Editorial
by David Stevens, MD, MA (Ethics) — Chief Executive Officer
Our Motto — Our Calling As the sun settled toward the horizon in an azure sky flecked with multicolored clouds, I quietly rolled my vehicle to a stop just yards away from a magnificent Masai lion crouching as he drank at a waterhole. It was a National Geographic moment! The clicking camera shutters from a visiting doctor and his wife in the back seat barely broke the tranquility — at least for the moment. Then a huge bull elephant broke noisily from the brush on the other side of the pool. He was clearly unhappy that this lion was at HIS waterhole. He stuck out his ears, swung his trunk, and assumed a threatening posture as my hand reached for the ignition key. He was about to charge, and could easily put a tusk through the door and flip my car like a coin. The lion was not impressed with the elephant’s show of bravado. Wasn’t he “king of the jungle?” Hyper alert, he stayed crouched and held his ground. His tail flicking back and forth, he tried to stare the elephant down. The largest living land mammal would not put up with the insult. He did not care what people wrote about lions in books! Before I could turn the switch, he trumpeted and charged full tilt toward the lion, then chased him around the waterhole and back into the brush creating a new “road” as brush and broken tree limbs went flying everywhere. Man! I hadn’t even brought my camera. I had missed a once in a lifetime “Kodak moment.” My guests promised to send me a photo, but after they returned home and the film was developed, they wrote, sheepishly admitting they had been so scared that the only image they captured was of the sky! My chance encounter, never to be repeated, illustrates the principle — most things don’t happen by chance. They happen by intent.
In 1994, CMDA had the slogan “A Fellowship of Christian Doctors.” I don’t know about you, but it did not light my fire. Fellowship is wonderful, but to me it is just a byproduct of working together to accomplish an important mission. Our catch phrase was not only not catchy, it did not encapsulate CMDA’s mission or communicate it well. After lots of thought and prayer, we adopted a new slogan: “Changing Hearts in Healthcare.” When you boil down all the programs, outreaches, and services we provide, our overarching purpose is to transform health professionals and then train and equip them to transform their world. That elephant and lion story reminds me that the achievement of this goal is not going to happen by chance. We must facilitate what only God can accomplish. We must pray and plan, pray and implement, pray and communicate, and then pray some more. Our faithfulness will lead to fruitfulness. What is true for our organization is true for you as an individual. Even if your heart has been transformed, you are unlikely to transform others by chance. It takes intent to prepare, prioritize, and personalize your ministry to your patients, your family, and your colleagues. Who are you mentoring? How are you going to demonstrate God’s love to someone today? How are you going to raise faith flags, tell a faith story, or share your testimony with a patient? How are you going to improve your service to let the Holy Spirit shine through you? I trust this issue of Today’s Christian Doctor will inspire, train, and equip you to better facilitate such “heart transplants.” Because when your life is over and your impact evaluated, the thing that will really count is, “How many hearts have you changed?” ✝
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
3
contents Today’s Christian Doctor
VOLUME 41, NO. 2
Summer 2010
The Christian Medical & Dental Associations® – Changing Hearts in Healthcare – since 1931.
12 A Piece of Your Mind by Gene Rudd, MD
Results of the 2010 CMDA Membership Survey
26 Our Obligation to the Poor Fifth in a Six-Part Series by Gene Rudd, MD
Who we are in Christ obliges us to help the poor
14 One Step at a Time is All He Asks
29 The Divine Invitation
by Timothy Peklo, MD
by Sarah C. Bauer, MD
How God used an interviewer’s question to redirect this doctor’s life
16 From Selective Memory Deficit to Forgiveness
Since she was eight, her calling has been clear, yet its implications have been transformed
30 Apologetics Series Jesus Claimed and Proved to be God
by Frederick B. Brown, MD
by Robert W. Martin III, MD, MAR
Before he became a follower of Christ at age forty-seven, this OB/Gyn performed hundreds of abortions
32 Bioethics Series The Continuation of a Doctor's Education
19 Changing Hearts about Physician-Assisted Suicide
by James Appel, MD
by Richard Johnson, MD
New Hampshire doctor describes how his testimony changed the direction of a bill legalizing PAS
22 How I Began Praying With Patients
5 34
Progress Notes Advertising Section
by David Levy, MD (with Joel Kilpatrick)
From “heal with steel” to “Can I pray with you?” — a neurosurgeon’s story
Regional Ministries
EDITOr
David B. Biebel, DMin EDITOrIAl COMMITTEE
Gregg Albers, MD Elizabeth Buchinsky, MD John Crouch, MD William C. Forbes, DDS Curtis E. Harris, MD, JD
Rebecca Klint-Townsend, MD Bruce MacFadyen, MD Samuel E. Molind, DMD Robert D. Orr, MD Richard A. Swenson, MD
VICE PrESIDEnT FOr COMMunICATIOnS
Margie Shealy ClASSIFIED AD SAlES
Margie Shealy • 423-844-1000 DISPlAY 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 US Patent and Trademark Office. ISSN 0009-546X, Summer 2010 Volume XLI, No. 2. 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 © 2010, 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 New American Standard Bible. Copyright© 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977 by the Lockman Foundation. Used by permission. Scripture references marked (KJV) are taken from King James Version. Scripture references marked Living Bible are from The Living Bible© 1971, Tyndale House Publishers. All rights reserved. Scripture references marked (NIV) are from the Holy Bible, New International Version®. Copyright© 1973, 1978, 1984 by the International Bible Society. Used by permission. All rights reserved. Other versions used 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. 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.
CMA Washington Office Lobbies for Conscience Rights The Christian Medical Association Washington Office has lobbied the administration and Congress to protect conscience rights in healthcare. CMA has met at the White House with the President’s top officials and on Capitol Hill with Congressional leaders, explaining how protecting conscience rights protects healthcare access for poor patients — by allowing faith-based physicians, hospitals, and clinics to continue to practice medicine under the ethical standards to which they are firmly committed. The partisan healthcare overhaul bill passed by Congress in March, however, contains weak conscience provisions. The law’s language only prevents discrimination against conscientiously motivated healthcare professionals by health insurance plans; it does not ban discrimination by governments or institutions. The law also only addresses discrimination related to abortion, and not to the many other ethical dilemmas confronting faith-based physicians. CMA expects the Obama administration to now move ahead with its announced plan to get rid of the only federal regulation that implements federal civil rights laws protecting the free exercise of conscience in healthcare. CMA will again lead a national conscience protection effort, enlisting the Freedom2Care (www.Freedom2Care.org) coalition of fifty conscience-supporting organizations such as Focus on the Family, CareNet, Salvation Army, the U.S. Conference of Catholic Bishops, Family Research Council, and others.
Tribute to Marian Ruth Schindler Marian Ruth Schindler went to be with the Lord on April 6, 2010 in her home after a long illness. A loving wife, mother, and friend, she had a deep love for the Lord and was a consistent Christ-like example to all she met. Her greatest joy in this life was her family. She and her husband, Dr. Robert Schindler, enjoyed an unusually close and wonderful marriage. The Schindlers were a definite team. She most enjoyed assisting her husband in their various ministries and life together. One of their projects was producing the book Following the Great Physician, which chronicled the first seventy years of CMDA. The dedication of this book says, “This book is dedicated to its primary authors, Dr. Bob and Marian Schindler, who tirelessly pursued every detail and available photo for months, soliciting salient quotes and tracking down pertinent facts like detectives on assignment. . . . The key word in the Schindlers’ life has been relationship. In everything they’ve done, they’ve sought to bring others — patients and colleagues — to a personal relationship with Jesus Christ, their own Savior and role model.” We will miss them both.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
5
CMDA Member Awards/Recognitions 2010 Servant of Christ Award The life of Dr. David Thompson has been marked by dedication and sacrifice. After a traumatic childhood experience, David asked God to allow him to become someone who could serve the sick and dying, and share with them the good news of Jesus Christ. So began the life of a Servant of Christ. After spending his childhood on the mission field in Cambodia, Dr. Thompson attended the University of Pittsburgh School Of Medicine. There he became active in CMDA. He served for three years as the student president of the CMDA chapter. In 1977, Dr. Thompson and his wife accepted a call from the Christian & Missionary Alliance to establish a new medical work in central Africa. In 1981, he returned to the states to complete a general surgery residency at White Memorial Medical Center in Los Angeles. The Thompsons then returned to Africa. In the years since, along with his wife and colleagues, Dr. Thompson transformed a small dispensary into a one hundred twenty-bed, full-service hospital. Of the tens of thousands of patients who received care, more than 7,000 have entered into a relationship with Jesus Christ. In 1996, Dr. Thompson helped establish the PanAfrican Academy of Christian Surgeons (PAACS). As one of the ministries of CMDA, PAACS is dedicated to establishing surgical training programs for African doctors at existing Christian hospitals. Dr. Thompson also serves as the Medical Director and Chief of Surgery of Bongolo Hospital, and he is the PAACS Director for Africa. Dr. Thompson has authored three books: On Call — his testimony/biography; Beyond the Mist — the story of
Dr. David Thompson, right, received the CMDA Servant of Christ award, presented by CMDA President, Dr. George Gonzalez, left.
6
T o d a y ’s C h r i s t i a n D o c t o r
the beginning of the church in south Gabon; and The Hand on My Scalpel — a collection of stories from his work. A fourth book on the theology of mercy, based on what he has learned in thirty years of serving, is currently being written.
2010 Missionary of the Year Award In Matthew 5 Jesus teaches that we are to be the light of the world. Our light is not to be hidden; rather, our light and good deeds should lead others to praise God. Such has been the life of Dr. Neil O. Thompson. Dr. Thompson grew up in New Jersey and was influenced by many godly mentors as a child. He was especially influenced by the Inter Varsity Christian Fellowship Urbana Missions Conference while a college student, and through an elective at Manorom Christian Hospital (MCH) in central Thailand. Dr. Thompson received his education from Jefferson Medical College in Philadelphia and his general surgery residency at Union Memorial Hospital in Baltimore. He served as a missionary surgeon in Thailand from 1979 to 2001, bringing high quality surgical care and spiritual hope to people in great need. Under his leadership, MCH had a ministry focused on staff development, high quality medical care, evangelism, and church planting. Dr. Thompson has been the U. S. Director of OMF International, formerly the China Inland Mission and Overseas Missionary Fellowship, since 2001. While it was difficult to leave medicine and Thailand, he embraced God’s call to mobilize professionals to see God glorified through establishing indigenous, biblical church movements in East Asia.
Dr. Neil O. Thompson, left, received the CMDA Missionary of the Year award, presented by CMDA President, Dr. George Gonzalez, right. Mrs. Wannee Thompson is in the center.
2010 Educator of the Year Award
2010 President’s Heritage Award
As Thomas Fuller wrote, “If you have knowledge, let others light their candles at it.” Wisdom is a gift from God, given to those who devote themselves to Him. Thankfully, there are people that recognize their gift and take it to the ends of the earth so that others can light their candles from it. Dr. Lawrence Norton is a graduate of the College of Physicians and Surgeons, Columbia University, in New York City. He trained in general surgery at the University of Colorado and the University of Kentucky. After residency, Dr. Norton served as a medical missionary in Assam, India, for five years. He then entered academic surgery, becoming a Professor and Vice-Chairman at both the University of Colorado School of Medicine and the University of Arizona College of Medicine. Dr. Norton is a member of many professional societies including the American College of Surgeons. He has edited three surgical textbooks and has published over 160 articles and chapters. Since retiring in 1997, Dr. Norton has made thirty-five visits to nineteen medical schools and ten mission hospitals in seventeen developing countries on four continents. Most of these trips have involved local missionaries with the hope of encouraging them and opening new doors to witnessing by lecturing in nearby medical schools and hospitals. As a CMDA member, Dr. Norton has taught in ten Continuing Medical and Dental (CMDE) Conferences in Africa and Asia, and has participated in more than a dozen Medical Education International (MEI) projects overseas, including seven trips to Mongolia. He has served on the CMDE Commission and on the MEI Advisory Board.
Teresa Collett, JD, has been a valuable legal advocate in CMDA’s efforts to protect human life. A graduate, with honors, from the University of Oklahoma College of Law, she began her teaching career as a visiting professor. Since 2003 she has been Professor of Law at the University of St. Thomas School of Law in Minneapolis, MN. In addition to teaching bioethics and constitutional law, Professor Collett serves as director of the Prolife Advocacy Center. As special attorney general, Professor Collett fought to keep the Oklahoma law requiring ultrasounds before abortions. Recently she served as special attorney general for the State of Kansas, defending that state’s reporting law related to statutory rape. She has represented CMDA in an appellate case related to abortion. As a member of the bar of the United States Supreme Court, she has represented the governors of Minnesota and North Dakota as amici curiae, as well as the Illinois State Medical Society in defending partial-birth abortion bans. As an elected member of the American Law Institute, Professor Collett has testified before committees of the U.S. House of Representative and the U.S. Senate Committee on the Judiciary, subcommittees on the constitution, as well as numerous legislative committees in the state. She often represents CMDA and many other groups in appellate cases. As her skills and effort have influenced many laws and lawmakers to honor life, CMDA proudly presents Teresa Collett with the 2010 President’s Heritage Award.
