whether the injury justified the helicopter (“helo”) flight, whether he could keep the guy going for a while by himself, whether the injury was so severe that the soldier wasn’t likely to survive anyway or whether he would have enough supplies. And every decision was second-guessed by others. “Why aren’t you calling for the helo?” “Come on, doc, the helo will be here soon, you’re losing this guy!” “Doc, he can’t wait! We’ve got to drive him out!” After weeks of these dilemmas and watching too many soldiers die while waiting for the helo, he finally gave permission for an armored vehicle to drive out an injured soldier. The vehicle was blown up within an hour of departure. A final story The doctor had been treating the little girl in the combat support hospital for two days. He only had four beds and two portable ventilators. Though the medical unit existed to care for combat casualties, he had decided to treat the girl to give her a chance at survival. But he had been directed to clear out his unit in preparation for the night’s upcoming military operations. The girl was still intubated and ventilated, but she had to be transported to the local hospital. So he reluctantly made the arrangements. As soon as she was transferred to the local ambulance, the doctor watched as the medics from the local hospital extubated her and pulled out her IV. They closed the doors and drove away. It happened every time. He knew she would be dead within minutes. But there was no other choice.
When Every Turn is Toward Death
special forces group; they had been pursuing this man for a week and had lost two of their own men in the firefight that day. This combatant was a “high-value unit” and possessed valuable information. They told him, “Doc, you have to save this guy.” Imagine yourself in his place. What would you do? The war is raging outside your tent. You must act. Decide now. You don’t have time to think. Each choice will result in death. But you’ll have to live with that choice for the rest of your life.
A Royal Marine from Bravo Company, 40 Commando rushed a young Afghan girl to hospital after she and a friend were hit by Taliban rocket fire at the Sangin Forward Operating Base. The girls were brought to the FOB where they received medical assistance, and were later flown to Camp Bastion for further treatment. The Royal Marines from 40 Commando were halfway through their six-month deployment to Afghanistan and were based in Taunton. They were working within 52 Infantry Brigade alongside the Royal Marines of the Armoured Support Group and their colleagues from the Royal Navy's Fleet Air Arm. This dramatic image scooped LA(Phot) Al Macleod no less than three awards in the Royal Navy's prestigious Peregrine Trophy annual photographic competition in 2008. w w w. c m d a . o r g
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When Every Turn is Toward Death
Dr. Jim Ritchie assists during the middle of an emergency thoracotomy while stationed in Afghanistan.
cal discussion recommended by Beauchamp and Childress — beneficence, non-maleficence, autonomy and justice — find little traction. Try to apply those concepts in the situation described in our first war story. What exactly is the most beneficent and least maleficent move? Which is the most just? And what about autonomy? A hostile enemy patient is not allowed free autonomy. Even a soldier “on your side” has given up much of his autonomy, including his right to life. Perhaps you can relate to such ethical crises. Maybe you have found yourself in such a situation in which you wanted to do the right thing, but every choice seemed to be a blind alley. Often in medicine, especially combat medicine or catastrophe-relief medicine, the end of a blind alley holds death. No-win? We hate the “no-win scenario.” We want to be like Captain Kirk from “Star Trek” who contends, “I don’t believe in the no-win scenario.” We want to have a lastminute revelation that will save the day and the patient. Such an idealistic mindset is the stuff of fun movies and great stories. I think it is hard-wired into us by our Creator, who has given us a vision of Heaven or of the world as He made it originally. But if misunderstood, this idealistic mindset can create horribly inappropriate expectations. I know of many military personnel, medical and otherwise, who have been crushed emotionally by overly idealistic expectations of themselves and their abilities. This isn’t Heaven. It’s a fallen place. And here, the nowin scenario is very real. War and catastrophe provide an overabundance of no-win situations. By all means, we should try for the right outcome. But when confronted with a no-win situation, we should recognize it as such, pray for guidance and realize that the power to make it all better is not ours.
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Let’s return to the story of my friend in the tent hospital. The special forces soldiers ordered him to take care of the injured enemy soldier instead of the Marines. He refused and treated the Marines. As a result, he saved two Marines and lost one. And the enemy soldier died. He was later charged with violations of the Geneva Convention and with disobeying an operational order. When I last spoke with my friend, he was the subject of a formal investigation. (I am embarrassed to say that I lost contact with him, and am unaware of the outcome of the investigation.) When he told me of his predicament, I tried to tell him that the accusations were unjust and that he was innocent. I tried to reassure him that surely he would be found not guilty. But he corrected me. He realized that he could have called for additional resources and could probably have saved all of the Marines, as well as the enemy soldier. He told me, “After I got past my denial, I realized that I am responsible for the death of two people, and indirectly wasted the loss of the special forces guys who died bringing in the enemy soldier. What I don’t need is for some judge to declare me not guilty. I am guilty. What I need is to be forgiven. And I asked God to forgive me, and He has. After that, all this other stuff isn’t as important anymore.” Made right How many people carry crushing guilt like this? How many are trying to keep the pain away with rationalizations, coping strategies and Prozac? Everyone who has made a decision resulting in death or great pain feels very real guilt. “Someone is dead because of what I did.” That sort of guilt can crush a soul. Gratefully, we know the One with the power to “make it right.” God knows all and sees all, he is all-just and all-powerful. He will judge the events and is in control of the ultimate outcome. We won’t see that outcome on this earth, but we will know it later. On this fallen earth, we have pain, injustice, error, loss and even catastrophe, sometimes
Flags outside the military hospital in Afghanistan fly at half-mast following the loss of a U.S. soldier.
The Christian as a Solider
with lifelong consequences. We will eventually see it all made right. How fabulous to know the One who can redeem the messes we create! The soldiers, the children, the other civilians and the victims of friendly fire — all who were guilty and all who were tragically victimized — will stand before the One who has knowledge of guilt and innocence. He has the power and the authority to forgive and to reward us beyond our understanding. He has promised to make it right. “If we confess our sins, He is faithful and righteous to forgive us our sins and to cleanse us from all unrighteousness” (1 John 1:9, NASB). ✝
Jim Ritchie, MD, has served in the U.S. Navy on active duty for 23 years. An emergency physician, he deployed to Operation Desert Shield/Desert Storm and has deployed twice to Afghanistan in combat-support roles. The most recent deployment was to a military hospital treating more combat casualties than all other military hospitals in Iraq and Afghanistan combined during that period. A periodic participant in MEI activities in Kenya and an active member in the local CMDA group, he lives with his wife and six children in Virginia.
When Every Turn is Toward Death
A common scene with an ambulance and medevac helicopter outside the military hospital where Dr. Ritchie was stationed in Afghanistan.
The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government. I am a military service member. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.
Some people may have difficulty with the idea of a Christian acting as a soldier. Certainly, there are Scripture verses that justify such a concern. But other verses clearly indicate God’s favorable view of valiant, honorable and effective soldiers. For example, 2 Samuel 22 and Psalm 18 reference training for battle and pursuing enemies. 2 Samuel 23:8-23 describes David’s Mighty Men, praising one of them for killing 800 men with a spear. Note the angel’s complimentary greeting to Gideon as “O valiant warrior” (Judges 6:12, NASB). In 2 Timothy 2:3-4, Paul sees a soldier as a prime example of single-minded dedication, and calls Timothy to “endure hardship . . . like a good soldier of Christ Jesus” (NIV 2011). Have you noticed that the only person whose faith “amazed” Jesus was the Centurion, a non-commissioned officer in the occupying army of Rome? (Matthew 8:10, NLT). Also, in Romans 13:4, Paul points out that the King “bears the sword” to keep a beneficial and forceful rule of good law. While the King bears a figurative sword, his soldiers’ swords are quite literal. We must reconcile all of these verses into a full understanding of the role of the military. We are not to murder, kill for our own personal benefit or to indulge emotion. Rather, as individuals, we are called to turn the other cheek (Matthew 5:39), and “so far as it depends upon you, be at peace with all men” (Romans 12:18, NASB) Acting as a soldier and even killing under proper lawful authority is an entirely honorable and admirable profession, praised by God’s word.
