Volume 51 No.1 • Spring 2020
Today’s
Christian Doctor The Journal of the Christian Medical & Dental Associations
AFTER EBOLA
Confronting the Trauma
Our
CM D A
Story
Partnering with CMDA for a Lifetime “I became involved with CMDA during my second year of medical school. CMDA has meant so much to me throughout the years that I could never see a time where I would not want to be involved in some way. CMDA has been a steady compass throughout the years, a constant source of encouragement and a reminder to look beyond myself.” —Joshua Evans, MD “The biggest way CMDA has impacted my life has been through the personal relationships I have made within its ministries. To have prayerful support and encouragement by fellow Christian physicians has been so uplifting. As a physician with my heart set on Christ, caring for my patients is ministry.”
—Hannah Evans, MD
Become a Lifetime Member of CMDA Drs. Joshua and Hannah Evans met through CMDA, and they are now Lifetime Members. When you join CMDA, you join Joshua, Hannah and more than 19,000 healthcare professionals across the country who are part of this growing movement of “Transformed Doctors, Transforming the World.”
Visit www.joincmda.org or call 888-230-2637 to join us today. Paid Advertisement
CEO EDITORIAL MIKE CHUPP, MD, FACS
KEY VALUES IN 2020
O
ne of the premier global events in 2020 will be the Summer Olympics in Tokyo, Japan in late July/early August under the theme “Discover Tomorrow.” The Olympic symbol with five different colored rings inspired us last fall to display our 2020 aspirational values (in CMDA colors) that will guide us from the CMDA national office in Bristol, Tennessee as we motivate, educate and equip Christian healthcare professionals to glorify God. Our senior leadership team agreed upon five key values to inspire us in 2020, as you can see in the five-ring figure displayed to the right. We chose “Demonstrate Courage” because these are certainly times in America when the biblically-based beliefs guiding us as Christians in healthcare are also subjecting us to vilification and even, on occasion, professional consequences. For this reason, “Be Strong and Courageous” is the theme for this year’s CMDA National Convention on April 16-19 at the Northern Kentucky Convention Center in Covington, Kentucky. Our devotional speaker, Rev. Bruce Boria, is Senior Pastor at Bethany Church, the largest church in New Hampshire with 1,500 members. Rev. Boria is no stranger to adversity or to the wiles of the enemy in attacking Christian leaders. The lead article in this edition of Today’s Christian Doctor highlights the courage SIM missionary Nancy Writebol demonstrated in returning with her husband to Liberia in 2015, the same country where she contracted Ebola in 2014, in order to oversee a trauma healing ministry to thousands of Liberians suffering after the losses experienced in the Ebola crisis in that country. Our next key value for 2020 is “Embrace Diversity,” because in Jesus Christ, “There is neither Jew nor Greek, there is neither slave nor free, there is no male and female, for you are all one in Christ Jesus” (Galatians 3:28, ESV). While we cannot control perceptions of the CMDA ministry that are not based upon facts, we do not want to give our enemy any foothold. We want to promote diversity in selecting staff, leaders, speakers, ministry stories, etc. within our organization. The third one is “Desire Humility,” because it is the character trait that probably best helps us emulate the Great Physician as He touched and healed those with great needs around Him. We hope you will enjoy the article in this edition by Dr. Timothy Allen, as it is an excellent example of a physician humbly accepting to love and treat the patients he found the hardest to care for in his family medicine residency: adolescent pregnant women with addictions. Humility is also the personal quality that best facilitates teams of professionals in healthcare and ministry to do excellent work, as God is able to
do great things through those who don’t care so much about who gets the credit when credit is due. “Protect Integrity” is of critical importance to our leadership team as CMDA leaders have been so faithful to members and donors, earning an amazing amount of trust capital over the last quarter of a century. The organizational governance and accountability structures in place at CMDA are robust and designed to help us continue to build that trust moving forward in the next decade. Finally, in light of pervasive hopelessness, which one New York Times editorialist called “The Age of American Despair,”1 and the burnout crisis so well described among healthcare professionals, we aspire to “Express Joy.” This is not a cautious optimism or putting on a good face in the midst of challenges we may encounter over the next decade as the world’s largest Christian healthcare membership organization. This is the paradoxical joy, the fruit of the Holy Spirit, that enables us to “Consider it pure joy, my brothers, whenever you face trials of many kinds” ( James 1:2). I hope you will read the encouraging article by Dr. Scott Conley as he explains how he found attending the CMDA National Convention to be therapeutic and of great help in his own struggle with burnout. I’ll wrap up this editorial by inviting you to join me each week for CMDA Matters, our new weekly podcast. Each Thursday, we release a new 30 to 40-minute program, which you can hear on the web at www.cmda.org/cmdamatters or by subscribing on iTunes, Google Play or your preferred podcast app. As your new CEO, I am hosting this new flagship audio program with interviews and news that we hope will educate and inspire you to be a faithful follower of Christ, pursuing God’s purposes in your healthcare practice, family and ministry. 1
https://www.nytimes.com/2019/09/07/opinion/sunday/theage-of-american-despair.html
Transformed Doctors ➤ Transforming the World www.cmda.org 3
TO DAY ’ S C H R I S T I A N D O C TO R
contents
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VO LU M E 5 1 , N O. 1
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SPRING 2020
The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.