Teresa Collett, JD, left, received the CMDA President’s Heritage Award, presented by CMDA President, Dr. George Gonzalez, right. Dr. Lawrence Norton, right, received the CMDA Educator of the Year award, presented by CMDA President, Dr. George Gonzalez, center. Mrs. Ann Norton is at the left.
Editor’s Note: These articles are excerpted or adapted from the actual award texts, which may be viewed at: www.cmda.org/2010awards.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
7
New Faces at CMDA In early July, J. Scott Ries, MD, FAAFP, will join CMDA as Vice President for Campus & Community Ministries, and Donald Thompson, MD, MPH&TM, will be coming on board as the Director for Global Health Outreach, both of which are Senior Staff positions. Dr. J. Scott Ries, an awardwinning family physician, has used his medical expertise to serve as medical consultant to NBC, CBS, FOX, and ABC network affiliates in both on and off air capacities for over ten years. 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. Dr. Ries has been involved in all levels of CMDA for twenty years, starting as a medical student leader on the campus of Indiana University School of Medicine and continuing as Resident Trustee on the CMDA Board of Trustees. As a Team Leader with Global Health Outreach, he has led over one hundred medical and dental students to follow God’s call to serve on medical missions experiences. Dr. Ries has continued in national leadership with CMDA on his second four year term on the Board of Trustees.
Dr. Donald F. Thompson was recently the Senior Medical and Public Health Program Director in the Center for Infrastructure Protection at the George Mason University School of Law in Arlington, Virginia, where he is engaged in policy analyses and developing recommendations for complex domestic and global health security issues. Dr. Thompson retired as a Colonel after a twentyseven year career in the United States Air Force. He is board certified in both Family Medicine and General Preventive Medicine and Public Health, and holds a Masters Degree in Public Health and Tropical Medicine from Tulane University, and a Masters Degree in Cross-cultural Ministries from Dallas Theological Seminary. He is a Fellow of the American Academy of Family Medicine and the American College of Preventive Medicine, and is fluent in Spanish and Italian. Don has been a CMDA member since medical school and has been on numerous Global Health Outreach mission trips. He enjoys hunting and reading, but not at the same time. (Look for an in-depth interview with Dr. Thompson in the fall issue of Today’s Christian Doctor).
“No one could understand the Esperanza story and remain an atheist!” a volunteer told Dr. Carolyn Klaus. Such comments prompted her to record the remarkable events which she and her friends experienced as they struggled to open and maintain an inner city health center in Philadelphia. Her narrative will take you on a white-water voyage from one miracle to another through a terrain of desperate needs — including her own. Along the way, important principles of the kingdom of God were learned, recorded, and now can be applied to the various ministries or circumstances in which you are involved. Prescription for Hope is not a dry enumeration of details, but a captivating retelling of the stories of real people — those who were learning and growing as they worked and served in the kingdom, and those who were served by Christ through them. These are not photo montages of perfect, smiling faces, but honest, excruciating glimpses into the lives of people God loves. Life is hard in the barrio, and sometimes it can be equally hard in the non-profit clinic, but when God is in charge, watch out! Change is on the way! Heart change is a beautiful thing, whether it takes place in a Christian or an unbeliever. Who knows what the Lord will do with your willingness to be changed? Paperback. 169 pages. $13.99
8
T o d a y ’s C h r i s t i a n D o c t o r
Prescription for Hope by Carolyn Klaus, MD
Available from CMDA Life & Health Resources: 888-231-2637 or www.shopcmda.org
from the
CMDA
President
George Gonzalez, MD
Transformed Doctors Changing Hearts in Healthcare “Above all else, guard your heart, for it is the wellspring of life” (Proverbs 4:23, NIV). I believe our hearts reveal our deeper affections. Our hearts should be reserved for Christ. Our motivations for serving as physicians and dentists should be to glorify Him. When we allow Christ to take full residence in our heart, our lives are cleansed and purified and our purposes made clear. At times in my past, I have subtly worshipped the gods of career, success, financial security, and man’s approval. I have been driven by pursuits of temporary goals in sports and athletics. I had moved Jesus off the throne in my heart. Uneasiness followed me for years as my heart ached, and I even developed atrial fibrillation, requiring cardio conversion and hospitalization. It was at that time when my heart was ill and downcast that suddenly my perspective changed. When you are faced with losing all, Christ is all. I cried out as Psalm 51:10 says, “Create in me a clean heart O God, and renew a right spirit within me” (NIV). Psalm 139:23 states, “Search me O God and know my heart . . .” (NIV). I knew I needed to trust in the Lord with all my heart as is urged in Proverbs 3:5. I continually asked God to give me an undivided heart, as beseeched in Psalm 86:11. The answer to transformation of our heart and that of healthcare is the transforming power of the Holy Spirit. When the heart of the healthcare provider is changed, we can then help to change the hearts of others. When our hearts are changed, our eyes are opened to see the true needs of those patients that God brings our way. A renewed compassion, care, and true phileo love can be ours to give to others.
We as Christian physicians and dentists need to be different from those in the world. We need to be light, contrasting the darkness of the world’s standards and values. We need to stay salty to make a positive impact. How is this done? Once we’ve experienced true transformation, it is an act of our will to focus on Christ and daily submit our hearts to His will. I try to begin every morning saying, “Lord, I’m your servant, use me to glorify you and touch the hearts of those you bring my way to advance your kingdom.” What does this mean to you? Maybe scheduling regular prayer times and times reading the Scriptures. Possibly, it means getting together regularly with other Christian physicians and dentists to hold each other accountable. I know sometimes it means loving the unlovely patient we’d rather not be serving. It may mean offering free services, forgiving overwhelming debts, or spending extra time on the phone or in person with those who are hurting. No doubt it is speaking the truth in love with patients, friends, family, and colleagues. And, for us workaholics, it may be taking time off to spend with family or to spend more time in ministry with those outside the office. We can’t always right every wrong, or change evil policies or political agendas, but we can be used by Christ as His instruments of redemption to change the heart of healthcare, one heart at a time. ✝
Members are invited to nominate a CMDA colleague for the 2011 Servant of Christ, Educator of the Year, and President’s Heritage awards. The Missionary award is selected by the CMDE Commission. A one-page summary of the person’s achievements and why they should be considered should be submitted to the Board of Trustees by e-mail at: board@cmda.org; by fax to: 423-844-1017 (Attn: Board of Trustees); or, mailed to CMDA, Attn: Board of Trustees, PO Box 7500, Bristol, TN 37621. To view nomination criteria and a list of past awardees, go to www.cmda.org/awards. I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
9
Global Health Outreach (GHO)
Faithfulness and Fruitfulness Samuel Molind, DMD, Retiring from GHO this Summer by David B. Biebel, DMin – Editor, Today’s Christian Doctor
Dr. Molind with yet another special friend
I first met Dr. Sam Molind in about 1987, when he lived in Vermont and I was serving CMDA as Regional Director from my home in New Hampshire. He had never heard of CMDA (then known as CMS), but he immediately and wholeheartedly embraced our vision and got involved in our activities, not only in New England, but on a national level, too. His heart is as big as his smile is wide — a one of a kind totally positive and totally committed person. It’s been a privilege to know and work with both him and Dorothy, his wife. Dr. David Stevens, CEO of CMDA recalls, “We got to know each other when Sam served as a Trustee, and then I asked him to coordinate the dental ministry on the first Prison Fellowship trip we took to Zambia. He had paid the way for a young lady who worked in his office in Vermont and with whom he had been sharing the gospel. After a long, hot, demanding day, Sam preached to the inmates. When he gave the invitation, many came forward to accept Christ. And in the middle of those kneeling murderers, rapists, and thieves was this girl down on her knees, praying. Sam made a beeline to pray with her.” In 1998, when the vision for GHO was being formalized, Dr. Stevens was apprehensive to call Sam and ask him to join the staff of CMDA. After all, he was chief of
staff at his hospital in Montpelier, Vermont; he had started an outreach for the homeless; Dorothy was running a crisis pregnancy center; Sam was the President of the Oral Surgery Society of Vermont; and, he was on their national examiners team. Dr. Stevens said, “The Molinds had lived in the same beautiful country house for decades, all their children were in the area, and his practice was thriving. But I will never forget when he called and said he was going to leave all that because God had called him to lead GHO. Sam’s incredible faithfulness, when most doctors are counting the days to retirement, has led to incredible fruitfulness for the kingdom of God. “Sam grew Global Health Outreach from a dream to the best short-term medical/dental mission program in the world!” Dr. Stevens added. “How? It was a combination of Sam’s incredible work effort, his commitment to excellence, his magnetic personality, and his passion for evangelism. God has honored his faithfulness. Hundreds of thousands of patients have been helped physically, our national partners’ work has grown, and tens of thousands have come to Christ. It has been a team effort, for sure. Dorothy has worked tirelessly coordinating volunteers, serving on teams as a dental assistant, and managing equipment and supplies. They are an unforgettable ‘dynamic duo.’” While his various awards speak for themselves, and the facts (forty-eight teams in 2009; an estimated fifty teams in 2010, with more than 20 percent in the 10/40 Window) describe a nearly nonstop, worldwide ministry, Sam’s burning passion has been to touch those who are “without hope and without help in a world of need” with God’s unconditional love in the form of faith-driven compassion and high quality care. Sam’s 1999 end of the year report contained this goal: “In the midst of all the work load and stress to maintain excellence and faithfulness to our mission and draw closely to Him who makes it all possible, so that His fingerprints are seen on everything we do and we all remain a wonderful blessing to Him.”
For InFormatIon about GHo opportunItIes, VIsIt:
10
T o d a y ’s C h r i s t i a n D o c t o r
www .cmda.orG/GHo
Medical Education International (MEI)
MEI, PAACS, and CMDA Western Region Partner at Korean-American Mission Health Council (KAMHC) by Dr. Jim Smith, Chair MEI Advisory Council
CMDA’s booth was visited by numerous doctors and students during the KAMHC conference
“May they be brought to complete unity to let the world know that you sent me and have loved them even as you have loved me” (John 17:23b, NIV). The increase in international and interorganizational partnerships is surely a sign Jesus’ prayer is being answered! In March, Medical Education International, the Pan African Academy of Christian Surgeons, and CMDA’s Western Region partnered to share a booth at the KAMHC. They were represented by Dr. Jim Smith, Dr. Bruce Steffes, and Rev. Michael McLaughlin. Several excellent contacts were made, with requests for teaching teams to Yemen, Egypt, Pakistan, and Malawi. Several subspecialists visited the booth and were excited to find that there were opportunities for them to serve in missions using their skills.
This was the third KAMHC conference held in Irvine, CA since 2006. The conference is aimed at the 1.5 and second generation (Korean-born and American-born, respectively) Korean American healthcare workers. Attendees were a mix of American-Koreans and about eighty participants from Korea. Twelve exhibition booths showcased Korean mission organizations. It was wonderful to see the large number of students, ranging from high school and college students to those from medical and dental schools, attending the conference. The high priority of missions and reaching out to others among Korean Christians was clearly evident. The conference included four worship/plenary sessions with excellent speakers from both Korea and the U.S. The worship sessions were excellent, with both Korean and English songs. Three workshop sessions covered all aspects of mission opportunities. Several well known U.S. speakers were participants in the workshops, including Drs. Dan Fountain, Michael Soderling, and John Crouch. “The closing worship session was mostly in Korean, but the fervor and excitement about missions was palpable even to an English-only-speaking participant like me,” writes Dr. Jim Smith, who chairs the MEI Advisory Council and has led teams to many countries. “It was a wonderful time of sharing with a whole group of brothers and sisters from multiple cultural backgrounds, a small foretaste of what it will be like in heaven when we join our voices to praise the King of Kings and Lord of Lords and fully realize the answer to Jesus’ high priestly prayer and all believers are finally one as God is One! For InFormatIon about meI opportunItIes, VIsIt: www .cmda.orG/meI
Go Green! You can receive Today’s Christian Doctor and Christian Doctor’s Digest electronically. If you choose to receive these resources electronically, you will be sent an e-mail notifying you when they are available to download, so we need your e-mail address. Contact our Membership Department at memberservices@cmda.org or call toll free (888) 230-2637 to have us change your delivery of these great resources. Christian Doctor’s Digest is also available as a podcast. Go to www.cmda.org/cdd to set up your RSS Feed. You can also change the status of any of your other CMDA subscriptions by going to www.cmda.org/subscriptions.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
11
A Piece of Your Mind Results of the 2010 CMDA Membership Survey by Gene Rudd, MD
As part of our 5-year cycle of Strategic Planning, CMDA conducted large scale membership surveys in 2000, 2005, and now in 2010. The purpose is to gain insights into the challenges, opinions, and expectations of members in order to better plot the course of this ministry. Of our 12,680 members with known e-mail addresses, 2,519 completed this year’s survey (late 2009). The response rate was 20% — which is considered a very good response for a survey in the medical community. This article will review what we learned when you shared “a piece of your mind.”