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“Has God indeed said . . . ?” A Biblical Perspective on Sexuality, Part 1
by André Van Mol, MD
Sexuality is a subject rooted in passion, but does that passion have a biblical basis?
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e are created as sexual beings, so sexuality rightly holds more than a passing interest to us. Likewise, sex sells, but the products offered are often flawed. Confusion lurks for our young people — older ones too — when encouragement for the loosening of sexual standards comes, as it sometimes does, from religious quarters. How should we respond? Pre-marital sex God set forth precisely what He thought about sexual relationships in Genesis 1:27, “So God created man in His own image; in the image of God He created him; male and female He created them;” and in Genesis 2:24, “Therefore a man shall leave his father and mother and be joined to his wife, and they shall become one flesh.”1 Jesus cited these passages again in Mark 10:6-9 and Matthew 19:4-6, and closed each reference by clarifying, “Therefore what God has joined together, let man not separate.” Notice that the Genesis verses precede the law of Moses, and therefore should not be dismissed as temporary cleanliness-code-type prohibitions. This is about a timeless covenant — in this case what the Jews considered a blood covenant, one only death could end — and it is from where we derive the “’til death do us part” vow of wedding ceremonies. Sex was for heterosexual marriage only. The
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Torah allowed for no other sexual union, in part because “they shall become one flesh.” It is a covenant with soul ties, a union both physical and spiritual.2 This is the biblical standard: sexual intercourse exclusively within a heterosexual covenant relationship of marriage. Our male and femaleness, when brought together in marriage and marital sexual union, exhibit a wholeness of the expression of the image of God that neither gender can portray alone. Were sexuality never again mentioned in Scripture after Genesis, the standard would still have been set. Yet this covenant relationship is spoken of in both the Old Testament and the New Testament as a central point and a priority. Ultimately, we are told the covenant between husband and wife is symbolic of a greater union, “This is a great mystery, but I speak concerning Christ and the church” (Ephesians 5:32). Scripture notes acts of fornication being punished, in keeping with its recognition as sin. Deuteronomy 22:1321 renders guidelines for handling a husband who claims his wife was found not to be a virgin, thus to have had premarital sex. If he lied, he pays; if she lied, she pays. Exodus 22:16-17 states that a man seducing a virgin must marry her if the father allows, but shall pay the full bride price regardless. It wasn’t a freebie, as critics claim. Some scholars say passages in Song of Solomon approvingly describe sex without reference to marriage. This
Porneia Critics contend that the only mention in Scripture against pre-marital sex is the Koine Greek word transliterated “porneia,” allegedly mistranslated as fornication. Since the Old Testament is written in Hebrew and not Greek, this would be irrelevant even if true, which it is not. The Jewish scholar/philosopher Philo Judaeus (born about 20 B.C.) considered the seventh commandment forbidding adultery to be inclusive of all sexual sin, which was a long list including prostitution, fornication, incest, bestiality and so forth.3 Forbidding fornication, among other practices, was common in Jewish religious teaching. It came from the Tanakh in the Old Testament. As for the New Testament, Jesus said in Mark 7:21-22, “For from within, out of the heart of men, proceed evil thoughts, adulteries, fornications, murders, thefts, covetousness. . . .” Notice how broad the listing is, including the Greek “moicheia” for adultery. This makes it awkward to reject porneia (in this case, the plural form “porneiai”) as a mistranslation of adultery not applying to fornication. The word is too complex, plus other words are employed to clarify the point. Biblical lexicons confirm this. More examples exist. Hebrews 13:4 states, “Marriage is honorable among all, and the bed undefiled; but fornicators and adulterers God will judge.” 1 Corinthians 6:9-11 warns, “Do you not know that the unrighteous will not inherit the kingdom of God? Do not be deceived. Neither fornicators, nor idolaters, nor adulterers. . . .” Again, the word listings are broad. These prohibitions are not about mistranslating porneia or the other Greek words used. To reiterate, were there nothing in the Bible about sex other than the first chapters of Genesis, enough was written to know all sex outside of heterosexual marriage was far from scriptural order.
Premarital sex does not prepare you to be a better married lover. Some presuppose, without justification, that premarital sex is the avenue to sexual compatibility and satisfaction, among other promises. This is a sales pitch, the error of which far too many have learned the hard way. Here are a few articles, selected from among many authors who found out premarital sex was not helpful: “Romances with Wolves,”4 “Why Wait for Sex? A Look at the Lies We Face”5 and “Why Wait Till Marriage?”6 Premarital sex is devoid of covenant — it is entrenched in doing something to achieve what’s in it for oneself. Covenant is about something larger than oneself. Dr. John Patrick often presents in his lectures that love outside of a committed/covenant relationship is inherently unsatisfying, thus leading to perversion to make up the difference. Premarital sex is a major cause of the problems of sexually transmitted diseases, abortion, divorce, wounded hearts and a guarantee of ruptured soul ties (since the two become one). God knew this and wanted to protect us. 1 Corinthians 6:18 gives good warning, “Flee sexual immorality. Every sin that a man does is outside the body, but he who commits sexual immorality sins against his own body.” One does not learn good sex skills from sin. Finer sex-
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analysis is flawed. Verses 6-11 in chapter 3 describe the wedding procession and chapter 4 concerns the bride’s beauty. In 4:16, the marriage is consummated. Prior to the wedding, passage 3:4 speaks of her taking the king “into the chamber of her who conceived me,” but this chapter is titled “Bride’s Dream of Separation” in the NKJV Study Bible — a dream, not an action. There was indeed a marriage in the text. The book does speak of the pleasures of erotic love. Why wouldn’t it? The Bible is replete with pro-erotic love passages, such as Proverbs 5:18-19 (which specifies “wife,” by the way, as do many others). In 1 Corinthians 7:5, Paul told married couples “Do not deprive one another” sexually, save for short periods for prayer and fasting. Erotic love is certainly part of biblical sexuality, which is meant for the context of marital union, not before.
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ual points are unique to the couple, learned together as they grow in intimacy. One might well find the experience gained from previous sexual relationships to be more of a hindrance than help. These physical skills are probably the least challenging element of the relational components that make for a good sex life. As for technical help to overcome skill ignorance or issues, seek the wise counsel of trusted and experienced married friends, Christian counselors and the plentiful Christian publications with frank guidance on this topic.