20 24 16 10 Cover Story
After Ebola: Confronting the Trauma by Nancy Writebol, CNA, SIM Global Trauma Healing Coordinator, as told to Richard Greene
How God is using an Ebola survivor to help others affected by trauma
16
The Temptations: Addressing Same-Sex Attractions
by Christopher Yuan, DMin
20
An excerpt from Christopher Yuan’s book
The Mountaintop
by Scott Conley, MD
One physician shares how a hiking experience helped reduce his burnout
24
G ifts & Miracles: My Unexpected Journey into Addiction Medicine
by Timothy Allen, MD
Opening the door to treating pregnant women who struggle with addiction
28
CMDA Ethics Statement on Advance Directives
Earn Continuing Education credits and learn more about this important topic 4 TODAY'S CHRISTIAN DOCTOR Spring 2020
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28
Classifieds
CONTINUING EDUCATION CREDITS AVAILABLE INSIDE
EDITOR Mandi Mooney EDITORIAL COMMITTEE Gregg Albers, MD; John Crouch, MD; Autumn Dawn Galbreath, MD; Curtis E. Harris, MD, JD; Van Haywood, DMD; Rebecca Klint-Townsend, MD; Robert D. Orr, MD; Debby Read, RN AD SALES Margie Shealy 423-844-1000 DESIGN Ahaa! Design + Production PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). Today’s Christian Doctor®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Spring 2020, Volume LI, No. 1. 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© 2020, 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, Tennessee. Undesignated Scripture references are taken from the Holy Bible, New International Version®, Copyright© 1973,
1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Other versions are noted in the text. Christian Medical & Dental Associations P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www. cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.
TRANSFORMATIONS
A
Find Connection in Your Specialty
mong all of our various ministries, CMDA’s Specialty Sections give you the unique opportunity to equip, network and fellowship with colleagues in your specific healthcare specialty. Organized by CMDA members, the sections listed below provide a wealth of resources for those who wish to connect with their colleagues. Don’t see a section for your specialty? Contact ccm@cmda.org for more information about starting a section.
Christian Academic Physicians and Scientists (CAPS) A community committed to helping one another navigate the difficulties of our profession and to living up to our faith-based calling. We endeavor to transform our academic communities through faith, fellowship and scholarship. www.cmda.org/caps Christian Physical Rehab Professionals (CPRP) Formerly Christian Physical Therapists International (CPTI), our mission is to encourage, instruct and challenge Christian physical rehab professionals to engage in a deeper walk with our Savior, equipping them to impact lives with the gospel and supporting them spiritually and professionally. www.cmda.org/cprp Christian Surgeons Fellowship A group of surgeons who encourage one another to show the loving care and compassion of Christ to the children and families, the staff and professional colleagues and the communities and world we are called to serve. We meet annually for fellowship and encouragement. www.cmda.org/christiansurgeons Coalition of Christian Nurse Practitioners (CCNP) We encourage, educate and challenge members of advanced practice nursing to engage in a deeper, more fulfilling walk with our Savior, thereby equipping us to impact the lives of others with the gospel. www.cmda.org/ccnp Dermatology Section We enable Christian dermatologists to work together for deeper mutual support and understanding through providing an annual meeting, participating in and funding scholarships for medical mission trips, participating in tele-dermatology consultations and mentoring resident and students. www.cmda.org/dermatology Family Medicine Section We motivate, educate and equip Christian family physicians and family medicine residents to show the love of Jesus to our patients, their families, our colleagues, our communities and the
world. We use biblical principles to guide competent, compassionate and scientifically-sound family medicine. www.cmda.org/familymedicine