Your World As a group, you are greatly challenged by life circumstances, but remain largely solid in your faith. Slightly more than three in four members report that their “spiritual health” is good or excellent. Only four members reported that their spiritual health was poor. Not surprising, 3/4ths of you also report that you are satisfied to highly satisfied with your career. But of note, this statistic is down about ten points from the 2005 survey. Similarly, those of you highly dissatisfied with your career rose from 3% to 7%. This concerning trend seems to be the result of changes in the healthcare environment. Recent anxieties over healthcare reform have not helped. We asked you to rank specific challenges in your life. Below is the percentage of members who ranked these as major challenges (if available, the number in parenthesis reflects data from the 2005 survey): • • • • • • • • •
57% - the current healthcare system (39%) 56% - time management (41%) 45% - pride (25%) 42% - stress/burnout (32%) 40% - finding God’s will (24%) 27% - parenting (23%) 27% - partner/professional relationships (14%) 24% - personal/family health 21% - marriage (17% and 24% in previous surveys) • 20% - sexual temptations • 20% - employment relationships (9%) • 12% - finding a life’s mate (17%) – this data was not adjusted for those who are single Note the significant increase in these related challenges: the healthcare system, time management, stress/burnout, partner/professional relationships, and employment relationships. Despite this, the great majority of members report positive spiritual health (77%) and career satisfaction 12
T o d a y ’s C h r i s t i a n D o c t o r
(74%). Though we face significant life challenges, most have found the peace of God in the midst of the storm! Nearly 2/3rds of you are involved in some manner of evangelism. Over half report some level of care for the poor. (When we drilled down on this question in a previous survey, less than 40% were caring for the poor in a meaningful way.) Over half of the membership report being in a mentoring relationship. Nearly one quarter have spoken publicly on a public policy issue. Four of ten of you have been involved in medical missions in the last two years, half on a CMDA mission. While there is diversity of views within CMDA, most of you report being conservative-minded (77%); nineteen percent are moderates; and 2% are liberal. Regardless of the political bent, the overwhelming majority define yourselves as “pro-life.” What you think of CMDA Overall satisfaction with the ministry of CMDA remains high and improving. Whereas 71% of you reported a high level of approval in 2005, that increased to 81% in 2010. Remarkably, over 90% think the dues level is just right. Below is how you rated CMDA’s most commonly used resources. The number is the percentage of members rating the resource as above average to excellent. (If available, the number in parenthesis reflects results from the 2005 survey.) • 66% - Today’s Christian Doctor (55%) 65% - Christian Doctor’s Digest (57%) • 60% - News & Views • 44% - Progress Notes • 58% - CMDA Website (50%) Understandably, the majority of you had not used or were not aware of the ePistle (newsletter sent to missionaries), SCAN (medical journal sent to missionaries), Life Support (audio digest sent to students and residents), and
Your Call (newsletter sent to those interested in a career in missions). About half of you were not aware of, or had not attended, a regional or national CMDA conference. The majority of those who had attended found them of high quality and useful. In addition to rating CMDA resources, we asked you to rank them. Today’s Christian Doctor and Christian Doctor’s Digest were clear favorites followed by the website, News & Views, and Progress Notes. In terms of participation, 60% of you have been involved in either a local chapter or another CMDA ministry group. One out of five had been on a medical mission with Global Health Outreach, and 5% have participated in Medical Education International. Reasons you cite as to why your Christian colleagues may not join CMDA, 88% think it is simply because they are not aware of CMDA or what it offers. Twenty-three percent think it may be due to the cost of membership, and 21% think some colleagues would not agree with CMDA’s policies or positions. We asked several questions to discover how you wish to receive communication. While postal mail is still useful and preferred by some, the majority prefer electronic communication (newsletters and e-mail). A small majority prefer receiving a smaller amount of information more often, rather than a large amount of information less often. Opinions are split between the preference for receiving audio files by CD or MP3. Since we receive lots of comments about these communication preferences, it is clear that many of you are not aware that you can customize the communications coming from CMDA. The easiest way to do this is to go to www.cmda.org/subscriptions. At that site you can decline specific publications or choose to receive them electronically or by mail. In addition to the multiple choices survey format, we allowed several opportunities to provide comments. Some of our most useful insights have come from the more than 7,600 narratives you submitted! Before highlighting the criticisms, it was important to remind ourselves that an overwhelming number of comments reflected your appreciation and approval for CMDA. Even when we asked for recommendations of what we should do differently, the greatest response was your endorsement for current strategies. While the encouragement is greatly appreciated, here are additional things we learned: • These are the most common reasons you joined CMDA: its mission, the need to identify with a Christian witness, the campus ministries, and the influence of a friend. • When asked what CMDA should be doing to help the profession and culture, the greatest response was that we should continue doing what we are doing. Many specifically mentioned continuing to be a “voice” to our profession and culture. The next two most common
•
•
•
•
•
recommendations (7% each) were to develop more local ministry and grow the membership. There were many single comments that CMDA was too much “this” or “that.” When we asked how we might be more helpful to you, the most frequent responses were affirming of what CMDA was already doing, or voicing no particular personal need that CMDA should meet. Eight percent made requests or suggestions for improved networking. We were particularly interested in your response to the question, “What should CMDA stop doing?” Over two-thirds felt we are right on track. Of the 585 who made specific comments to this question, 15% had negative comments about CMDA public policy positions or involvement. That is 3% of all who completed the survey. We also had a few comments about too much mail or solicitation, and too much focus on a particular issue (various issues, no particular pattern). As for which public policy issues are most important to you, the top five are life advocacy (i.e., abortion), right of conscience, healthcare reform, physician-assisted suicide/euthanasia, and healthcare for the needy. The survey allowed for additional comments following the multiple choice question about life challenges. The most common challenge not listed in choices was “balance.” Next in order were spiritual growth, planning for or adjusting to retirement, eldercare, and being an effective witness. The final question asked for general comments or recommendations. Sixty-two percent of you took the opportunity to offer kind words and encouragement. That will keep our batteries charged for many days to come. Thank you! It was difficult to catalog the remaining responses. The most common (only ten) were recommendations or criticisms of the survey. A few of you had very specific concerns. The most troubling to us were times when someone felt CMDA had let them down. That is when we wish the survey was not anonymous so we could follow up. If we have failed or disappointed you, we would like an opportunity to seek forgiveness and try to make it right.
The CMDA Board of Trustees and administrative leadership thank you for your participation in guiding this ministry forward. Throughout 2010 we will sift through and reference your opinions as we craft the next five-year Strategic Plan. May it be for His glory! ✝ I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
13
One Step at a Time is All He Asks by Timothy Peklo, MD
Money, comfort, and an easy work schedule sounded so wonderful . . . but then there was the megaphone of God
“I
s there anything else you can see yourself doing?” was the last question of a daylong interview with the CFO. I answered calmly, “No, this sounds like a great opportunity.” This was the perfect position for a physician; it was a ten minute drive from my upper middle class home, no weekends, no holidays, and no call. There was also potential to make more money each year I stayed with this outpatient elective procedure company. My income would at least double! But from that moment on, God wouldn’t let that question out of my head. On the three hour drive home from the corporate office, and for the next two days I was tormented with that question: “Is there anything else you can see yourself doing?” Day and night I was hounded with what I knew was the real answer. It had been three months since my April 2006 Global Health Outreach (GHO) trip to Honduras, and I had tried to push it out of my mind. I was tired of working in ERs for the past eight years. A change was definitely needed in my life. I felt God was telling me to follow Him one step at a time. Just one step at a time was all He was asking. Discontentment was overwhelming me, and my wife and God kept telling me to take a trip with GHO to Honduras. I had been there on a college trip, and my Spanish was still serviceable. Not knowing what path it might start me on, I decided to just take one step and follow His leading to Honduras anyway. The trip was a wonderful time of seeing patients without all the things I disliked about the American healthcare system. My team leader was Ron Brown. Every night we would debrief on what had happened during the day. These were tremendous opportunities to process and evaluate. There were several team members on the trip of Chinese/Taiwanese descent. Every day we would talk about China because I had been there twice. It struck me as odd that we talked so much about China while we were in Honduras.
14
T o d a y ’s C h r i s t i a n D o c t o r
Mission field medicine means service without all the red tape
Then, something even more peculiar happened. One night, before our usual meeting, I had a strange thought come to me that made no sense. In my head there was a voice saying, He is going to talk about China tonight, and I want you to listen. What? Where do I get these crazy ideas? I answered myself. Within five minutes Ron got up and said, “Tonight we are going to do something a little different. We are going to talk about China and what is happening there.” He went on to talk about a GHO trip that was scheduled for September 2006. Dumbfounded, I realized that this was the next step on the path. God was asking me to go on that trip in five months. God had given me one step, and because I had been faithful, though somewhat reluctant, He was entrusting me with the next one. After looking into the GHO China trip, I put the idea aside and began to examine the outpatient elective company. Maybe I was scared of following again on an unsure path. So I visited the elective procedure office and began reading up as much as I could about what they did. It sounded perfect in so many ways. However, there was still a nagging thought that this was not the correct next step. The more I looked into this company the less I noticed the nagging. It was like putting ear plugs in when someone is talking to you. Pretty soon I could barely hear His voice, and I was following the road to wealth and the self-reliance that it can bring. Money, comfort, and an easy work schedule sounded so wonderful after all the garbage I had endured in the ER. Eventually, I wound up interviewing with the corporate headquarters, and there was mutual interest. They sent me a contract to sign, and the deal would be all done after I signed it. But then the ear plugs came out, and a megaphone assaulted me. God was loudly and clearly telling me I was not following the next step He had given me. He would
ured out, nor do I want to. It has been much better trusting Him a step at a time than straining in vain to see all the way down the path to the end. The journey is definitely sweeter with the ear plugs out and on the path with Him, than with the ear plugs in and on my own path leading to a life predominantly focused on myself, which is just another form of idolatry.