reference to limitation or exclusion based on gender, as some allege. Leviticus 20:10 states, “the adulterer and the adulteress, shall surely be put to death.” Deuteronomy 22:22 specifies, “If a man is found lying with a woman married to a husband, then both of them shall die. . . .” Obviously, the sin was wrong for either gender. The seventh commandment against adultery, as stated previously, was deemed by the Jewish scholar/philosopher Philo Judaeus to include all sexual sin, and applied to all people. Jesus said in Matthew 5:27-28, “You have heard that it was said to those of old, ‘You shall not commit adultery.’ But I say to you that whoever looks at a woman to lust for her has already committed adultery with her in his heart.” Jesus both reinforced the prohibition as set forth in the Old Testament and raised the bar. Polygamy
God gave us a sex drive, and our job is to manage it rightly. 1 Thessalonians 4:3-8 addresses this and warns of those who would mislead you or reject biblical sexual teaching, “For this is the will of God, your sanctification: that you should abstain from sexual immorality; that each of you should know how to possess his own vessel in sanctification and honor, not in passion of lust, like the Gentiles who do not know God; that no one should take advantage of and defraud his brother in this matter. . . . For God did not call us to uncleanness, but in holiness. Therefore he who rejects this does not reject man, but God, who has also given us His Holy Spirit.” Adultery Again, Genesis 1:27 and 2:24, and references to them by both Jesus and Paul, are the standard for sexual relations — one man and one woman in marriage. Exodus 20:14 and Deuteronomy 5:18 forbid adultery with no
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As set forth in Genesis 2:24, God’s intention for marriage was one man and one woman. Psalms 128:3 speaks of “your wife,” not wives. Proverbs 5:18-19 says, “And rejoice with the wife of your youth,” not wives, and does so with some erotic exuberance. Solomon’s many wives served to turn his heart toward other gods away from loyalty to the Lord (1 Kings 11:4), which is precisely why Deuteronomy 7:3-4 forbade Jews from marrying foreign women. The Book of Esther has been commented upon as allegedly approving of the harem system, and as being tacitly pro-polygamy. The text notes Esther was a commoner forced by edict of King Ahasuerus to participate in a beauty pageant, the prize of which was to be the replacement for Queen Vashti. Esther became queen, not a concubine. Paul visits the subject too. 1 Corinthians 7:2 notes, “Nevertheless, because of sexual immorality, let each man have his own wife, and let each woman have her own husband.” Certainly the Bible documents polygamy, which is not the same as approving and commanding it. This is one of the ways we know the Bible is historically reliable and not merely propaganda: it includes all the dirt on its main characters. It is important to be diligent to separate the recorded history of peoples and cultures from the timeless commands and instructions by which God specifies we are to live. The Bible is entirely accurate, but it is not all “thou shalt.” As a modern example, American literature contains ample record of spousal abuse, but we do not approve of it. Finally, the harshness of some of the books of the Law reflects how God views sin and our need for a savior, pointing us to the Messiah. As a technical point, polygamy is not polyamory. University of Texas professor J. Budziszewski details in his book, “What We Can’t Not Know,” that polygamy is in fact a series of marriages between one man and one
woman; it is several marriages, not a group marriage.7 Even so, polygamy is not the biblical standard. ✝ Look for the second part of this series in next quarter’s issue, focusing on sexuality and the rights of women, prostitution, same-sex sexuality and other topics. Bibliography 1
All Bible quotes are from the NKJV unless otherwise stated.
For more on the neurophysiology of this, see Hooked, by Drs. J McIlhaney and F. Bush, Northfield Publishing, 2008. 2
3
Gagnon, R. The Bible and Homosexual Practice (Abingdon Press, 2001) p.192.
4
http://www.leaderu.com/everystudent/sex/articles/wolves.html.
5
http://www.leaderu.com/common/whywaitfor.html.
6
http://www.leaderu.com/orgs/probe/docs/whywait.html.
7
Budziszewski, J. What We Can’t Not Know: a Guide. Dallas, TX: Spence Pub., 2003. p.36-37.
André Van Mol, MD, is a board-certified family physician in private practice. He serves on the boards of Bethel Church of Redding, PrayNorthstate and Moral Revolution (moralrevolution.com) where he writes the Ask the Doctor blog. He speaks and writes on bioethics and Christian apologetics, and is experienced in short-term medical missions. He and his wife Evelyn — both former U.S. Naval officers — have two sons and a daughter, and are foster parents.
2012 National Convention
Featured Speakers: Rev. Rico Tice Associate Pastor (Evangelism), All Souls Church – London, England Commissioner Israel L. Gaither Former National Commander, The Salvation Army – Alexandria, Virginia
April 26 – 29, 2012 Ridgecrest Conference Center Ridgecrest, North Carolina (Asheville area)
Jean Wright, MD Chief Medical Officer at Carolinas Medical Center Northeast – Mint Hill, North Carolina
REGISTER EARLY AND SAVE
John Stonestreet, MA Speaker, Writer, Cultural Commentator, The Point and Summit Ministries – Colorado Springs, Colorado
Numerous breakout sessions: Medical & Dental Lectures Faith & Missions Topics Ethics Track American College of Pediatricians Marriage & Family Topics
Human Trafficking Sessions Women in Medicine & Dentistry Track
For Students and Residents
For more information, call the Meetings Department at 1-888-230-2637 or visit the website at www.cmda.org/nationalconvention.
Sarah’s Story Sarah’s life couldn’t be going any better. She was graduating high school in a few months and had landed a four-year athletic scholarship to college to play the sport she loved — soccer. The man she loved was also matriculating to the same college and there was talk of marriage. When she skipped a period, she chalked it up to stress. It wasn’t until she missed a second period that she became alarmed and took a home pregnancy test. In the short time it took for the second line to appear indicating a positive test, Sarah’s perfect life came crashing down. Confused panic enveloped her and made thinking clearly impossible. All she knew was by Walt Larimore, MD that she just couldn’t have a baby right now. What would her parents say? What about the scholarship she had worked so hard for? Her career would be over; she’d let everybody down. Sarah had always been opposed to abortion, but now she felt trapped and frightened. As if it were someone else making the decision, she rationalized that she had no choice; she had to abort. Her boyfriend didn’t argue with her, voicing that it was her body and he would support whatever decision she made. The abortion clinic recommended the medical abortion, stating it was more “natural, just take a few pills and the ‘tissue’ passes much like a miscarriage.” She was unprepared for the amount of cramping and bleeding that she experienced, but was too afraid to tell her parents. Just when the cramping became unbearable, she felt something pass out of her body. The horror of her decision came crashing through her well-constructed wall of denial when she saw the tiny embryo floating in the toilet. In the coming weeks and months, numbness replaced the pain which Sarah unwittingly had stuffed way down. During college, using alcohol to excess became the norm, as did purging to maintain her weight for soccer. She and her boyfriend split up, less than a year after the abortion. Sarah started experiencing panic attacks and continued to self-medicate with alcohol. She eventually got married and had a baby, but suffered a severe bout of postpartum depression. It would be years before she would put the pieces together, understand the impact of her abortion and begin the path towards healing. (Fictitious character based upon real stories.)
Suffering in Silence Pathways to Grace by Sandy Christiansen, MD, FACOG
Developing a passion for helping your patients find healing after abortions
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ow many Sarah’s have you seen in your office? You’ve met them, you just may not have recognized them. Stories like hers are shared daily in pregnancy resource centers (PRCs) across the country and serve as a sad and frightening legacy to abortion. According to the Guttmacher Institute, it is estimated that more than 43 million abortions were performed in the U.S. between 1973 and 2003.1 How have women who made the choice to have an abortion fared? The cold reality is that many individual lives have been psychologically devastated as a consequence of choosing abortion. As Christian physicians, we must be able to identify the psychological impact of abortion in our patients’ lives and be ready to point them in the direction of health and healing. An ever-growing body of literature reveals a host of long-term health risks associated with induced abortion. Chief among the potential risks are psychological problems. According to Dr. Priscilla Coleman, Professor of Human Development and Family Studies at Bowling Green State University, hundreds of studies documenting abortion as a significant risk factor for mental health problems have been published in premier psychology and peer-reviewed medical journals over the last two decades. Sufficient data is available in the scientific literature to conclude that induced abortion substantially increases the risk of anxiety, depression, substance use, suicide ideation and suicide. Induced abortion is implicated in 11 percent of cases of panic disorder, 13 percent of cases of alcohol dependence and 16 percent of cases of bipolar disorder.2 In light of the approximately 2 million abortions performed in the U.S. each year, this issue represents a significant public health concern.