Fellowship of Christian Optometrists (FCO) An organization of Christian optometrists, optometry students and allied ophthalmic personnel committed to worldwide eye care missions and intra-professional Christian fellowship. www.cmda.org/fco Fellowship of Christian Physician Assistants (FCPA) The purpose of FCPA is to share our faith, the strength of Jesus Christ and our common concerns through a support network for physician assistants; provide a support network for the spiritual, professional and personal lives of our members; and equip and encourage members to share their faith in all aspects of life and to glorify God in service to others. www.cmda.org/fcpa Fellowship of Christian Plastic & Reconstructive Surgeons (FCPRS) We encourage, educate and challenge members to engage in a deeper, more fulfilling walk with our Savior, equipping us to impact the lives of others with the gospel. We also inform members about social and bioethical issues within the plastic and reconstructive surgery profession. www.cmda.org/plasticsurgery Neurology Section We seek to raise awareness among neurologists, neurology health professionals, neurology residents, fellows and medical students of the great need for neurological care—domestically and globally—and, through their response to those needs, share the gospel. www.cmda.org/neurology Psychiatry Section A fellowship of believing psychiatrists providing affiliation and support, clinical and academic collaboration, opportunity for deeper personal ministry, spiritual growth and mission to the community. We promote fellowship and provide community to support and encourage Christian physicians in the practice of psychiatry. www.cmda.org/psychiatry Ultrasound Education Section A multi-disciplinary group of healthcare professionals and Jesus followers who have a passion for using and teaching ultrasound, with the goal of equipping Christian international healthcare workers to incorporate ultrasound in the most challenging of settings. www.cmda.org/ultrasoundeducation Transformed Doctors ➤ Transforming the World www.cmda.org 5
TRANSFORMATIONS
In Memoriam Our hearts are with the family members of the following CMDA members who have passed in recent months and years. We thank them for their support of CMDA and their service to Christ. Max R Hickman, MD Chillicothe, Ohio • Member since 1966
Ross Markello, MD Getzville, New York • Member since 1997 Acques M. O’Hara, MD Blue Creek, Ohio • Member since 1963
Leonard R. Ritzmann, MD Wilsonville, Oregon • Member since 1959 Craig Stump, MD, PhD Marana, Arizona • Member since 2016 Leonard L. Sullivan, MD Wichita, Kansas • Member since 1977
Richard A. Ulrich, MD Bonaire, Georgia • Member since 1963
EVENTS For more information, visit www.cmda.org/events.
2020 New Medical Missionary Training March 5-8, 2020 • Bristol, Tennessee 2020 CMDA National Convention April 16-19, 2020 • Covington, Kentucky Italy Tour #1 May 3-15, 2020 • Italy Voice of Christian Doctor’s Media Training May 15-16, 2020 • Bristol, Tennessee Italy Tour #2 May 24 – June 5, 2020 • Italy Women Physicians in Christ Annual Conference September 17-20, 2020 • Newport Beach, California Marriage Enrichment Weekend September 25-27, 2020 • Grand Rapids, Michigan Marriage Enrichment Weekend October 23-25, 2020 • Kingston, Tennessee Remedy West 2020 October 23-25, 2020 • Riverside, California
MEMORIAM & GIFTS
Gifts received October through December 2019 Memory
Chris Lantz in memory of Dr. Bill Lawton Kenneth and Ruth Kuntz in memory of Dr. Bill Lawton Frank and Monica Mitros in memory of Dr. Bill Lawton Dr. and Mrs. Samuel Amstutz in memory of Dr. Bill Lawton Jeffrey and Dana Lynch in memory of Dr. Bill Lawton Dr. Paul Heidger in memory of Dr. Bill Lawton Dr. Rodney J. Schlosser in memory of Dr. Bill Lawton Dr. Wilbur L. Zike in memory of Dr. Bill Lawton Wendy R. Kelly in memory of Dr. Bill Lawton Janet Hill Lamm, PT, in memory of Dr. Bill Lawton Dr. David L. Larson in memory of Dr. Bill Lawton Venessa C. Barker in memory of Dr. Bill Lawton Dawn LeFrancois in memory of Dr. Bill Lawton Randall W. Jordison in memory of Dr. Bill Lawton Joseph J. Bafaro, Jr. in memory of Dr. Bill Lawton Kenneth D. Fox, Jr. in memory of Dr. Bill Lawton Georgia A. Fine in memory of Dr. Bill Lawton Sharon E. Sullivan in memory of Dr. Bill Lawton Joseph Thuman Family in memory of Dr. Bill Lawton Wanda and John Evans in memory of Dr. Bill Lawton Dr. and Mrs. Michael Armstrong, Jr. in memory of Dr. Francis Joseph Maly Mrs. Annalyne Barnett in memory of Dr. Hughes Melton Van Wert Elementary School in memory of Dr. Luke Rhodes Hurst Christine and Steven Carpenter in memory of Dr. Luke Rhodes Hurst Cathy and Tom Fuller in memory of Dr. Pete Dawson M. Donna N. Lin in memory of Dr. Charles Lin Elizabeth Ritzmann Helms in memory of Dr. Len Ritzmann