Dr. Peklo has found serving the underserved to be a very satisfying endeavor
How about you? What step has God been asking you to take? You don’t have to know more than the first step He is leading you toward. Can you hear what He’s telling you? Take out the ear plugs and listen. I know what it’s like with them in and out, and, believe me, listening to Him beats following any other voice. Does He want you to become a follower of Jesus if you aren’t already? Does He want you on a GHO trip? Does He want you teaching/discipling students or residents? Does He want you being more vocal or consistent in your office or hospital? Does He want you spending more time mentoring your own children? He will lead you. The journey starts today if you are willing, and will continue into eternity. It will cost you something, but Jesus said if you hold onto your life too tightly you will lose it. Give it to Him, and you will gain everything. In the memorable words of another missionary who gave his life to reach the Auca Indians of Ecuador, Jim Elliot, “He is no fool who gives up what he cannot keep to gain that which he cannot lose.” ✝
One Step at a Time is All He Asks
not force me to follow Him, but He was making it as obvious as a two by four to the head that He wanted me to go on the GHO trip to China. For three days there was an all out war in my heart and head. Would I choose the life of ease, or follow Him on the next step down the path toward the unknown? Finally I gave in. “Okay, okay, okay!” I told God. I put down the pen as I was about to sign the contract, and called the CFO. “You know, when you asked me whether I could see myself doing anything else? Well, I answered it truthfully at the time, but I have realized there is something else I have to do, something God has been leading and asking me to do, and I need to go do it,” I said. I had resolved to accompany Him on the next step on the path that led to China. With relief and exhilaration, I was free from a chain with which I had been binding myself voluntarily. Immediately after hanging up the phone, I excitedly rushed to the computer to look at the GHO website, whereupon I was stunned to see that the trip to China was closed because it was less than two months away. Discouraged and confused, I sat and wondered what disaster I had just perpetrated against myself. There were ten long minutes of silence and introspection. Why did I throw away a great job for nothing? In the midst of my self-flagellation I heard a very quiet voice: Pick up the phone and call Tennessee (GHO office) and see if you can go on the trip anyway. Alicia, who had been on the Honduras trip with me, answered my call. I inquired if there was any chance I could still go on the trip to China. She quickly answered, “I sure think so, because just this morning we were praying that another doctor would come on the China trip. I’ll go ask Sam Molind, the team leader, if you can join us, though, just to make sure.” After a few moments, which seemed to me like an eternity, she returned to the phone, and informed me that I was now on the team. That September I flew across the Pacific and then embarked on a thirty-six hour train ride up to Zhalantun, Inner Mongolia, China. On that GHO trip God used the Chinese patients and translators and fellow Americans to show me that the next step was to continue to follow Him to full-time work in China. Many steps have followed those initial ones, but He has only graciously given me one at a time. During this journey I have often been reminded of Elijah. He was only told one step at a time. First he was told to go to Ahab; once he got there he was told what to say. Maybe he wouldn’t have gone had he known what he had to say next. Maybe I wouldn’t have gone to Honduras in April 2006 had I known that today I would be living and working in China for going on two years. One step at a time is all He asks. Will I trust and follow Him today? I don’t need to have my whole life fig-
Timothy M. Peklo, MD, received his MD in 1997 from the University of Illinois College of Medicine. He worked as an emergency room physician, in two locations, between 2000 and 2008. He completed a Family Practice residency in 2000. He is a member of the American Academy of Family Physicians and CMDA.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
15
From Selective Memory Deficit . . . to Forgiveness
Photo courtesy of Michael Clancy
by Frederick B. Brown, MD
Samuel Armas several years later, in Washington, where his parents testified at a Senate hearing
Twenty-one-week-old fetus Samuel Armas, being operated on in utero, grasps the surgeon’s finger
A
s an Obstetrician/Gynecologist in a faculty position in a family medicine residency program, I am blessed to perform and teach ultrasounds in pregnancy. It is truly phenomenal to demonstrate a fetal heart beat at six weeks gestation when the unborn child is the size of a Tic-Tac. A few short weeks later, between nine and ten weeks gestation, we see the baby beginning to move, and we can record and print crisp images of the baby to include hands, feet, and full torso images. It is a privilege to introduce the unborn child to the pregnant mothers and to the fathers and families. It is the beginning of a wondrous and beautiful love story. It is also a powerful opportunity to demonstrate to the residents and medical students the awesome wonder and beauty of God’s creation through the power and truth of the phenomenal technology of ultrasonography, a science that the Lord has provided. Ultrasound technology is a relatively recent innovation. It was only around 1980 that we could detect fetal motion with “real time” ultrasound. It was only around 1990 that we had accurate first trimester sonograms. How 16
T o d a y ’s C h r i s t i a n D o c t o r
After he came to Christ, the author — a former abortionist — realized the truth of what he had done, then found forgiveness
I wish that this technology had been available thirty years ago when I was an unbeliever and an abortionist. From 1967 to 1971, I was a medical student at Georgetown University in Washington, DC. These were tumultuous times. The sexual revolution was underway. The Feminist Movement was exploding. The prevailing teaching was that an early pregnancy was, “Just a clump of cells,” “Just tissue,” or, “Nothing more than a blob of flesh.” Nobody could prove otherwise. Tragically, I saw an eighteen-year-old from the suburbs die of complications from a criminal abortion, although I knew where early, safe, illegal first trimester abortions could be obtained at upscale OB/Gyn practices. I was young and impressionable — a captive of the culture — a sign of the times. Then came the Supreme Court ruling of Roe versus Wade that stated: “We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy and theology are unable to arrive at any consensus, the judiciary, at this point in the development in man’s knowledge, is
Ultrasound image courtesy of Kansas Bradley
I am eternally grateful to CMDA through its ministry to motivate, educate, equip, and encourage Christian physicians and dentists to take ownership for the ministry to their patients, colleagues, and communities — in essence to practice “eternal medicine.” I am proof of their success — the fruit of their labors for the glory of the kingdom. I am a late arrival. I count my blessings daily. I look upon myself as the worker who showed up toward the end of the day and received a full day’s wage. I came to know, love, and trust Jesus over twenty years after my graduation from medical school at the age of forty-seven — coming home to a place I’d never known before. CMDA played a significant role in the process. At the time of my salvation I had spent eighteen years of my medical career in Colorado Springs. I was aware of CMDA members in my midst as they consistently demonstrated special qualities. I really attracted their attention in my late forties when I experienced divorce and foundered. I was a marked man. It was a finely crafted, exquisitely executed campaign for my soul. In April 1993 — when I accepted Jesus as my Lord and Savior — a CMDA brother and his wife were at my side. I had new faith and needed knowledge and guidance and nurturing. Another CMDA member met weekly with me as I struggled to get my bearings — helping me with prayer, Scripture memorization, guidance, and accountability. Yet another CMDA brother boldly approached me with a CMDA membership packet and said, “You need to join and participate.” I obediently did both. CMDA changed my heart — I attended a “Saline Solution” weekend conference in Chicago that rewired me in how I viewed my calling in medicine and in how I interacted. I developed an appetite — in actuality a strong hunger — for all that CMDA provided, including Christian Doctor’s Digest, News and Views, Progress Notes, local, regional, and national meetings and conventions. I credit CMDA with motivating, equipping, educating, and encouraging me for my role in medical education here in San Antonio in the CHRISTUS Santa Rosa Family Medicine Residency Program. Of the endeavors in my life, I have received the best return on the investment of my time, energy, and money through my investments in CMDA. CMDA has made an eternal impact on me.
From Selective Memory Deficit to Forgiveness
not in a position to speculate as to the answer.” Because they would not speculate as to the beginning of life, they decreed that abortion was not against the law. It was a private issue between the pregnant woman and her physician. Abortion rapidly became an accepted, respectable medical position. This being so, when I was a resident in OB/Gyn, I willingly participated. I did what was right in my own eyes. After my residency, I was in the Army and stationed at a military base hospital where the standard of care was abortion on demand in the first trimester. I also worked for Planned Parenthood performing abortions for additional income. The turning point was the Hyde Amendment in 1977 that prohibited abortions in government hospitals or at government expense. With this change, the hospital commander also asked that I no longer work for Planned Parenthood. At the age of forty-seven, through an extended series of divinely guided situations and experiences, I became a Christian. I accepted Jesus Christ as my Lord and Savior. I was a new creation. I had come to my senses. I was blessed to be discipled by spiritual mentors and to have accountability, fellowship, Bible study, and a strong church community. One January Sunday a pastor presented a sermon on the sanctity of life and forgiveness. He said that if you have ever been involved in an abortion, to, “. . . confess your sin and God is faithful and just and will forgive you your sin and protect you from all unrighteousness.”
Images like this help parents see the truth and begin bonding with their baby
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
17
From Selective Memory Deficit to Forgiveness 18
Obstetrical ultrasonagrapher Shari Richard has made it her mission to use her technology to save the lives of unborn babies. Her website is: www.unborn.com.
My heart was impaled. I was immediately overwhelmed with the stark reality of my personal sins as an abortionist. At that instant, I felt that the blood of those I had killed was still on my hands. You see, I had developed a selective memory deficit. I had psychologically suppressed the memory of my role as an abortionist. I had absolutely stuffed it. I had proudly kept track of every delivery in my career. However, had you asked me how many babies I had aborted, I would not have been able to give a specific number — though it was in the hundreds. The pastor also directed us to “confess your sin to each other and pray for each other so that you may be healed.” My community of faith rose to the occasion and helped me navigate the turbulent emotional and spiritual aftermath. Today, on one hand, I am ashamed of the man and the doctor that I once was. However, on the other hand, I’ve learned that confessing one’s sins brings glory to God and is a wonderful way to establish a close relationship with Him. I am so blessed to be where the Lord has led me, assured of His forgiveness through the blood of Jesus. Today, I am an advocate for the sanctity of life while extending the healing ministry of Jesus Christ. I interact with others — patients, their families, colleagues, residents, medical students, church members, neighbors, and whomever the Lord brings across my path. I emphasize what I know and believe now through the T o d a y ’s C h r i s t i a n D o c t o r
science of procreation and ultrasound — namely, that life begins at conception — the beginning of a genetically unique, fearfully and wonderfully made unborn human being with human rights — the right to be protected — the right to live. I close with these encouraging facts: • The majority of our nation honors the sanctity of life. • An increasing majority of the younger generation — the millennials — honors the sanctity of life. • The majority of physicians in our country honors the sanctity of life. • The vast majority of OB/Gyn specialists does not perform abortions. • The number of annual abortions in our country has declined to its lowest mark since the first year after Roe versus Wade. • Physicians who perform abortions report social stigma, marginalization, professional isolation, and peer pressure. • The number of abortion providers has been declining for many years, resulting in a situation in which 87 percent of counties in the U.S. have no abortion providers. • The science of genetics and ultrasound will prevail in providing the truth. • Most importantly, this battle belongs to the Lord and we are His warriors — for life. Remember: – Abortion stops a beating heart. – Abortion breaks the hearts of those involved. – We can change the heart of healthcare and the heart of our country, one heart at a time. ✝
Frederick B. Brown, MD, is a board-certified Obstetrician/Gynecologist who joined the faculty of CHRISTUS Santa Rosa Family Medicine Residency Program in San Antonio as the Co-Director of the OB/Gyn Services in 2004. Since graduating from Georgetown University School of Medicine, his career has been segmented into military medicine, mainstream private practice of obstetrics and gynecology, medical education, and advanced gynecologic surgery. He is a member of the Christian Medical & Dental Associations and serves on the San Antonio Area Council for CMDA. He lectures on the spiritual aspects of medicine on the local, regional, and national level.
Changing Hearts about Physician-Assisted Suicide by Richard Johnson, MD
Even legislators’ hearts can be changed through a doctor’s testimony
I
visited a couple in assisted living at a Christian facility that has residential retirees, assisted living, and skilled nursing modules. In the lobby I met the chaplain, and we talked a bit about life in this community. He brought up the fact that he will frequently hear residents wonder why, “God hasn’t taken me home yet?” This led to a discussion of end-of-life issues, and his wondering what difference, if any, there was between terminating care or treatment and letting someone take their life or intentionally ending their life. Since such a question might have been deemed inappropriate a few decades ago, it is enlightening to take a brief look at how we could arrive at such a conversation. At the beginning of the last century, there was very little that physicians could do to change the course of disease. Most people died at home. By the end of the 20th century, one’s life span had increased 50 percent. It is estimated that around 85 percent of those who died did so in a hospital.1, 2 The reason for this was the tremendous advancement in medical technology which allowed us to keep people alive despite the presence of trauma or diseases which would, in an earlier era, have taken the patient’s life earlier on. In that sense, medical technology is both a blessing (because of the lives it saves and prolongs) and a curse (when the lives it prolongs degenerate through diseases such as cancer or Alzheimer’s). In the case of Karen Quinlan (1976), the NJ Supreme Court case declared she had the constitutional right to die. This “right to die” movement was aided by both the presence of procedures and technology that prolonged the dying process and the high cost that this placed on the patients, family, and society. In 1990, the Supreme Court, in the case of Nancy Cruzan, implicitly sanctioned the use of
the advance directive. The state of NY in 1994 concluded that patients should be allowed to refuse life-sustaining medical treatment, but that physician-assisted suicide and euthanasia should not be allowed. In this context the plea for patient autonomy enters the discussion. Dr. Robert Orr states, “The dominant principle in secular medical ethics today is autonomy.”3 But it is not often differentiated (as Dr. Orr has explained) into “negative autonomy rights” (right to refuse treatment) which are nearly unassailable and available to all patients, or “positive autonomy rights” (a demand for treatment). For instance, one cannot demand antibiotics for a viral infection or narcotics for a mild headache. But it is here, in the pressing for positive autonomy rights, that we see the point of the physician-assisted suicide wedge being hammered in. There is a fundamental difference between allowing (at their request) patients to die by withholding or withdrawing medical treatment, and hastening death by intervening with drugs or devices. The Hippocratic Oath gives no mandate for treating the terminally ill, but it does prevent us from assisting in a person’s suicide or performing euthanasia. What are the underlying fears? One might expect that the patient’s primary fear would be the “fear” of dying in pain. However, the main reason given by patients in the Netherlands for seeking death is “loss of dignity.”4 All but one of the twenty-three persons who were reported to have used Oregon’s assisted suicide law during its first year wanted suicide not because of pain, but for fear of losing functional ability, autonomy, or control of bodily functions.5 Can these fears be addressed? Ever since Cicely Saunders founded the first modern hospice in England in 1967, there has been steady progress in our ability to alleviate end-oflife pain or suffering. Dr. Joanne Lynn, director of George I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
19
Changing Hearts about Physician-Assisted Suicide
Washington University’s Center to Improve Care of the Dying says, “People find it hard to believe, but almost all patients can be kept conscious and out of pain. The rest can be kept sedated and out of pain.” She noted that “the literature on end-of-life care is replete with the incorrect assumption that terminal illness defined retrospectively carries no distinction from terminal illness defined prospectively.”6 The February 2009 Bulletin of the American College of Surgeons devoted a six page article to encouraging the training of surgeons in palliative medicine. Society has a fear that the cost of care will outstrip the financial resources that the patient, family, or society as a whole will have. “There are currently 36 million Americans older than 65 years; 90 percent have one chronic illness, and more than 77 percent have two or more chronic illnesses. By 2030 it is expected that the number of older Americans will have more than doubled to 70 million — or one in every five Americans.”7 It is estimated that up to 31 percent of Medicare beneficiaries undergo surgical procedures in the last twelve months of life.8
Then there are those of us who fear that if physicianassisted suicide and euthanasia become legal, as it has in Oregon, Washington, Montana, the Netherlands, and an Australian province, there will be abuses, and the “slippery slope” phenomenon will take place. A 1990 survey of the Dutch experience found that out of 129,000 deaths during 1990, 2,300 were requests for euthanasia, 400 were physician-assisted suicide, and 1,000 were euthanasia without explicit request. In nearly half of the involuntary cases, physicians did not consult with family members but took it upon themselves to perform the procedure. The Dutch found that more requests for hastening patients’ deaths came from family members than from patients, and that family members and healthcare providers often pressured patients to request death.9 There have been many studies dealing with end-of-life 20
T o d a y ’s C h r i s t i a n D o c t o r
issues, and an overwhelming conclusion is that a desire for hastened death is tantamount to a diagnosis of depression, or at the very least a “cry for help.” Yet, in Oregon, the frequency of psychological consults dropped steadily from 35 percent to 5 percent. On 26 June 1997, the US Supreme Court upheld the NY state laws against assisted suicide. It made clear, and upheld, the distinction between assisting in suicide and withdrawing life-sustaining treatment. The court highlighted three issues of critical concern: pain management, patient control over life-sustaining treatment, and the recognition and treatment of depression. Finally, the court felt that the debate over physician-assisted suicide and euthanasia should continue in the legislative process. Hence there will be ongoing and persistent attempts to introduce PAS legislation in your state and mine. In 1996 and again in 2009, physician-assisted suicide legislation was introduced in New Hampshire where I practice, and I felt it was incumbent upon me to step forward and speak truth into the obfuscation foisted upon the public by the promoters of PAS. Much of the appeal of their arguments came from heart-wrenching stories of patients suffering needlessly at the end of their lives. Following the principle that it is better to light one candle than to curse the darkness, I went, on both occasions, to testify about the dangerous public policy that the proposed PAS bills would create. After my testimony before the Judiciary Committee, one legislator told me that because of my testimony, the panel had decided to take PAS off the legislative agenda. You and I need to take the principles of the imago dei and convert them into compelling public arguments. We need to work toward affordable healthcare for all. Our neighbors, friends, and chaplains need to hear the compelling arguments for adequate pain control, support of advance directives, and durable power of attorney for medical care. We need to advocate for the diagnosing and treatment of depression. This calls for family and society to be physically and emotionally present for the elderly, the sick, and the dying. Should we ignore this responsibility (in reality, a privilege), the infirm and elderly will come under undue pressure to end their lives. This pressure will come from financially burdened or selfish families or from a patient’s fear of being alone, a burden to others, or that he or she may experience a loss of control. We will be seduced by the idea of a painless death, but will have to live with the abuse and selfishness of family and society as we try to save money and avoid responsibility. The Hippocratic Oath prevents us from abusing our power over the vulnerable and exposed. We voluntarily set limits on our conduct, remembering that our primary service is to the sick, not to their family or the national deficit, nor to the hospital or the nursing home.