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lowing symptoms in your patients who report a prior Sarah’s life is full of the psychological fallout that can abortion: be associated with an abortion decision. Substance • guilt abuse, relationship problems, eating disorders, anxiety, • anniversary syndrome depression and suicide have all been linked to induced • flashbacks abortion.3,4,5,6,7 Women are not the only ones affected, as • avoidance of babies, pregnant people, etc. men also regret the abortion and suffer from the fallout.8 • substance abuse My residency training in obstetrics and gynecology • eating disorders provided no education about the negative impact of • anxiety and/or depression abortion. I first learned about how abortion affects • difficulty bonding with a child or partner women through my volunteer work with a crisis pregBy identifying these factors and raising the possibility nancy center. I began to gently ask my patients about of a connection with her abortion, you may be helping their past abortions. For many, it was clear that this was to release her from the prison that has held her captive. a painful subject, one that they had seldom spoken of as Be aware that she may not be ready to pursue healing. the memory was still raw. Others were matter of fact in For those who are, the following are some of the their responses, until asked if they had experienced any resources available. While secular efforts may bring depression or other struggles; then the tears would flow. some degree of healing, true healing is only achieved The local pregnancy center was a great resource. At the when the relationship with God is reconciled. center, I was confident they would experience the love of Christ and receive the needed care to heal from their 1. Care Net is a Christian organization that proabortion. As physicians, we are uniquely positioned to vides support to more than 1,200 PRCs which hear our patients’ secret pain, to validate their feelings offer hope to those facing unplanned pregnanand to set them on the path to healing. cies by providing practical help and emotional The first step is learning to recognize post-abortion support. Care Net’s PRCs are uniquely equipped symptoms in our patients, both male and female. If you to minister to women who are suffering emoare not in the habit, start asking about past abortions tionally and spiritually after an abortion. Postalong with the reproductive health history. Ask for abortion recovery Bible studies such as Linda details about the abortion, just as you would a full-term Cochrane’s “Forgiven and Set Free” have propregnancy. How far along? Was it a surgical or medical vided the necessary support to experience true procedure? Were there any immediate complications? healing and forgiveness for hundreds of women. Ask specifically, if they experienced feelings of depresAs a medical director of a PRC, I have met many sion or anxiety, or suicidal thoughts. Don’t be surprised by sudden tears; you may be the first person to ever ask about the experience. You may be the only person she’s ever told. Many of these men and women shoulder enormous guilt. Your compassionate, nonjudgmental approach will literally be a balm for their wounded spirits. Don’t be fooled by the typical “I’m fine” response. For those who deny any post-abortion issues, give them a list of signs and symptoms to look out for, as well as a list of helpful websites. Over time, the suppressed pain may start manifesting and this list may be a lifesaver. While you won’t find “postabortion stress” in the DSM-IV, you will want to look for and be able to recognize the folDr. Sandy Christiansen greets a patient outside a Care Net pregnancy resource center.
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give voice to the scientific data supporting the negative psychological impact of abortion. To find an abortion aftercare group near you, go to www.silentnomoreawareness.org. For women and men hurt by abortion, the words of Psalm 39:2 describe their suffering, “So I remained utterly silent . . . But my anguish increased” (NIV 2011). As we identify patients who are struggling with a past abortion, compassionately hear their stories and point them to Jesus, we will be giving them “streams in the wasteland” and hope for a brighter tomorrow.9 ✝ Bibliography
Dr. Christiansen comforts a patient and offers advice during a consultation.
Finer LB, Henshaw SK, Estimates of U.S. Abortion Incidence, 2001–2003. Guttmacher Institute August 3, 2006; www.guttmacher.org/pubs/2006/08/03/ab_incidence.pdf, accessed February 20, 2011.
1
2 Coleman PK, Coyle CT, et al. Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the national comorbidity survey; J Psychiatr Res 2009; 43, 770–776.
women who regret their abortions. Pregnancy centers truly are sanctuaries where captives are set free from the pain of past abortions. To find a Care Net PRC near you, call 800-395-HELP or go to www.theoptionline.org. 2. Weekend retreats at Rachel’s Vineyard offer a supportive, confidential and nonjudgmental environment where women and men hurt by abortion can begin the process of restoration, renewal and healing. For more information and to find a retreat center, go to www.rachelsvineyard.org. 3. Ramah International is a Christian ministry dedicated to helping individuals heal after abortion. Written by Ramah’s education staff and Sydna Masse, “Her Choice to Heal: Finding Spiritual and Emotional Peace after Abortion,” is another resource. www.ramahinternational.org 4. Silent No More is a Christian group seeking to expose and heal the secrecy and silence surrounding the emotional and physical pain of abortion. Men and women make public their stories of the devastation abortion caused and
Fergusson DM, et al. Abortion in young women and subsequent mental health. J of Child Psychology and Psychiatry 2006; 47(1): 16-24
3
Pedersen, W. (2007). Childbirth, abortion and subsequent substance use in young women: a populationbased longitudinal study. Addiction, 102 (12), 1971-78.
4
Coleman PK, et al, Predictors and Correlates of Abortion in the Fragile Families and Well-Being Study: Paternal Behavior, Substance Use, and Partner Violence;; Int J Ment Health December 2008
5
Coleman, P.K., Coyle C.T, Shuping M., Rue V.M. (2009). Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the National Comorbidity Survey. J Psychiatr Res 2009; 43, 770–776.
6
7 Gissler M, et al, Injury deaths, suicides and homicides associated with pregnancy; European J of Public Health, Vol. 15, No. 5, 459-463; 2005. 8
Condon G, Hazard D, Fatherhood Aborted, Tyndale 2001.
9
New International Version 1984, Isaiah 43:19.
Sandy Christiansen, MD, FACOG, serves as the National Medical Consultant to Care Net and is the medical director of Care Net Pregnancy Center of Frederick in Maryland. Dr. Christiansen has been a spokesperson for life in a variety of forums providing testimony before the President’s Council on Bioethics, the Maryland Senate and Capitol Hill. Sandy and her husband Kyle are thankful for God’s grace in their lives and for the joy that raising and home schooling their three delightful teenage sons brings to their lives.
Cell Phone Drive When you upgrade your cell phone to the latest iPhone, Droid or Blackberry, what do you do with your old phone? If you’re like most of us, you have a drawer somewhere crammed with unused cell phones and chargers. Did you know that CMDA can help you clean house? We are able to receive your old, unused cell phones, recycle them with our ministry partner iDonate and then use the proceeds to expand our Campus Ministries! All you have to do is collect those unused phones, package them up and send them to: CMDA Attn: Campus & Community P.O. Box 7500 Bristol, TN 37621 So what are you waiting for? Grab those unused cell phones, send them in and recycle while supporting CMDA!
In this issue, we’ve been focusing on the theme of A Piece of Your Mind with our contributing authors concentrating on subjects that they are passionate about in their work and their lives. Dr. David Levy’s recently published book “Gray Matter” showcases his passion for praying with patients. Below are several selections from the first chapter of “Gray Matter.”
M
aria, the well-dressed businesswoman sitting in my office, had a brain aneurysm. One of the blood vessels in her brain had weakened, causing the vessel wall to balloon out in one place like a snake that has swallowed an egg. From the size and irregular shape of the aneurysm I had concluded that if not dealt with relatively quickly it might burst and kill her. She was employed in high-level management and looked the part: she wore a black suit and heels, and an attaché case that appeared to be full of paperwork, presentations, and binders rested on the chair next to her. It looked as if she might be here on a lunch break between important meetings. I half expected her to say something like, “I’ve got ten minutes until my face-toface with clients, Doc. Make it snappy.” But I could see that this sudden and unexpected diagnosis was causing her concern — a brain aneurysm isn’t exactly one of those things you put on your calendar and schedule into your life. It was our first meeting. She had been referred to me a week earlier by the neurologist who had picked up on the aneurysm, an unexpected “catch” that might very well save Maria’s life. Many brain problems don’t announce themselves. Aneurysms, notoriously, give no warning; they hide in the brain until one day, when the blood pressure proves too great for the strength of the artery wall, they rupture and bleed, causing a tremendous headache, loss of consciousness — and eventual death. Sometimes, in the fortunate cases, the aneurysm will push against a nerve or brain structure and prompt some odd symptoms that might alert someone before a catastrophic rupture. In Maria’s case, there hadn’t even been a suspicion of an aneurysm. The MRI scan had been ordered for a completely different, minor concern. But like a video security system that happens to catch images of a wanted killer lurking in the background, the scan had detected this menace inside her skull. My job was to fix it before it could do any real damage.