Honor Dr. Mark S. Walls in honor of Dr. W. Roger Matkin Susan and Paul Grier in honor of Drs. Jennifer and Andrew Jamison Cathy and Tom Fuller in honor of Dr. and Mrs. Ken Rutledge James and Pamela Riley in honor of Dr. and Mrs. Ken Rutledge Donald and Gladys Villnow in honor of Dr. and Mrs. Ken Rutledge William and Carol Templeton in honor of Dr. and Mrs. Ken Rutledge Irene Gan Huong in honor of Dr. and Mrs. Ken Rutledge Jeanne F. Grant in honor of Dr. and Mrs. Ken Rutledge Donna E. King in honor of Dr. and Mrs. Ken Rutledge Dr. Robert N. Raju in honor of Dr. William Wilson Poh-Lian Lim, MD, MPH, in honor of Dr. Clydette Powell Mr. and Mrs. Cranston Chip Vaughan in honor of Jean and Cy Vaughan J.J. and Lois Noval in honor of Dr. William Alexander Vandergrift, III David and Lucy Change in memory of Dr. Mattew Suh For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.
6 TODAY'S CHRISTIAN DOCTOR Spring 2020
TRANSFORMATIONS
CMDA Welcomes New Northeast Regional Director Thomas B. Grosh, IV, DMin, joined CMDA as the new Northeast Regional Director in January 2020. He serves as a connection point for CMDA members living in Connecticut, District of Columbia, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Virginia, Vermont and West Virginia. Tom has a passion to devote his ministry to transforming lives with the gospel through healthcare. Prior to becoming Northeast Regional Director, Tom ministered through CMDA as the Area Director of South Central Pennsylvania. Tom brings to CMDA over 20 years of experience with InterVarsity Christian Fellowship / USA, most recently as the Associate Director of the Emerging Scholars Network where his responsibilities included conferencing, digital ministries, fund development, networking and resource development.
inary) and a doctor of ministry in ministry to emerging generations (Gordon-Conwell Theological Seminary). Tom and his wife Theresa grew up in Lancaster County, Pennsylvania where they now reside with their four daughters. We are excited to welcome Tom to CMDA. To contact him, please email northeast@cmda.org.
GET INVOLVED
Campus & Community Ministries is a network of more than 78 local graduate ministries and more than 300 campus chapters providing opportunities for members to connect and live out their Christian faith in their practices, on campus and in their communities. To find a CMDA chapter near you or learn more about your regional ministry opportunities, visit www.cmda.org/ccm.
Tom has a bachelor’s of science degree in biology (Grove City College), a master of arts in higher education (Geneva College), a master of arts in religion in spiritual formation (Evangelical Seminary), a certificate in spiritual direction (Evangelical Sem-
Regional Ministries Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 503-522-1950 west@cmda.org
Northeast Region Tom Grosh, DMin 1844 Cloverleaf Road Mount Joy, PA 17552 609-502-2078 northeast@cmda.org
Midwest Region Allan J. Harmer, ThM, DMin 951 East 86th Street, Suite 200A Indianapolis, IN 46240 Office: 317-257-5885 cmdamw@cmda.org
Southern Region Grant Hewitt, MDiv P.O. Box 7500 Bristol, TN 37621 402-677-3252 south@cmda.org
MAP International Fellows Scholarship Paid Advertisement
If you are a 4th year medical student participating in a Christian overseas medical mission, you may be eligible for up to
$2,000 towards
your international airfare through our MAP Fellows Program. Email crowell@map.org for more information. www.map.org Transformed Doctors ➤ Transforming the World www.cmda.org 7
INTRODUCING
A new weekly podcast with the latest news from CMDA and healthcare www.cmda.org/cmdamatters
I
n January 2020, Christian Doctor’s Digest, our popular audio magazine, expanded to a weekly podcast. And with an expanded vision comes a new name, CMDA Matters. We are so excited about this new format and bringing you the latest news in healthcare and from CMDA on a weekly basis. This popular member resource hosted by CMDA CEO Mike Chupp, MD, FACS, is released each Thursday and is available on the CMDA app, iTunes and our website. Each episode includes an interview with an expert in a field pertaining to Christian healthcare professionals. Topics include bioethics, healthcare missions, financial stewardship, marriage, family and much more. Plus, you’ll get recommendations for new books, conferences and other resources designed to help you as a Christian in healthcare. You don’t want to miss an episode! Each Thursday, a new episode is released, and you can listen to CMDA Matters in a variety of ways. With your smart device, it is easier than ever to listen in your car, on your phone while out exercising and more.