Editor’s note: Dr. Johnson attended CMDA’s media training workshop in order to become better equipped to address issues like PAS in the public arena. The next training avail-
Changing Hearts about Physician-Assisted Suicide
Respected physician-ethicists (Gaylin, Kass, Pellegrino, Siegler) have stated that, “Neither legal tolerance nor the best bedside manner can ever make medical killings medically ethical.”10 Dying is part of living. We cannot heal or comfort by making nil. The physician-euthanizer is a deadly self-contradiction. When you think of the unbelievable change in the “doctor/patient” relationship physician-assisted suicide creates, and compound that with the loss (as a physician) of your right of conscience to refuse PAS as treatment, the practice of medicine will, at the end of life, change from compassionate caregiving, to balancing the financial books of the nursing homes and hospitals. We cannot stand by and let that happen. The debate will not be in the courts, it will be in the public square. Each of us needs to be knowledgeable enough to explain in basic terms why PAS is bad public policy. One very helpful way to understand how to prepare yourself is to participate in the media training course offered by CMDA. Then, when you meet the chaplain, your neighbor, colleague, or your state legislator, you will be able to change their minds and hearts on this issue, before it is too late. ✝
able to members, as this issue of our magazine goes to press, will be May 16-17, 2011. Bibliography 1
2 3 4 5 6 7 8 9 10
Freis, James, “Aging, Natural Death and the compression of Morbidity,” NEJM 1980: 130-135. Vladeck, Bruce, “End of Life Care,” JAMA (1995): 449. Orr, Robert, Medical Ethics and the Faith Factor. Medical Post, 16 March 1999. NEJM (18 Feb 1999, Vol. 340, Issue 7. Larson, E. & Amundsen, D. A Different Death, 248-9. Bulletin American College of Surgeons (February 2009). Health Serv Res. (2004:39:363-375). Larson, E. & Amundsen, D. Op. Cit., 234-235. JAMA (1986:2139).
Richard E. Johnson, MD, FACS, earned his MD at the University of Colorado School of Medicine, and did his surgical residency at Dartmouth-Hitchcock in New Hampshire. He has lived and practiced in New Hampshire with Dartmouth-Hitchcock for thirty years. He has been a member of CMDA since 1982, and has participated in short-term missions to Africa and Central America. He currently serves on the Marriage Commission and the Board of Trustees.
A great opportunity for fun, fellowship, and fishing. Nov. 18-21, 2010, with Dr. David Stevens hosting the event on the Watauga and South Holston Rivers located in Northeast Tennessee. No fly fishing knowledge or experience is needed as professional guides will be on hand to provide personal instruction. Special regulations and slot limits have blessed these rivers with a thriving population of resident trophy trout. This is your time to relax and meet your CMDA colleagues for a time of encouragement and recreation. Full details can be found at www.cmda.org/fishing. E-mail: stewardship@cmda.org, or call toll free 888-230-2637.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
21
HOW I BEGAN PRAYING WITH PATIENTS by David Levy, MD (with Joel Kilpatrick)
M
y heart was pounding wildly as I climbed the back stairs at the hospital and entered the pre-operative area. Nurses, anesthesiologists, and doctors rushed by holding charts, IV bags, and vials of medicine. I have some nervous anticipation before surgery, especially before complex cases, but am always the portrait of a confident neurosurgeon. Even the smells of the hospital — rubbing alcohol, latex, sterilized steel — trigger feelings of ascendancy in me. But today I was terrified. I had made up my mind to pray for a patient before surgery. For years I had passing thoughts about praying for patients, not just in my head but in their presence. But I could not imagine what prayer would look like in the medical practice. In all my training and in practice, I had never seen a physician pray for a patient. The surgeon’s motto is “heal with steel.” Prayer is a polar opposite. My own opinion of spirituality and medicine had changed a great deal since medical school. I had always believed that spirituality and medicine were weakly connected and could be explained by the placebo effect. But as I grew in my appreciation for the connection between our physical and spiritual lives, my opinion changed. One Saturday I was in the dentist’s chair preparing to have a filling replaced. My dentist friend had the Novocaine syringe with the long needle in his hand. Like most surgeons, I hate having the needle or scalpel turned on me. My dentist friend sensed my apprehension, put his other hand on my shoulder, and said a short prayer asking God to guide his hands during the procedure. A sense of peace washed over me. The procedure went fine, and I went home feeling not just fixed but encouraged. That confirmed to me that God wanted me to pray with my patients before surgery and transmit that same kind of peace to them. But I remained skeptical and kept giving God my best reasons against it: To call on a higher power would be to admit weakness or lack of control. Prayer, as I saw it, could be an admission that I was not confident, comfortable, or skilled in the procedure. This was exactly the opposite of what I wanted to convey. Patients may be offended. Would patients think I was trying to convert them or badger them with religion when they were vulnerable? They might even report me, and I could be reprimanded or let go. If I prayed and things went badly, it could ruin someone’s faith. What would happen if I prayed and the surgery went poorly? Would it shake someone’s faith? Would they be angry with God? If a patient had no faith and things went poorly, would my praying make it less likely they would ever have faith?
Since this neurosurgeon began praying with his patients, both his practice and his life have been changed
22
T o d a y ’s C h r i s t i a n D o c t o r
I would lose my reputation in the medical community. My colleagues would not accept or respect someone who introduced spiritual matters, what they might term “superstition,” into the scientific practice of medicine. They could say that prayer is not the “standard of care.”
I wanted to be credited for my successes. I was trained to believe that success in surgery was always the result of applied knowledge and expert technical skills. To suggest that these were inadequate was to challenge my own sense of self-worth and the way medicine was practiced. In addition, praying would turn the typical doctor-patient relationship on its head. That relationship puts the doctor in the superior position. The patient was often a passive participant, not a partner. But prayer would put God in the superior position and make the patient an equal partner with me. Was that desirable? Was it even proper? Despite all of these reasons, I felt God wanted me to pray. He seemed to be saying, “If you are worried that you will be misunderstood, I can promise that you will be. Jesus was. But you still need to do the right thing. . . .” I decided to try it a few days later. Heart pounding, I entered the pre-op area where Mrs. Jones was separated by thin curtains from patients and nurses on both sides of her. “Good morning. How are you today?” I said. “Okay, I guess,” she said, smiling anxiously. Her two adult daughters stood nearby, observing me. I gave the brief presentation I give to patients on their way to surgery, but my heart was hammering. Here face to face with an actual patient and her family, the idea of introducing prayer seemed far-fetched and out of place. There was no telling how Mrs. Jones or her daughters would react. I was also afraid of praying with a nurse present, so I kept waiting for her to leave. I even stretched the length of my talk to try to outlast her. But when I was finished, the nurse was still going through her checklist. I was aggravated, but I had no other reason to be there. If I stayed, I needed a good reason. “If there are no more questions, I’ll see you after the procedure,” I said, disappointed. “Thank you, doctor,” Mrs. Jones said. I ducked through the curtains. Frustrated, I walked back to the nurse’s desk in the center of the pre-op area. But I decided in that moment not to give up so easily. Today was not going to be a normal day. I was going to start praying for my patients no matter what. I leaned against the desk at the nurses’ station, feeling awkward and scanning her chart to appear as if doing something useful. I did notice that she was categorized
as “Christian” in the chart. That gave me hope that prayer wouldn’t be a totally foreign concept. All the time I kept hoping the nurse would leave Mrs. Jones alone for just one minute. I felt more nervous than before any surgery in my career. I had confidence in my surgical skills, but I was definitely out of my comfort zone asking to pray with a patient. To kill time, I called and checked my home voice mail, then my office messages. I had just left home; there were no messages, but I kept the phone to my ear listening to the dial tone. I tried to think of who else I might call — old friends, anybody — but it was too early. “How strange,” I thought as I watched her from afar. “It’s like I’m waiting to commit a crime; all I want to do is pray with her.” Then suddenly, the nurse left. I quickly hung up the phone and stood up with a surge of renewed confidence. But just then the anesthesiologist and nurse anesthetist arrived. I smiled at them and glanced at my pager and acted as if I was being paged while I retreated back to the nurses’ station and picked up the phone again. There was no way I was praying in front of an anesthesiologist. Then I had a fearful thought. In a few minutes, the transportation team would come and take her away. I didn’t want to detain them to pray. There was not much time left.
How I Began Praying With Patients
I still believed in the separation of the physical and spiritual. I was trained to respect the gulf between medicine and faith. By relying on something other than science, I would be admitting that science did not have all the answers.