S
o much of a doctor’s job is in not just diagnosis but in demeanor and presentation as well — the way you come across as you speak, the way you comport yourself, the way you relate to patients. Are your eyes steady, or are they shifty? Do you look into their eyes or over their shoulders or around the room? What does this subtly tell them about their prognosis? What can they read into your body language, your hand motions, your almost imperceptible movements of facial muscles, your ease or lack of ease, and your willingness to engage with them as persons, not just medical problems? Pre-surgical consultation is a dance. You have to practice it, becoming light on your feet and making the right moves in sequence, for it to seem graceful to you and to your patients. Fortunately, I have a calm manner that seems to set people at ease. Still, it takes a great deal of experience to make bedside manner seem effortless, and ultimately that is what you want to achieve: a sense of peace and confidence in spite of a bad diagnosis. I explained the risks and benefits of intervention, and the risks and benefits of doing nothing. She nodded and followed along, taking it all in. As she looked at me, her eyes pleading for good news, I knew she was waiting for me to tell her that there was a pill or an easy treatment — something quick and painless that would solve her problem. Most patients believe, or at least hope, that a doctor can do anything. We are the modern medical high priests, called upon in almost spiritual fashion to rid people of the inconveniences of illness and to heal on demand. At least, that’s how people treat us and how, especially in my field of neurosurgery, we often want to be treated. But I had made a decision to give up the role of high priest, even if I still looked like one in my white coat and light blue scrubs — the standard, intimidating outfit that helps to signal the surgeon’s separation from and, technically, superiority to the people around us. Yes, I am a highly trained medical professional, but I am not my patients’ ultimate healer, and I certainly am not their god. I believe that position is already taken.
excerpts from
GRAY MATTER
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Excerpts From Gray Matter
“I
know that I have given you a lot to think about. Would it be okay if I said a prayer with you?” I asked in a tone that made it safe for her to say no if she wished. I had asked earlier about her spiritual history and learned that her parents were Catholic but that she did not attend services. She tilted her head to one side and looked at me curiously, as if reading a financial report she didn’t understand. She relaxed slightly and nodded. “Uh, okay,” she said, a little confused. “Fine.” I slid my rolling chair over to her and slowly reached out my hand. As surprised as she was, she instinctively reached out with both of her hands and grabbed it as if grabbing a lifeline. I bowed my head to give her privacy. Then I began to pray. “God, thank you for Maria and for allowing us to find this problem,” I said. “This is a surprise to us but no surprise to you. I am asking that this aneurysm not cause her any problems until we can fix it. Please give her peace and good sleep leading up to this surgery. God, we are asking you for success for this surgery. Give her the sense that you are with her. In Jesus’ name, Amen.” I opened my eyes after the short prayer. Maria’s chin was on her chest and she was crying softly. Tears had made water marks on her skirt. Peace seemed to blanket her, and she was tranquil and centered, like a visitor in a church or other sacred place. Gone were the extraneous movements born of high stress. She breathed deeply and seemed to exhale the concerns that had nearly overtaken her. This sudden change might have surprised me if I hadn’t seen it happen so many times with so many other people. After a few moments she looked up at me. Tears were blending with her mascara and running down her cheeks in gray streaks. She nodded her affirmation of the prayer and dabbed her nose with a tissue that I handed her from the box I keep on my computer stand. “Thank you, Dr. Levy,” she said with a sparkle in her eyes that spoke of calm and hope. “I’ve never prayed with a doctor before.” I smiled. I’d heard that many times. This simple act had done what no conversation, no psychological analysis, no recitation of the medical facts had ever done, in my experience. She had received something no insurance company, medical provider, surgeon, or drug could offer: confidence and peace from a simple prayer. And even, I believe, a welcome touch from God.
M
y experiences have convinced me that spirituality is a crucial element to the wellbeing of a person as a whole; moreover, if we let him, God can do powerful, supernatural things in our everyday lives. That’s why I began inviting God into my consultations, exams, and surgeries. Many would be surprised that a neurosurgeon — a man of science, logic, and human progress — would be such a strong believer in God and divine intervention. Yet the experience has been nothing short of phenomenal. ✝
excerpts from
GRAY MATTER
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If you are interested in reading more about Dr. Levy’s experiences with his patients, “Gray Matter” is now available at your local bookstore or online at www.amazon.com. Taken from Chapter 1 of “Gray Matter” by David Levy. Copyright © 2011 by David Levy. Used by permission of Tyndale House Publishers, Inc. All rights reserved.
David I. Levy, MD, practices neurosurgery in San Diego, California. He specializes in brain aneurysms and diseases of the blood vessels of the brain. He attended Emory Medical School in Atlanta, Georgia, and did his neurosurgical training at The Barrow Neurological Institute in Phoenix, Arizona. He did a Fellowship in Endovascular Neurosurgery at The University of Vienna, Austria. He is the author of the book “Gray Matter: A Neurosurgeon Discovers the Power of Prayer . . . One Patient at a Time.” The book shares the account of Dr. Levy professionally using his hands and brain in challenging surgeries as he struggles with an issue of faith — to pray or not to pray. Written with Joel Kilpatrick, it is now available through Tyndale House and online.
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SUFFERING AND DISABILITY IN THE BIBLE AND THE CHURCH
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JJoni oni E Eareckson a reck son Tada Tada aand nd o others t hers join join seminary semina r y pr professors, ofessors, ministry deliver ministr y leaders, leaders, aand nd medical medica l professionals professiona ls tto od eliver ttheological heologica l reflections with reflections on on ssuffering uf fering with wit h real-world rea l-world application, application, aall ll w it h an an a im to to ttrain ra i n C hristia ns in in ministering ministering to to those t hose wh who hurt. hurt. aim Christians who “It h “It has as b been een ssaid a id tthat hat ssuffering uf fering iiss the t he m most ost ccommon ommon d denominator enominator aamong mong h u ma n s . W het her yyou ou aare re o n o ne he 6 60 m i llion p eople humans. Whether one off tthe 660 million people w orldwide aaffected f fected b isabi lit y, or or your your suffering suf fering takes ta kes another a not her worldwide byy d disability, fform, orm, yyou’ve ou’ve pr obably aasked sked tthe he q uestion, ‘‘Why, W hyy, G od ? ’ H ere iiss probably question, God?’ Here ab ook tthat hat aaddresses ddresses tthe he d if ficu lt iissues ssues ssurrounding urrounding ssuffering uf fering book difficult aand nd d isabi lities. I ccommend ommend W Wa aters aand nd Z uck , aand nd tthe he o t he r disabilities. Waters Zuck, other ccontributors, ontributors, fo ffor or p ower f u lly ccalling a lling tthe he cchurch hurch to to provide provide a powerfully b iblica l rresponse esponse tto o ssuffering uf fering aand nd tto op oint p eople tto oC hrist.” biblical point people Christ.” SSteve t e ve B undy, Ma n agi ng D irector, JJoni oni aand nd F riends Ch ri s ti a n Bundy, Managing Director, Friends Christian IInstitute nstitute oonn D i s a b i lit y Disability
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OF
MICE
MAGGOTS by J. Scott Ries, MD
Does your passion to help your patients have a good smell or a bad smell?