After awhile, the anesthesiologist and nurse anesthetist left. I saw no transportation team approaching. The nurses were away. It was my big break. I darted over. Mrs. Jones was sitting up on the gurney with an IV in her arm. Her daughters were seated by the bed. When they saw me, they stood. Strangely for a perfectionist
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
23
How I Began Praying With Patients like me, I had not thought about what to say at this moment. Somehow I figured I would be inspired to say just the right thing. This lack of planning now struck me as a major mistake. Mrs. Jones looked at me as if to say, “Is there something new about the surgery?” After a few hesitant seconds, I finally could stand it no longer. I said sheepishly, “I . . . I would like to say a prayer . . . if that is OK with you?” Mrs. Jones looked surprised, but then her face softened. “Okay,” she said. Neurosurgeons are not trained to be touchy-feely. We like to touch people but prefer that they are washed with a sterile solution, covered with a blue drape, and anesthetized. Then we like to touch them with a very sharp scalpel. Recalling how my dentist friend had put his hand on my shoulder, I carefully put my hand on her shoulder. As if by routine, her daughters moved in and bowed their heads. Once again, I froze. My mind was blank. I forced myself to start: “God, we thank you for Mrs. Jones. . . .” It was an awkward beginning, powerless, not nearly what I had hoped for. Then, out of nowhere, I felt a rush, like a wind at my back, pushing me on. I just spoke the truth as I knew it, and the prayer began to flow. “God, you’ve been with her since she was a baby, and you know that she is here. You know all about these ves-
24
T o d a y ’s C h r i s t i a n D o c t o r
sels, and you can help me fix them. I ask you for wisdom, for skill, and for success today. Give peace for her and her family. In Jesus’ name. Amen.” I looked up, not knowing what to expect. Mrs. Jones and her two daughters were crying and trying to wipe their tears, but smiling. She looked at peace. The prayer had been so brief that I couldn’t believe it had produced such a dramatic response. I had no idea how to respond to their emotional display. Just then the nurse returned, surveyed the situation, and handed them tissues. I smiled politely and left, deciding to let the nurse deal with evident emotions. I slipped out thinking, “Wow! I did it!” It wasn’t the smoothest, but I prayed with a patient. And something wonderful happened. Prayer brought peace. Mrs. Jones’s surgery went well. I treated the aneurysm and noticed that I had unusual joy during surgery. After the procedure was complete and Mrs. Jones woke up, I spoke with the daughters. Their faces were taut with concern. “I’m happy to report that things went well,” I said. I explained that their mother would be in the recovery room soon. Then the older one spoke. “The prayer you said for our mother meant a lot to her — and to all of us,” she said. “It really gave us peace.” Now it was my turn to smile. God clearly had honored my obedience. “I’m very glad,” I said, trying to look appreciative and professional at the same time. In their appreciation I felt God encouraging me that I had done the right thing. I prayed with another patient before surgery that day, and he was equally thankful. Reflecting later, I realized I had communicated something important to them: “You may be looking to me for your outcome because of my skills and many years of training. I am good at what I do, but I am willing to admit that ultimately I cannot control the outcome of your surgery. We need God’s help, and I am not ashamed to ask for it.” It required humility and authenticity — and it felt great. I had also brought another dimension of the human experience into that room, a power that I had not seen except in church. When someone is moved to tears for spiritual reasons, it often means the deepest part of them has been touched. From that day forward I have offered to pray for nearly every patient before surgery. I always ask their permission. If they hesitate, I move right along and make sure they know they have not offended me. I smile and say, “It looks like you’re not comfortable, so don’t worry about it.” I also added two questions to my patient history form: “In what religion were you raised?” and “Are you prac-
Nothing has changed about my surgical technique. I still strive to be the best, and I take great satisfaction in high-level performance. But by praying and blessing, I acknowledge God’s sovereignty and impart God’s peace. I have learned that my words have power. Using words to bless patients often makes them smile, cry, or both. When people hear my words and feel loved by God, it blesses me. ✝
Paid Advertisement
David Levy, MD, is a practicing neurosurgeon 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 received his neurosurgical training at The Barrow Neurological Institute in Phoenix. He completed a fellowship in endovascular neurosurgery in Vienna, Austria. His training allows him to do surgery on brain aneurysms through the vessels, without opening the skull. His book, with Joel Kilpatrick, about the role of praying with patients, comes out from Tyndale House in 2011.
How I Began Praying With Patients
ticing that now?” This gives me some background on each patient and helps me not offend anyone. I usually offer prayer to everyone, regardless of faith. If they are Jewish or Muslim, I do not pray in Jesus’ name. My goal is to bless and bring peace, not to convert. Within a few months, I began to pray in front of the nurses. Soon I began asking to pray with patients after surgery. I would lean over the head of the bed in the recovery room and ask, “Shall we thank God that things went well?” It is a beautiful thing to cultivate gratitude, whispering in their ear, thanking God for answering our prayers, and asking for continued healing. Before going home, I love to bless their relationships, jobs, and finances. When they come back to the office, I ask for permission to pray for them again, and they seem to enjoy being blessed. Blessing my patients has become my favorite part of the day. The atmosphere before, during, and after surgery has become more joyful. I am free to conduct the surgery without this messianic idea that I could control every outcome, which had been causing me a tremendous amount of stress and had taken much joy from my practice of medicine and my life. Before, I typically had to go for a long run after surgery just to get the adrenaline out of my system. Now I don’t. I enjoy God’s peace and I am sleeping better than ever.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
25
Editor’s Note: This article is the fifth of six in a series focused on “Professionalism in Peril.”
PROFESSIONALISM IN PERIL Part 5 — Our Obligation to the Poor by Gene Rudd, MD
“In everything set them an example by doing what is good . . .” (Titus 2:7, NIV).
S
o far this series on Professionalism in Peril has looked at the historical meaning of professionalism as being an obligation or moral commitment; how our current overemphasis on autonomy undermines scientific and personal integrity; how God views the unjust billing practices so common in today’s healthcare; how “third parties” result in professional adultery; and how personal character is foundational to our professions. In this session we will consider our obligation (professionalism) to the poor.
What is the current state of affairs? Do doctors of faith care more for the poor than our secular counterparts? Apparently not — at least under the broad definition of faith. In the May/June 2007 edition of the Annals of Family Medicine, Farr Curlin, MD, reported the results of a survey of 2,000 practicing US physicians in which he found that religious physicians are no more likely to care for the underserved. Disappointing, isn’t it? Even shameful. While not mentioned in the conclusion of the paper, data in the body of the paper and personal discussions with the author revealed that there was a group
26
T o d a y ’s C h r i s t i a n D o c t o r
with “high spirituality” that did care more for the poor (39% versus the 26% average). When CMDA asked the same questions of its members we found their commitment to caring for the poor the same as Curlin’s “high spirituality” group. I was initially pleased until it occurred to me that still the majority of our members may not be serving the poor in any capacity. In CMDA’s 2010 Membership Survey, 56% of the respondents reported taking care of the poor (the percent of their practice efforts were not defined). Since those who participated in the survey were somewhat more likely to be longer-term CMDA members than the average member, this datum may be skewed to those more committed. Nevertheless, many, but not nearly all, CMDA members have some outreach to the poor. But should we all? What is our Professional Obligation? The answer to this question depends on the era in which the question is asked. In generations past it was generally considered the duty of each physician or dentist to share in the care of the poor. It can be rightly argued that
Professionalism in Peril
this obligation was in part stimulated by a social ethos — the concept of a “social contract” espoused by Rousseau and others. In Bird and Barlow’s review of medical oaths (Codes of Medical Ethics, Oaths & Prayers: An Anthology), there are references to the tradition of the physician’s obligation to provide care despite socioeconomic status or ability to pay. It is helpful to remember that in prior days, the business of medicine was primarily “cash on the barrelhead.” As in providing care, the financial transaction of medicine was quite personal — face-to-face. In that environment, doctors more commonly linked their expectations and charges to what a patient could pay. In addition to this charity care, bartering was not uncommon. Today, however, this obligation has been blunted by the sense that social systems should bear this responsibility. As one colleague stated, “I pay taxes to care for the poor. I’m also required to see non-paying patients in the Emergency Department. That should be enough.” While this perspective may seem harsh in the context of this article, with variation, it seems to be widely shared. In our current healthcare system, over half of all physicians are employees, beholding to the policies of their employers. Unless the employer has a commitment to charity and allows that to be exercised at the doctor-patient relationship, most employed healthcare professionals do not have the authority to care for the underserved within their employment agreement and practice setting. And since so much of the business of medicine is managed by office staff inanimately relating to third party payers, there is less personal dynamics to stimulate charitable response. In addition to loss of income, care for the poor requires other sacrifices. There will be a higher “no show” rate leading to scheduling problems. This is not difficult to understand when we consider how much less control they have over their lives. No childcare, no taxi fare, and perhaps no one else who even cares. There will be those whose crisis is self-inflicted by poor choices (sexually transmitted infections, gambling, alcoholism, etc.). There will be those who waste their limited resources of self-indulgences, neglecting their health, yet expecting someone to provide free care. Providing care for the poor requires overcoming these obstacles. Logistical reasons explain in part why doctors are less apt to care for the poor, but there are other factors more difficult to face. Lack of compassion, greed, lack of courage to challenge the system, spiritual insensitivity, etc.; these issues of character need to be considered by each of us.
What would Jesus do? Long before that question became popular as a bracelet inscription, as a teenager I recall the influence this question had on me when reading Seldon’s In His Steps. In that story, individual lives, a church, and a community were radically changed when people began considering and doing what Jesus would do. To know what Jesus would do we begin by reading the Gospels. Jesus cared for the poor. Moreover, His teachings make it clear that He expects us to do the same. It is helpful to know that Jesus was not suggesting we could eliminate all poverty. For as He said, “The poor you will always have with you” (Matthew 26:11). Nonetheless, we have a personal responsibility to help those around us. In teaching us the importance of adding works to our faith, James says that religion that God finds acceptable involves caring for orphans and widows (James 1:27). I think this list was not intended to be exclusive, but rather an example of our obligation to help those in need. In Matthew 25 Jesus shares the compelling story of a future judgment when we will be separated into sheep and goats. The goats will be cursed and cast out. Why?
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
27
Professionalism in Peril 28
“For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me. They also will answer, Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you? He will reply, I tell you the truth, whatever you did not do for one of the least of these, you did not do for me. Then they will go away to eternal punishment, but the righteous to eternal life” (Matthew 25:42-46, NIV). Though it was shared in an earlier edition of Today’s Christian Doctor as an encouragement to care for the poor, an analysis of Jesus’ parable of the Good Samaritan bears repeating here (Luke 10). You likely remember the characters in the story; so I’ll ask you, “Which character(s) best represents doctors in our culture?” The robbers? Sadly we have bad apples among our ranks, but thankfully they are few. What about the man who was beaten and left for dead? CMDA regularly ministers to doctors who find themselves in the midst of a life crisis that overwhelms them. But again, at any point in time, that is a small percentage. Each of us would prefer to think of ourselves as being like the Good Samaritan — willing to sacrificially help someone in need. But for most doctors, help like this is the exceptional situation. As the statistics cited earlier show, a minority of doctors help the poor. Therefore, a good argument can be made for doctors being like the priest and the Levite in the story. They choose to walk down the other side of the road rather than engage the man in need. While we might think them simply hard-hearted, remember that they worked for an HMO. Well . . . not exactly. However, they were part of an institution that had rules that governed their behavior — too many misguided rules according to Jesus (Matthew 5:20). One of the rules was that they were not to touch the dead or dying. Such a distortion of righteousness led to their failure to meet the need of the man in crisis. I dare say that many doctors today feel likewise constrained by unrighteous rules. But there is another character in the story that I think best represents doctors — the innkeeper. The inns at that time were the closest thing anyone had to a hospital. As demonstrated in this story, after emergency medical assistance was provided by the Good Samaritan, the innkeeper was the healthcare provider for inpatient care. Of particular note, the innkeeper was well
T o d a y ’s C h r i s t i a n D o c t o r
paid for his participation. The Good Samaritan gave him two silver coins and the promise to add more if needed when he returned. By one theologian’s reckoning, two silver coins were enough to provide medical care for at least a month. We are left to wonder what would have happened if the Good Samaritan had only one silver coin to pay for healthcare. Would the innkeeper have participated? Or worse, what if the Good Samaritan could not afford to pay anything? Would the innkeeper have participated? What do you think most doctors today would do? Most importantly, what about you? Pause to differentiate between your good intentions and your actual behavior. It is important to remember what led Jesus to tell this story. The “expert in the law” who was trying to trap Him asked, “What must I do to inherit eternal life?” When Jesus affirmed that the correct answer was to love God foremost and “love your neighbor as yourself,” the expert in the law wanted clarification on “who is my neighbor?” As Jesus’ parable reveals, our neighbors are those people who cross our paths who are in need. Their need, our proximity, and our ability to meet their need constitute an obligation. I’ll leave it to you to contemplate how responding to that obligation affects our eternal future. So we’ve seen that, contrary to historical norms, most doctors today do not care for the poor. Even those doctors who are “highly religious,” those who are members of a Christian medical organization, perhaps only half care for the poor. More than abandoning our professional obligation to the poor, we who are followers of Christ have a moral obligation to the poor — an obligation somehow linked to the very core of who we are in Christ. Should we be concerned? I think so. If you agree, what are you going to do about it? ✝
Gene Rudd, MD, co-author of Practice by the Book, serves as Senior Vice President of the Christian Medical & Dental Associations. A specialist in Obstetrics/Gynecology, Dr. Rudd has experience in maternal-fetal, medical education and rural healthcare. He has garnered numerous awards including the Gorgas Medal. While working with World Medical Mission, he established the Christian Medical Mission of Russia, directed the rehabilitation of the Central Hospital in Kigali, Rwanda, and served in Belarus, Bosnia, and Kazakhstan.