“P
lease not Room 12. Anything but Room 12!” More a hope than a prayer, it was the instinctual response to an unwelcomed page in the middle of the night, just as I hit the on-call room bed. An intern in the middle of a 36-hour shift, I had finished an unrelenting string of admissions from the Emergency Room during that day and evening, and I was hoping for just a few moments of respite before the next wave arrived. Groping for my pager in the dark, I rationalized that a call from the wards with a lab result would be better than another trip to the ER. Surely it couldn’t be another admission already! I had just checked the ER board before making the trek to the call rooms and discerned no imminent admissions. But if it was an admission, I desperately hoped it would not be from Room 12. Room 12, after all, was the isolation room. Bad things lurked in Room 12. Seconds after I dialed the familiar extension glowing in the pager’s LED light, the ER secretary brusquely confirmed my angst with just two words, “Room 12.” Click. As I approached the ER, my gaze roamed past the rooms and the nurse’s station before landing on Room 12. The closed door was a bad sign. Even worse was what hit me as I opened the door and stepped into the room. The smell. Like a ton of bricks hitting the pavement from a 10-story fall, the overwhelming smell of rot, filth and excrement stole my breath. My eyes fell to the gurney revealing a mound of swollen flesh barely recognizable as human. I brushed flies away from my face before I realized the oddity of discovering them in this reverse ventilation isolation room. The EMS report told the story. More than two weeks prior, this gentleman had stumbled onto his front porch in a drunken stupor and laid down on his couch. He had
consumed the Big Macs and beer brought to him by his “friends,” ultimately drinking himself into his current coma. He had not moved from his couch in two weeks, not even to relieve himself. Eventually the stench became so bad the neighbors called the police which resulted in his trip to the ER and now Room 12. Unresponsive, with distant heart sounds, minimal respiratory ventilation and profound anasarca, he was barely clinging to life. Examining him more closely, I discovered that he was also teeming with maggots. Those small, white, squiggling creatures were crawling from literally every orifice on his body. Determining it was a futile effort, I dutifully did my best to stabilize him and then wrote orders for his transfer to the ICU, including a “bath” in acetone to eliminate his maggot infestation. You Smell! There were a number of remarkable things about this man, but the most prominent was his smell. Unmistakable. Unavoidable. Do you realize that you smell too? You smell because God says you do. Paul reminds us in 2 Corinthians 2:14-16: “But thanks be to God, who always leads us in triumphal procession in Christ and through us spreads everywhere the fragrance of the knowledge of him. For we are to God the aroma of Christ among those who are being saved and those who are perishing. To one we are the smell of death; to the other, the fragrance of life.” w w w. c m d a . o r g
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Of Mice and Maggots
When is the last time you thought about how you smell . . . in a spiritual sense? We think of our smells each day as we shower and apply deodorants and other fragrances. But what about our spiritual aroma? We can probably distinguish between others-centered smells (joy, patience, love, kindness, thoughtfulness and mercy) and self-centered smells (bitterness, anger, frustration, impatience and discord) in others with little difficulty; but how often do we do a diagnostic check of our own aroma? What fragrance are we emanating when:
choose death instead. The “maggot man” had the unmistakable smell of death. However, to those who love Jesus, that same aroma of the gospel is better than the finest rose. What fragrance are we wearing? We may not know whether the next patient, the orderly cleaning the OR, the new colleague on the medical staff or the anxious parents beside their child’s bedside is in the “being saved” or “perishing” category. But we do know that we are God’s aroma to them. The Smell of Victory
• We are stuck in line at the grocery with the slowest checkout clerk of all time? • Someone carelessly cuts right in front of us on the highway? • Another parent criticizes our child on the ball field? • A colleague unjustly accuses us of wrongdoing to the medical staff? • Someone has the audacity to interrupt our very busy schedule with a personal need? What do we smell like then?
“But thanks be to God, who always leads us in triumphal procession in Christ and through us spreads everywhere the fragrance of the knowledge of him.” In the time of Christ when a general was victorious in battle, runners would precede him back to the city with the good news. People would line the streets, burning spices and incense, allowing the fragrant aroma to waft through the town. As they smelled the sweet aroma, others would realize their general was victorious and soon the streets would be full with jubilant supporters applauding and cheering their general. The soldiers marched home in line behind their victorious leader. The excitement and celebration would be bathed in the “sweet smell of victory.” The imagery of the passage in 2 Corinthians is powerful. We are in a spiritual battle, but the victory has been won! With Christ as our victorious leader, we are in triumphal procession; however, in this case we don’t have to burn incense to spread the good news. Rather, God has chosen us to be the very fragrance of Jesus himself to this world. We are the fragrance of Him! A New Smell
“We are to God the aroma of Christ” Science recognizes the power of smells relating to memory. Corporate America has recognized the importance of using fragrance in its marketing plans, now formalized as “Scent Marketing.” Realtors advise us to bake cookies or bread to fill our home with a comforting aroma to entice the buyer. But Scripture reminds us we bear a fragrance of eternal value, the fragrance of Christ himself. The gospel of Jesus Christ has the most fragrant, sweet smell one can imagine. It is the smell of the gift of God himself. Some choose to reject the “fragrance of life” and
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The rest of the night following my maggot-infested patient’s admission to the ICU was busy with other admissions through the ER. As I made my way to the ICU some hours later to do my morning rounds, I presumed it would be easy to sniff out his location. However, after two passes through the ICU, I smelled neither the familiar stench of earlier that morning nor the scent of acetone. Nor were any flies detectable in any of the rooms. After being enlightened by the astute nurses of the morning shift, I stepped into his room. Once again, I was met with an overpowering blast of smell. Only this time it was different. This time the unmistakable aroma was one of cleanliness, like the smell of a freshly bathed baby. The nurse attending to him had spent the entire night ministering to this comatose gentleman. Not only had she eradicated all of the maggots with acetone, she had bathed him several times to remove all scent of that aromatic compound. His hair had been shampooed and
even trimmed. His finger and toe nails, once black with grime, now were clipped and clean. The beard caked with McDonald’s remnants that I had pushed aside during his difficult exam now gave way to a smoothly shaven face. Here he was, lying in clean gown and linens, not recognizable as the same person. This nurse had devoted her entire shift to restoring to this man the dignity of a person created in the image of God. The transformation that had taken place was profound. When I inquired of the other nurses who had provided this man’s care during the night, none knew her identity. I never saw that nurse again. An angel? Only God knows. What I do know is that morning I was smelling the aroma of Christ. What Fragrance Are You Wearing? How can we spread the fragrance of Christ each day in our homes, practices and communities? Here are just a few ways. 1. Grow as a disciple of Jesus. Yes, we are busier than ever, but unless we are intentional with time in the Word and in prayer, our smell will quickly stagnate. Be a disciple maker as well. Helping others mature in their faith will strengthen yours. 2. Pray for and with your patients. More than 80 percent of patients express a desire for their physician to be sensitive to their spiritual needs. Look for opportunities to sensitively inquire of their permission to pray with them. Then just watch how God will open the doors. 3. View medicine as a calling, not just a career. Have you consecrated your practice to God as your ministry? You can be God’s agent of restoration in health, relationships and faith in the lives of your patients, staff and even colleagues. Your aroma will be welcomed as you view others as God does. He has placed you in this place, at this time, for His reason—your day is full of divine appointments.
5. Use your talents to care for the poor. Part of Christ’s attractive fragrance was His love and concern for the poor. If we want to truly smell like Jesus, we should give of our time to meet the needs of the poor and underinsured. Whether domestic or international, opportunities to spread His fragrance abound.
Of Mice and Maggots
4. Be a servant. We give orders well, but how well do we serve those around us? Can we honestly say that we would not ask a member of our staff to do something we ourselves wouldn’t do? Take a risk—let your staff witness you cleaning up the next time you encounter a bodily mess left by a patient. The smell your staff encounters will likely change dramatically!
You may be wondering about the outcome of the man of maggots. Did he live? No. But that’s not the point. You would be thinking just like I was on that long night on call. Focused on what I could do to save the physical life of my patient, I had missed the invitation God had given me to love him as Christ would. Thankfully, the nurse answered that call and simultaneously taught a valuable lesson to this intern. Each day we are given the opportunity by the One who leads us in triumphal procession to be the aroma of Christ. I don’t know what tomorrow will hold for you, but I do know this: God wants to spread His fragrance through you. ✝
J. Scott Ries, MD, serves as CMDA’s National Director of Campus & Community Ministries for CMDA, and has his finger on the pulse of issues facing students and residents in today’s rapidly changing medical environment. An award winning family physician, his clinical career has included faculty appointments at Indiana University School of Medicine and Butler University, and has spanned from academic medicine, to clinical research, to full time private practice. He continues to actively see patients in the Tennessee/Virginia area. He has also functioned as a medical consultant for ABC, CBS, NBC and Fox network affiliates. Dr. Ries has been involved with CMDA for the past 20 years, serving initially as a student leader, and then on the Board of Trustees and as a team leader on short-term medical mission trips with Global Health Outreach.
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A Biblical Foundation for Medicine Part 1: Medicine Within a Christian Worldview by John Dunlop, MD, MA (Bioethics)
In this three-part series, we’ll be discussing the ways that the Bible should be impacting your practice, beginning with this essay on medicine within a Christian worldview. In the next edition, we will look at how our understanding of the attributes of God can inform our professional lives. The third essay will present an overview of the role of medicine in the Scriptures as we reflect on where the healing professions fit into God’s plan for redemption.
A
re you a Christian doctor or are you a doctor who happens to be a Christian? It may not seem like a great distinction, but how you view yourself can make a major difference in how you practice medicine or dentistry. Striving to be a Christian doctor involves grounding your career within a Christian worldview. To the question, “What does my faith have to do with my day-to-day practice?” the Christian practitioner must answer, “EVERYTHING.” To know what this means
requires you to answer an even more complex question, “In what ways should the Bible impact my practice?” It must be acknowledged from the outset that many individuals in medicine practice an exceptionally high quality of medicine, but are either ignorant of the Bible or frankly discredit it. They love their patients, sacrificially give of themselves to their work and maintain a high standard of excellence. In short, they demonstrate many of the Christ-like characteristics found in Scripture. They would likely not credit the Bible for these laudable traits, even though their behaviors are probably sourced in Judeo-Christian values. Made in the image of the very God they deny, these practitioners are the recipients of God’s common grace. The Role of Christianity in the History of Medicine Our knowledge of the practice of ancient medicine in the Western world is limited. We know that little could be done to actually affect the course of disease; at most, some symptoms were palliated. Ancient medicine allowed for the wide practice of euthanasia and abortion, two methods not subject to a code of ethics or a belief in a transcendent reality. That started to change in the fourth century B.C. with Hippocrates, a member of the Pythagorean School. To the best of our understanding, he led a small group of Greek physicians who
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took the Hippocratic Oath based upon their awareness of a transcendent reality. In doing so, they forswore the practices of abortion and euthanasia.1 It is unclear how popular that stand was in the culture of the day, but it was likely held only by a minority of physicians. His ideas later gained widespread acceptance. As Hippocratic scholar Ludwig Edelstein notes: At the end of antiquity a decided change took place. Medical practice began to conform to that state of affairs which the Oath had envisaged . . . Now the Oath began to be popular. It circulated in various forms adapted to the varying circumstances and purposes of the centuries . . . . Small wonder! A new religion [Christianity] arose that changed the very foundations of ancient civilization. Yet, Pythagoreanism seemed to bridge the gap between heathendom and the new belief. Pythagorean ethics, its concepts of holiness and purity, justice and forbearance . . . . Even the Church Fathers abounded in praise of the high-mindedness of Hippocrates and his regulations for the practice of medicine.2 Medical historian Albert Jonsen says that the guiding principle of modern Western medicine is historically a synthesis of the competence emphasized by Hippocrates and the compassion taught and modeled by Jesus.3 Consequently, to understand the essence of medicine, it is imperative to appreciate the contribution that has been made not only by Hippocrates, but by Jesus and the Scriptures. In addition to its role in the foundation of medicine, a Christian worldview has continued to contribute significantly to the development of medicine, even in the present day.
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To note just five significant contributions: 1. The conviction that the universe was the product of an intelligent, purposeful God, and not that of time and chance, has been the basis of much of modern science including medicine. German astronomer Johannes Kepler described science as “thinking God’s thoughts after him.”4 Medical science today has drifted far from these roots, but it is difficult to deny that this conviction in an intelligent creator God was a primary motivator behind the early discoveries of medicine. 2. Having taken the challenge to learn medicine not by theory but at the bedside, Thomas Sydenham was known as the father of clinical observation. His contributions to the science of medicine were profound. John Patrick quotes him in the context of his spiritual understanding: It becomes every man who purposes to give himself to the care of others, seriously to consider the four following things: First, that he must one day give an account to the Supreme Judge of all the lives entrusted to his care. Secondly, that all his skill, and knowledge, and energy as they have been given him by God, so they should be exercised for His glory, and the good of mankind, and not for mere gain or ambition. Thirdly, and not more beautifully than truly, let him reflect that he has undertaken the care of no mean creature, for, in order that he may estimate the value, the greatness of the human race, the only begotten Son of God became himself
a man, and thus ennobled it with His divine dignity, and far more than this, died to redeem it. And fourthly, that the doctor being himself a mortal man, should be diligent and tender in relieving his suffering patients, inasmuch as he himself must one day be a like sufferer.5 3. Princeton ethicist Paul Ramsey’s 1971 publication of “The Patient as Person” became a seminal work for the field of bioethics. In the book, he emphasized the value of individual choice over the paternalism of the medical profession and defended patient autonomy in strongly Christian terms. 4. An emphasis on the fields of hospice and palliative care were recovered at St. Christopher’s Hospice in London by Dame Cicely Saunders. Initially agnostic in terms of faith prior to founding the hospice, “she discovered she believed in God. It was, she said, ‘as if a switch had flipped.’”6 5. The life of Mother Teresa has been an inspiration to many throughout the world. After founding the Missionaries of Charity in Calcutta, India, in 1950, she continued to serve the poor, sick, orphaned and dying in the name of Christ for the next 45 years.
Thinking Biblically My approach to a biblical basis for medicine is based on how I view the role of Scripture in our lives. For this, I look to what the Bible claims for itself. In 2 Timothy 3:16-17, we read, “All Scripture is breathed out by God and profitable for teaching, for reproof, for correction, and for training in righteousness, that the man of God may be competent, equipped for every good work” (ESV). The Bible thus provides us with the principles necessary to successful living. That does not imply it gives all straightforward answers, but it does give us the foundation we need to make right choices. Indeed, when we spend time in the Scripture, we should not only be reading words but listening to God speak. God’s word is “living and active” (Heb. 4:12). In addition to studying the Scriptures carefully, we should aim to understand the totality of their teachings. By doing this, we will be in a position to “think biblically” about the complex choices we will be called to make. It is not adequate to merely quote a single passage (prooftexting) to arrive at a “biblical perspective.” No! It is essential to be sufficiently familiar with the entire cannon of the Scriptures and be adequately trained in the basic rules of biblical hermeneutics to respond in the very way God would respond to any situation confronting us. In other words, the Bible must transform our thinking to the point where it controls all of our thoughts and a Christian worldview dominates our thinking. This is what Paul meant when he wrote to the Corinthians to “take every thought captive to obey Christ” (2 Cor. 10:5, ESV).
Substance and Style Before considering a biblical foundation of medicine, we must distinguish between substance and style. Substance involves what we do while style is how we do it. Substance has much to do with the science of medicine while style has more to do with the art of medicine. Scripture does not say much about the substance of medicine, but it says a great deal about style. This represents the major Judeo-Christian contribution to modern medicine. Christianity was slow to impact the substance of medicine because church dogma in the early Christian era interfered with scientific discoveries. In the second century, Galen was confined to doing animal dissections in his scientific investigation of human anatomy by the church’s prohibition of human vivisection. It was not until the start of the modern era that a Christian-based conviction of the intelligent design behind the human body led to the scientific studies which were foundational to modern medical science.
Medicine is Philosophically Compatible with a Christian Worldview Medical professionals place inherent value in all people, are committed to serve and are willing to operate on the basis of the highest intellectual standards available. Research-driven, evidence-based medicine is squarely founded in modernity and continues to be the driving force. It employs a reductionistic scientific method to determine the best approach to any individual problem. This approach deemphasizes individual variation. More recently, an emphasis has been placed on diversity within humankind, thereby recognizing that there may not be one right answer applicable to all persons and cultures. I would propose this is a beneficial result of postmodern thinking. As a result, the clinician must adapt research findings to the specific needs of the individual patient. It is interesting that medicine has been increasingly rooted in genetics for the past half century. Our DNA is largely the same across the species and that determines our biologic identity. Medical science is now recognizing that DNA may
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not be so determinative. This is the thrust of the relatively new field of epigenetics7 (literally “over genes”). Rather than believing that we are totally determined by our genes, the science of epigenetics recognizes how lifestyle choices lay chemical tags on our chromosomes telling some genes to turn on and others to stay off. Thus, evidence-based medicine is moving from a strictly material and chemically (largely genetically) determined view of the human organism to one that recognizes the importance of individual variation. I would propose that this is compatible with the Christian view of the metaphysical component of humanity — the immaterial soul. This amalgamation of genetic homogeneity and social diversity, of genetics and epigenetics, of determinism and diversity, has not grown out of a Christian worldview but is fully consistent with it.