The Divine Invitation by Sarah C. Bauer, MD
Sarah C. Bauer, MD, a Phi Beta Kappa graduate of Indiana University, is a 2004 graduate of the Pritzker School of Medicine at The University of Chicago. She did her pediatrics residency at The University of Chicago Comer Children’s Hospital. She was the Intern of the Year as Chosen by the Faculty in 2005 and was the Senior Resident of the Year as Chosen by the Faculty in 2007. She received the Herbert T. Abelson Award for Outstanding Research in Educational Innovation and The University of Chicago Child Protective Services Robert Kirschner M.D. Advocacy Award. In 2009, she was honored by the Illinois Council on Child and Adolescent Psychiatry with the Jay G. Hirsch Award. She is currently finishing a fellowship in Developmental and Behavioral Pediatrics at The University of Chicago. She and her husband, Cris Kennedy, reside in Chicago.
When I decided to become a doctor at eight years of age, it is because I believe I was called to do so. Now, twenty-four years later, I know it was a calling. It has to be. Under no circumstance would anyone follow this course unless it was due to a divine invitation. At least this is how I felt after a recently troublesome time in clinic when I learned the importance of praying for the children and families God has placed in my life. It seemed as if I had nothing to offer any of the children and families I saw in clinic. I could not fix the economic situations which precluded them from following through on any of the therapies I recommended. I could not fix the cumulative effects of poverty, addiction, and domestic violence. Furthermore, I could not erase the cumulative toll of all of these things and how they impacted the next generation. What was the point of them seeing a doctor if I could not help them? After leaving clinic, I just felt sad and overwhelmed for them. While I tried to listen, to be supportive, and to provide a reachable goal, I felt ineffective and helpless. I wondered if I was taking on some of their feelings of helplessness. It seemed as if the ailments of society presented themselves in the forms of distressed children and parents, coming to the doctor to fix them and make everything better. Every evening, I prayed for them, because I did not know what else to do. I prayed for wisdom and discernment in my role as their doctor. I prayed for His mercy in their lives, and I prayed for hope. In my selfishness, I went through a phase of anger and frustration. I truly felt and still feel guilty for these feelings, but here they are. What did they expect me to do? I cannot fix poverty, and accepting its consequences seems unpalatable to me. Over the course of the week, I sought God’s will and believe that this is what He taught me: When I cannot fix the unfixable, perhaps it is my job as a doctor to show them love and mercy and to try to give them hope. Perhaps that is why I decided to become a doctor in the first place. These recent frustrations brought me full circle to what I believe God wants me to do in the next phase of my service to Him. Perhaps it is a good thing that I was so disturbed by these experiences, for it means that I truly care about what happens to the children and families of my clinic. When I entered medicine, I knew I would have sleepless nights. What I did not know is that these could happen in the comfort of my own home. It was not the children and parents keeping me up at night. It was the helplessness I felt in the face of the adversity they faced on a daily basis. It was me praying for wisdom and wondering if I had what it takes to be Lord, make me an instrument of Your Peace. Where there is hatred, let me sow love, their doctor. Where there is injury, pardon, Medicine can be a lonely place, especially on those sleepWhere there is doubt, faith, less nights. My way of dealing with such nights is reminding Where there is despair, hope, myself that I am not alone. God is with me and with the chilWhere there is darkness, light, dren and families whom I have been called to serve. In times and where there is sadness, joy. such as these, I spend time in prayer, reading the Bible, and O Divine Master, grant that I may reading poems and prayers that have meant something to me not so much seek to be consoled, as to console; To be understood, as to understand; over the years. One of these is St. Francis of Assisi’s Prayer for To be loved, as to love; Peace, which reminds me of my role as a doctor. It reminds For it is in giving that we receive; me that my sleepless nights are nothing in comparison to what It is in pardoning that we are pardoned; these distressed children and families experience on a daily And it is in dying that we are born to eternal life. basis. It reminds me to let go of my selfishness, and it reminds – St. Francis of Assisi, Prayer for Peace me of the divine invitation I accepted at the age of eight.
APOLOGETICS SERIES
Jesus Claimed and Proved to be God by Robert W. Martin III, MD, MAR
Note: This is the ninth and final article in our series on apologetics. The pages are designed for ease in copying for personal study, discussion in a group setting, or for distribution to colleagues and staff. For the sake of space savings, notes refer to books listed in the bibliography in each case.
glory will I not give to another” — irrevocably declaring that the inherent glory of God belongs to God alone, yet this is the same eternal glory Jesus claimed! Jesus also claimed to be Jehovah by declaring to be the first and the last (Rev. 1:17; cf. Isa. 42:8); the good shepherd (John 10:11; cf. Psa. 23:21); the judge of all men (John 5:27f; cf. Matt. 25:31f); the bridegroom (Matt. 25:1; cf. Isa. 62:5); and, the light of the world (John 8:12; cf. Psa. 27:1).
I. Introduction
B. Jesus claimed equality with God
“Jesus was a great man, but not God . . . . Jesus never claimed to be God!” Christian physicians have wonderful opportunities to evangelize unbelievers. At other times we must first remove obstacles to faith (apologetics). We have established the existence of absolute truth, the undeniability of the law of non-contradiction, the evidence that God exists, the possibility that miracles may occur, and the reliability of the New Testament. The next step is to demonstrate that Jesus claimed and proved to be God.
Jesus accepted worship. In John 20:28 Thomas plainly called Jesus “My Lord and my God.” If Jesus were not God, He would have corrected Thomas sharply (Exod. 20:1-4; Rev. 22:8-9). Yet Jesus commended Thomas. Jesus also accepted worship elsewhere (Matt. 8:2, 9:18, 14:33, 15:25, 20:20; 28:17; Mark 5:6; John 9:38). Jesus claimed equality with God by claiming His word would never pass away (Matt. 24:35); to forgive sins (Mark 2:5f); the power to raise and judge the dead (John 5:25, 29; 12:48; cf. 1 Sam. 2:6, Deut. 32:35, 39; Psa. 2:7; Joel 3:12); to be honored as God (John 5:23); and the authority of God (Matt. 28:18-19). Further, Jesus placed His word on par with God’s (Matt. 5:21-22) and gave a new commandment (John 13:34).
II. Jesus Claimed to be God
C. Jesus claimed to be the Messiah — God
One of the most absurd claims by unbelievers is that Jesus never claimed to be God. Having shown that the New Testament is a historically reliable document written by trustworthy eyewitnesses, Christians respond that if the New Testament says Jesus said something — He did! Consider the evidence summarized by Norman L. Geisler (129-135).
The Old Testament teaches that the coming Messiah will be God (Isa. 9:6). Jesus applied Psalm 110:1 to Himself in Matthew 22:43-44 and referred to Himself as the Son of man (Dan. 7:22) in Mark 14:62-64.
A. Jesus claimed to be Jehovah (Yahweh—YHWH)
D. Jesus disciples acknowledged Him to be God
Perhaps the strongest claim Jesus made to be Yahweh is in John 8:58, where He said, “Before Abraham was, I AM.” This statement claims existence before Abraham and equality with the “I AM” of Exodus 3:14. Jesus literally said to the Jews, “I AM Jehovah,” and it is clear that they understood Him, because they attempted to stone Him. Hebrew law allowed stoning in only five situations: familiar spirits (Lev. 20:27); blasphemy (Lev. 24:10-23); false prophets (Deut. 13:5-10); stubborn and rebellious adult son (Deut. 21:1821); adultery and rape (Deut. 22:21-24; Lev. 20:10). The only legal ground the Jews had for stoning Christ (actually they had none at all) was blasphemy. Later, in John 10:33, the Jews again attempted to stone Christ and accused Him of making Himself God. In John 17:5, Jesus prayed, “And now, O Father, glorify thou me with thine own self with the glory which I had with thee before the world was” (KJV). But in Isaiah 42:8 Jehovah declared, “[M]y
Jesus’ immediate disciples called Him, “God” (John 1:1 20:28; Col. 2:9; Heb. 1:3, 8; Phil. 2:5-8). They attributed titles of deity to Jesus such as the first and the last (Rev. 1:17; 2:8; 22:13); true light (John 1); rock or stone (1 Cor. 10:4; 1 Pet. 2:6-8); bridegroom (Eph. 5:28-33; Rev. 21:2) chief shepherd (1 Pet 5:4); great shepherd (Heb. 13:20); great God and redeemer (Titus 2:13; Rev. 5:9); forgiver of sins (Acts 5:31; Col. 3:13); and, Savior of the world (John 4:42).
30
T o d a y ’s C h r i s t i a n D o c t o r
E. Jesus requested prayer Jesus also requested prayer in His name (John 14:13, 14), which the disciples did (John 14:5; 15:7; Acts 7:59). The writers associated Jesus with God’s name in prayer (1 Cor. 5:4; Acts 7:59); benedictions (Gal. 1:3; Eph. 1:2); and the trinitarian formulas (Matt. 28:19; 2 Cor. 13:14).
F. Jesus possessed powers of God Jesus possessed the powers of God — raising the dead (John 5:21; 11:38-44); forgiving sins (Acts 5:31, 13:38); creating the universe (John 1:2; Col. 1:16); and, sustaining the existence of the universe (Col. 1:17). G. Conclusion This enormous amount of evidence demonstrates that Jesus claimed to be God, and His immediate disciples acknowledged His claim to be God. Since we have shown the New Testament documents as historically reliable, there are only four options regarding Jesus (following Lewis, 55-57). Either Jesus is a legend, liar, lunatic, or He is Lord of all. First, Jesus was not a legend. There is ample evidence that He existed. It takes at least two generations and isolation for myth and legend to develop. Neither is applicable in this circumstance. Second, Jesus was not a liar (deceiver). Otherwise, He would have been in league with Satan. The entire unbelieving world recognizes Jesus as a great moral teacher. His teaching refutes this option. Third, Jesus was not a lunatic. His life story does not reflect someone who thought He was a poached egg. Therefore, Jesus IS Lord! III. Jesus’ Godhood was Miraculously Confirmed Dr. Geisler compellingly argues that Jesus’ claims were confirmed by the many prophecies about Himself, His sinless and miraculous life, and His prediction and accomplishment of His resurrection (135-137).
Jesus was severely whipped, crowned with thorns, had three (sixinch) spikes driven into his hands/feet; and a spear thrust into His side. If the whipping, nails, blood loss, and spear did not kill Jesus, then asphyxiation certainly did. The Romans, who were professional executioners, did not break Jesus’ legs because they knew He was already dead (John 19:33). Pilate confirmed the death of Jesus before allowing them to bury Him (Mark 15:44-45). Jesus was embalmed in about seventy-five pounds of spices and bandages (John 19:39). He was laid in a garden tomb, blocked by a 3,000-4,000 pound rock, sealed with a Roman seal, and guarded by soldiers. He remained in the tomb for parts of three days. If Jesus were not dead when He went in, He would have been dead by Sunday. Medical authorities have verified Jesus’ death on the cross (JAMA March 21, 1986, 1463f). D. Jesus Resurrected! The resurrection is confirmed by a number of details. There is a permanently empty tomb that is not venerated. The rock was rolled up and away from the gravesite, and the grave clothes were left behind, folded neatly. Jesus made twelve different physical appearances over forty days to over 500 witnesses (Acts 1:3; 1 Cor. 15:3-6); during which He taught, performed miracles, claimed to have flesh and bones (Luke 24:39), was physically touched (John 20:27-28), and ate food (Luke 24:42-43). Most compellingly, twelve scared, scattered, skeptical disciples suddenly became the most aggressive and effective peaceful evangelical missionary force the world has ever known. Eleven of the twelve died martyrs for what they saw. Despite intense persecution, Christianity spread by peaceful means throughout the Roman Empire. Only an impact event like the resurrection could explain the rapid spread of Christianity by peaceful means.
A. Jesus fulfilled prophecies IV. Conclusion — Jesus is God! ✝ Jesus fulfilled messianic prophecies of being born of a woman (Gen. 3:15; cf. Gal. 4:4), born of a virgin (Isa. 7:14; cf. Matt. 1:21f), “cut off” (die) 483 years after the declaration to reconstruct the city in 444 BC (Dan. 9:24f). He was a descendant of Abraham (Gen. 12:1-3, 22:18; cf. Matt. 1:1; Gal. 3:16), Judah (Gen 49:10; cf. Luke 3:23, 33; Heb. 7:14), and David (2 Sam. 7:12; cf. Matt. 1:1). He was born in Bethlehem (Micah 5:2; cf. Matt. 2:1), anointed by the Holy Spirit (Isa. 11:2; cf. Matt. 3:16-17), and heralded by the messenger of the Lord (Isa 40:3; Mal 3:1; cf. Matt. 3:1-2). He performed miracles (Isa. 35:5-6; cf. Matt. 9:35); cleansed the Temple (Mal. 3:1; cf. Matt. 21:12); and was rejected by the Jews (Psa. 22; Isa. 53; cf. Matt. 27:3, 10). B. Jesus’ sinless and miraculous life Jesus (John 8:46); His disciples (1 Peter 1:19, 2:21-22; 1 Jn. 3:3-5); Paul (2 Cor. 5:21); the writer of Hebrews (Heb 4:15); and His enemies (Mark 14:55; Luke 23:22) attested to His sinlessness. Jesus was confirmed by at least thirty-five miracles in the gospels. Nicodemus, Peter, and the writer of Hebrews also recognized that Jesus’s identity was confirmed by miracles (John 3:2; Acts 2:22; Heb. 2:3-4). C. Jesus’s Death Jesus predicted His resurrection (John 2:19, 21; 10:18; Matt. 12:40; Mark 8:31, 9:31). But in order to resurrect, Jesus had to die.