Conclusion We have seen briefly how the history of medicine has been impacted by a Christian worldview. The style in which Christian practitioners approach patients must be informed by and flow out of a clear understanding of the Scriptures. It is fascinating to note how much of the contemporary philosophy of medicine is compatible with a Christian worldview, even when it is ostensibly grounded in an evolutionary understanding of human origins. A major feature of this Christian view of medicine includes how our understanding of God and theology informs the way that we should approach our patients. This will be the focus of the second part of this series in the next edition of Today’s Christian Doctor. ✝
Bibliography 1
Dr. John Patrick. Web. 22 Mar. 2011. <http://www.johnpatrick.ca/papers/jp_hippoc.htm>. 2
Edelstein, Ludwig. The Hippocratic Oath, Text, Translation and Interpretation, Johns Hopkins, Press, Baltimore. 1943. p. vii as quoted by Nigel Cameron. The New Medicine. Crossway Books, Wheaton, IL. 1991. 38. 3
Jonsen, Albert R. The New Medicine and the Old Ethics. Cambridge, MA: Harvard UP, 1990. 8. 4
Johannes Kepler. Hellenica, Information about Greece and Cyprus, Michael Lahanas. Web. 06 June 2011. <http://www.mlahanas.de/Physics/Bios/JohannesKepler.html>. 5
Patrick 6
Web. 26 May 2011. <http://www.bmj.com/content/331/7510.toc>. 7
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The study of epigenetics is being increasingly pursued in a number of academic medical centers. For example, see this overview of the work being done at Johns Hopkins: Web. 15 Jan 2011. www.hopkinsmedicine.org/institute_basic_biomedical_sciences/ research/research_centers/epigenetics.
T o d a y ’s C h r i s t i a n D o c t o r
John Dunlop, MD, MA (Bioethics) practices internal medicine and geriatrics at the Aurora Health Clinic in Zion, Illinois. He received his MD from Johns Hopkins where he did residencies in Internal Medicine and an MA in Bioethics from Trinity International University where he serves on the adjunct faculty. He is the author of “Finishing Well to the Glory of God: Strategies from a Christian Physician,” (Crossway 2011). He can be reached at JDunlopMD@gmail.com.
CLASSIFIEDS Practice for Sale Dental Practice – Northwest Florida – Established crown & bridge/restorative practice with focus on comprehensive care. Fee-forService/PPO mix with great loyal patients and steady new patient flow on 3.5 days a week. 4 ops, panorex, in 2,000 sq. ft. office (expandable) in free-standing professional building just off main road in rapidly growing area of Pensacola. Great practice to take to next level. Real Estate also available. Interested parties can call Dr. Paul Rang at: 407-671-2998.
Dental Dentist – Stony Plain, Alberta – We need a team-minded Christian to join us in Stony Plain, Alberta. We believe God is calling someone interested in working with children, providing compassionate care, and a possible future buy-in. Fax: 780-963-2904; e-mail: turnerhm@yahoo.com. Dentist – Concord, New Hampshire – Large busy general/pediatric dental practice established 30 yrs. ago seeks a motivated pediatric dentist to replace retiring dentist. All phases of pediatric dentistry performed including hospital rehabilitations. The mountains and the ocean are only 90 minutes away as well as historic Boston. Position to open late 2011. Team active with Christian medical/ dental short-term missions. Contact Office manager Margie at 603-225-6541; or email grace.pediatric.dentistry@comcast.net. Dentist – Northern New York – Let me help you be successful in reaching your dreams for the Lord in a private office setting as an associate. Earn ~$140,000.00/20-hour week and ~$55,000.00/20-hour week for the NYSDOC. State job pays for benefits while the private sector job allows you the freedom to practice dentistry the way we were taught in dental school. Pediatric practice will do great in this setting. Real estate in the area is very reasonable. Malone, N.Y. offers office space options in an old train depot and a former Pediatrician office. Contact Michael T. Guldan, D.D.S. at mguldan@twcny.rr.com or 315-705-6455.
Oral Surgeon – Illinois – Established 26-yearold practice looking for associate to become a partner. Great place to raise a family, close to Chicago, Milwaukee and Madison. Full scope, Implants, light trauma, laser, I-CAT, mostly fee for service. Guaranteed salary and benefit package. Fax CV to 815-877-4254 or send by email to os1161732@aol.com.
Medical Chief Medical Director – Needed for a busy faith-based non-profit health center in Atlanta, Georgia. Physician will be joining a team of nine Health Care Professionals and is responsible for supervising the delivery of clinical services. Good Samaritan Health Center offers a comprehensive range of services to adults and children who are without health insurance or the means to afford care. The center offers medical, dental, health education and mental health services to patients in a comfortable environment. Please email CV and cover letter or email Roberta@goodsamatlanta.org or call 678553-4902 if you have any questions regarding this position. Family Practice – “Live in Paradise before you Die.” Board certified physician, PA or Nurse Practitioner to join two doctors in beautiful Hawaii. Minister to patients. Salary based on collections. www.hawaiifamilyphysicians.com. Call Ruth 808-345-7007. Orthopedics – “Do right, love mercy, walk humbly.” – Micah 6:8. Do you share this intent? Ours is a 35+ year old practice devoted to these guiding principles. We aim to help people through our professional and compassionate care as well as our outreach to the community and beyond. Find your niche in an environment that is familyfriendly, community-focused, and patientcentric. Low malpractice and cost of living, on-site surgery center, mission minded, vibrant community with a university, new physician-managed surgical hospital opening in mid-2011, great schools, low crime rate, and lots of ways to make a difference. We want to add at least one other general orthopedist as well as a sub-specialist. Won’t
you contact us? Kearney Orthopedic & Sports Medicine, Kearney, Nebraska; Medical Director, Dr. Chris Wilkinson at: 308-6274664; or cwilkinson@kearneyortho.com. Our Administrator, Vicki Aten, at: 308-8652512; or vaten@kearneyortho.com. Podiatry – Established Podiatry Office is seeking a Christian DPM. Our practice is in the beautiful Blue Ridge region of TN/VA. Enjoy an excellent payer mix; work with a professional staff in a family friendly region. Best candidate will be willing to enhance a multi-location regional practice. Missions strongly encouraged. For more information and to apply send CV, photo & cover letter to highlandspodiatry@gmail.com. Pediatrician – Sole pediatric practitioner on Roosevelt Island, New York City looking for an Associate who will take over the practice in the next few years. There are opportunities for growth in this predominantly international community. Please email resume to snolt@cathedralconsulting.com. Pediatrician – Five doctor group in North Carolina seeking a value minded, conservative pediatrician for our practice. Call is 1:5. Competitive salary and benefits. Call or e-mail Dr. Rosemary Stein at: 336-212-1200; Infamclin@aol.com. Pediatrician – “. . . My hope is in Him . . .” – Psalm 62:5. Hope Pediatrics was founded in 1999 based on this scripture and His vision for this practice. We are currently seeking a third physician to join our practice located in rural Western Pennsylvania between Pittsburgh and Erie. We aim to provide Christcentered, comprehensive, compassionate medical care to children here and around the world. Four season community features biking and hiking trails, fishing, and hunting. Low cost of living, good private and public schools, low crime rate, and many opportunities to make a difference. This would be an employee position with great benefits and opportunities for profit sharing and ownership. One hospital with 1:3 to 1:5 call coverage. Interest can be directed to our office manager, Lori Ray, via e-mail at: lray@hopepediatrics.com; or by calling: 814677-3717.
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