Bibliography Geisler, Norman L. Bakers Encyclopedia of Apologetics. Grand Rapids: Baker, 1999. Lewis, C.S. Mere Christianity. New York: Macmillan, 1952.
Robert W. Martin III, MD, MAR, lives in Lafayette, Indiana, where he practices Dermatology and Dermatopathology. He is married, with four children. He has served on the faculty of Johns Hopkins, Case Western Reserve, and now Indiana University and Purdue Pharmacy School. He has a Masters in Religion from Southern Evangelical Seminary. His Just Add Water (Volume 3.1: Apologetics for the Health Professional), available via CMDA’s Website, utilizes Norman Geisler’s twelve-point “Classical Apologetic” approach fashioned after Paul’s apologetic in Acts 17. Dr. Martin may be reached by e-mail at: martinr@arnett.com.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
31
BIOETHICS SERIES
The Continuation of a Doctor’s Education by James Appel, MD
The goal of this column is to consider a problematic medicalethical dilemma that presented in the medical mission field. The doctor’s story reflects the life and death decision making that is commonplace apart from traditional medicine. – Nick Yates, MD, MA, column editor
“The pain started suddenly at four o’clock this morning,” I am told. The man stretched out before me on the gurney is in obvious distress. His abdomen is swollen, and he’s gasping for air. I look at his carnet. His name is Gaouna. “How was he yesterday? Was he sick at all?” I ask through his brother who interprets from French to Ngambai and back again. “Yeah, yesterday he was fine, but this morning, the pain started right here.” He points to the upper abdomen, below the man’s sternum. I examine the patient’s abdomen, finding it to be firm but not tense. When I tap with my fingers, it sounds hollow and seems to be full of air. Gaouna winces in pain with each touch (this is a “peritoneal sign” and often indicates infection). His breathing is shallow, and his heart rate is rapid with a weak pulse. My working diagnosis is a perforated ulcer, and I order antibiotics to be given in the IV that is already started in Gaouna’s arm. I also tell Abel (my assistant) to call in Samedi from home to see the last of the emergency room patients while the operating room staff preps for an immediate exploratory surgery. The family doesn’t have money to pay, but they are well to do, and they leave their motorcycle at the hospital as collateral for future payment. After finishing in the emergency room, I go to the operating theater. Gaouna is lying on the operating room table with intravenous fluids rushing fast into both arms. A urinary catheter has relieved a large amount of dark urine. Gaouna’s arms are stretched out on the arm boards and tied down as if he’s about to be crucified. His eyes are closed, and his breathing is even more shallow and more rapid than it was before. The beep of the monitor instantly tells me that he is not getting enough oxygen. I glance at the numbers, noticing that the 60 percent oxygen saturation is well below what it should be. I'm afraid Gaouna is not going to survive the surgery. Maybe we are too late.
32
T o d a y ’s C h r i s t i a n D o c t o r
As we have no oxygen, I decide to intubate Gaouna with the hope of raising his oxygen saturation. I grab a cardboard box — containing a mixture of all of our breathing tubes — from a top shelf. I select one that I think will work and test the cuff while Abel pulls out the necessary equipment. In my haste, I forget to get the suction machine ready and neglect to put a guide wire in the tube. I check the device before inserting the breathing tube, and the light works. Abel injects some intravenous anesthetic, and I slide the blade into the patient’s mouth. The light isn’t working, so I pull it out and tap on it a little. Next, I take the blade off and put it back on the handle. Finally, it works again. I put the instrument back in his mouth, and in lifting up the tongue, I briefly see the vocal cords before a mass of saliva obscures my view. Calling for suction, I try to put the breathing tube in anyway. Missing the target, the tube bends down away from the vocal cords. I quickly leaf through a drawer in the anesthesia cart to find a guide wire for the breathing tube. This should help me place the tube into the trachea. I try again, and this time I’m successful. Once the tube is in the proper position, I put a bag on the end of the tube and start to breathe for the patient, and the oxygen saturation comes up to 85 percent. Abel preps and drapes the abdomen while I finish scrubbing for the surgery. I’m sure that Gaouna’s breathing will improve with the release of the abdominal tension. I take the large scalpel and, with a quick and decisive incision into the abdomen, a surge of dark red, slimy fluid gushes out. We quickly suction out over three liters of fluid. The intestines look injected and angry but don’t seem to be gangrenous. I start to explore and soon discover the real problem. As I extend the incision of the abdominal wall to expose more of the abdominal contents, a purplish, lumpy, alienlooking mass pops out of the right upper quadrant. Gaouna has end-stage liver cancer. Inside, I am furious! As I try to quickly close up the useless operation, many thoughts whirl through my head. How could the family deceive us? Of course, Gaouna had been sick for months, if not for years. Without CAT scans and other diagnostic equipment, physicians and surgeons base so much of the diagnosis on history taking and the physical exam. This particular surgery could have been avoided. How could God have let me make such a big mistake costing so much money for Gaouna’s family and so much of the hospi-
tal’s resources? Now, in all likelihood, the patient will die before making it out of surgery. I have never closed up a surgery more quickly. I remove the breathing tube, and Gaouna’s oxygen saturation goes down to 57 percent before it stabilizes as he starts breathing on his own. I just really want to get him out of the operating room, and we transfer Gaouna to the gurney and wheel him out to the wards. I see one of Gaouna’s family members, but it’s not the same one who gave me the false information. I briefly explain the situation as the dying patient is wheeled away to the hospital ward.
COLUMN EDITOR’S COMMENT: Medical experiences from the mission field expand the heart, engage the mind, and awaken the soul. Often, the physician must ‘make do’ and sometimes ‘do without.’ The experiences often illustrate God’s handiwork coupled with God’s loving permisiveness of human behavior. Thank you to the thousands of CMDA members who have served on the medical mission field.
SUGGESTED READING: DENOUEMENT: An hour later, Pierre comes to inform me that Gaouna has “rendu l’ame” (given up his spirit).
Thomas Hale, Don’t Let the Goats Eat the Loquat Trees (Zondervan, 1986). David Stevens, Jesus, MD, A Doctor Examines the Great Physician (Zondervan, 2001).
REFLECTION: Due to the frequency of death in Chad, the people have developed a response to tragedy, without blaming God, that allows them to help each other during the time of need and to grieve with each other as an important part of healing within their society. To the Chadians, everything, and especially the day of one’s death, is in the hands of God. For me, if I did not have faith in a time when death and suffering would be no more, I would have been devastated by the outcome of this event. What if we had not operated? Gaouna may have lived several more days — or perhaps even for several weeks — but he would have suffered. Our hospital has little medication for good pain control. For outpatient pain relief we only have what is considered, in developed countries, to be over the counter pain medications. Without the surgery, it is likely that Gaouna would have suffered a slow and painful death; by operating on Gaouna, we let him slip away into a coma that, likely, was free from any suffering. Certainly, the operation didn’t save his life, but it might have saved him from a torturous death. The family seemed appreciative that we had performed the surgery, as this action seemingly made them feel that we had truly done all that we could have done for Gaouna. Maybe it was the right thing to do after all. But now I’m faced with bigger questions: What can I offer Gaouna and his family if I do make the right diagnosis? I cannot offer adequate pain medications to control the pain of an end-stage cancer. Should I just tell the family, “Tough luck, take him home to suffer and die?” Should I offer them “anesthesia,” as that is the only really effective medication we have for severe pain? What about other options? We have plenty of good medications to help people sleep, but in certain combination they could depress respiration and actually hasten the death of the patient. Would that be a bad thing in this context where pain is uncontrollable and suffering intolerable? I don’t have the answers, but this experience has made me more eager than ever to find them. ✝
James Appel, MD, grew up hearing stories about his grandfather’s adventures in China and his father’s childhood in India. He finished medical school at Loma Linda University in 2000 and a Family Practice Residency in 2003 at the Ventura County Medical Center. For the last six years he has been the medical director and only physician at the Bere Adventist Hospital in rural Chad. James met Sarah Andersen, a volunteer Danish nurse, at the Bere Hospital. In December 2004 they were married in Denmark. They have no plans of leaving Africa.
Nick Yates, MD, MA (Bioethics), is Associate Professor of Clinical Pediatrics at the State University of New York at Buffalo, and is Adjunct Professor of Bioethics at Trinity International University. He is a member of the Executive Committee for the Section on Bioethics for the American Academy of Pediatrics. He also serves as the Chairman for the Ethics Committee for the Christian Medical & Dental Associations and is the Interim Consultant for Clinical Ethics at the Center for Bioethics and Human Dignity.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Summer 2010
33
CMDA APPROVES ETHICS STATEMENTS Three ethics statements were approved during the recent CMDA House of Representatives, meeting at Ridgecrest in North Carolina, April 2010. These are: Assisted Reproductive Technology (revised and updated), Human Subject Research, Physician and Industry Relationships. The texts are posted on the CMDA website, and a discussion of the statements will appear in the Fall 2010 issue of Today’s Christian Doctor.
CLASSIFIEDS ADVERTISE WITH CMDA
Do you have a position open, a practice for sale, or some other opportunity you’d like to make known to our readers? Place a classified ad. It’s simple, direct, inexpensive, AND it also helps offset the costs of our ministry through this magazine. For information, including rates, contact Margie Shealy at 423-844-1000.
Positions Open Dental – Associate for thriving general and prosthodontic dental practice. Christian dentists, in-house lab, no insur. Great experienced staff, area needs dentists. 2 1/2 hrs to NYC, safe, beautiful, stable area, low housing costs. Long established practice with excellent reputation. Partnership opportunities. Contact: jboyd13168@gmail.com. Internal Medicine/Family Practice – Wellmont Health System is seeking an IM/FP for Wise Medical Group located in Norton, Virginia. Employment position with generous salary, signon, relocation, 1:7 call, and teaching opportunities. Contact Jason Freeman at: 423-230-8270 or Jason.Freeman@Wellmont.org. Interventional Pain Management – Westlake (Cleveland), Ohio. Seeking a BE/BC Fellowship trained Christian physician to replace a retiring physician. A private practice with competitive compensation. M-F 9 am - 5:30 pm. For more information, go to www.clearwaterpainclinic.com. Position available summer 2011. Contact Administrator SunHee at: 440-899-8622 or 44clearwater77@adelphia.net.
Paid Advertisement
Orthopedic – Well-established practice of three orthopedists and one podiatrist committed to providing care with compassion as well as excellence. Time off for short-term missions. Would like to talk with general and subspecialty orthopedists about the possibility of joining us in practice. On-site surgery center; local hospital within walking distance. Located in a family-oriented city where many recreational and cultural activities are available. Less than a 10-minute commute from any area of the city. Low malpractice rates and cost of living. Vacation at the mountains and the beach; live here and enjoy all four seasons. Please contact our Medical Director, Dr. Chris Wilkinson at: 308-627-4664 or cwilkinson@kearneyortho.com. Our clinic manager, Vicki Aten, can be reached at: 308-8652512 or vaten@kearneyortho.com. Otolaryngologist – Beautiful North Cascades area of Washington State. Located between Seattle, Washington and Vancouver, B.C. The area offers quick access to the San Juan Islands or the Cascade Mountains for hiking, fishing, kayaking, to name just a few of the exceptional outdoor recreational opportunities available. An excellent partnership opportunity to join a well established five-physician practice in Washington State. We are seeking a board eligible or board certified physician. Please contact: Human Resources Department, Brooke Herzberg, Director, Cascade Medical Group, 360-336-2178, brookeh@cascademedicalgroup.com. Plastic Surgeon – If your are primarily interested in reconstructive surgery and are interested in trying to structure a practice so that there is more than the usual time for ministry, call me and we can talk about possibilities. Evenings (EST) are best. 303-829-7003 or smorris1949@yahoo.com.
34
T o d a y ’s C h r i s t i a n D o c t o r
CHRISTIAN MEDICAL & DENTAL ASSoCIATIoNS P.o. Box 7500 Bristol, TN 37621-7500
Nonprofit Org. US Postage
PAID
Paid Advertisement
Bristol, TN Permit No. 1000