8 TODAY'S CHRISTIAN DOCTOR Spring 2020
WAYS TO LISTEN
CMDA App
Find the weekly podcast on the CMDA app. You can download our app from your device’s app store on a variety of mobile devices, such as an iPhone, iPad, Android, etc. (Plus, when you download the CMDA app, you’ll have access to more of our great resources.)
iTunes or Google Play
Subscribe to our iTunes and Google Play channel by searching for “CMDA Matters” on your device. When you subscribe, you will receive each new episode automatically.
CMDA Website
Visit www.cmda.org/cmdamatters at any time to listen to each episode.
CMDA PODCAST NETWORK
CMDA Matters is only one of the podcasts CMDA produces on a regular basis. Are you missing out on all these different resources? Learn more and subscribe to each one at www.cmda.org/podcasts. 1. CMDA Matters: A weekly podcast with the latest news from CMDA and healthcare. Host: Mike Chupp, MD, FACS
2. D ental Soundbytes: A regular podcast from CMDA’s Dental Ministries with topics for dentists. Host: Bill “Griff” Griffin, DDS
3. Healthy Doctor: A monthly podcast from CMDA’s Center for Well-being. Host: Steve Sartori, MD
4. Let’s Go GHO: A podcast from Global Health Outreach, a short-term missions program. Host: Trish Burgess, MD
5. Student Pulse: A podcast for healthcare students from
CMDA’s National Student Community. Host: Bill Reichart, MDiv
HOW DO YOU WANT TO LISTEN? Each quarter, we will be releasing a physical CD with a compilation of “The Best of CMDA Matters” interviews from the weekly podcast. We will continue sending these CDs to our members who prefer to listen through that format. Due to high mailing costs and drastically increased breakage problems in mailing physical CDs, we encourage you to go green and begin listening to CMDA Matters electronically through your mobile device. To update your subscription preferences and elect to stop receiving a physical CD, please visit www.cmda.org/ cmdamatters.
PODCAST GUESTS
E
ach week on CMDA Matters, Dr. Mike Chupp is joined by a featured guest for an interview focusing on an important topic for Christians in healthcare. These guests are experts in their fields, and their conversations with Dr. Chupp explore a variety of topics, including ethical issues facing healthcare in today’s culture, how to use your finances for God’s purpose, facing burnout at work and much more.
RECENT GUESTS Dr. James Dobson Protecting the Family In this inaugural episode, Dr. Chupp talks with the legendary Dr. James Dobson about the moral decline of our culture, his influence and catching up on what he is doing today. Dr. Dobson is the Founder and President of the James Dobson Family Institute, a non-profit organization that produces his radio program, “Dr. James Dobson’s Family Talk.” He is the author of more than 30 books dedicated to the preservation of the family.
Christopher Yuan Holy Sexuality Dr. Christopher Yuan’s powerful testimony articulates a biblical view of sexuality through the narrative of his personal transformation from an agnostic gay man to a Bible professor. This inspirational story of redemption and grace transcends the topic of sexual identity touching on issues such as drug addiction, promiscuity, incarceration and HIV. Dr. Yuan has taught at Moody Bible Institute for over 10 years and his speaking ministry on faith and sexuality has reached five continents.
Andrè Van Mol, MD Transgender Tsunami Transgenderism has risen to the top of concerns that trouble our members. This interview with Dr. Andrè Van Mol will help you navigate the waters as you come in contact with patients who are struggling with their identity. Dr. Van Mol is a board certified family physician in private practice. He is the cochair of the American College of Pediatricians’ Committee on Adolescent Sexuality.
Jean Wright, MD Innovation in Healthcare Dr. Jean Wright is the Chief Innovation Officer for Atrium Health in Charlotte, North Carolina. In that position, she is responsible for leading the advancement of the organization’s innovation initiatives. This episode discusses how innovation is making a difference in healthcare. Dr. Wright practiced as a pediatric anesthesiologist and intensivist, and she has given testimony in the U.S. House of Representatives and U.S. Senate on fetal pain.
Zachary Meade Leading & Innovating in Medical School Zachary Meade joined the U.S. Army at 17, never imagining his experience as an army technician would one day lead him to a career in healthcare. After graduating from an electrical engineering undergraduate program, he began attending Carle Illinois College of Medicine, the first engineering-based medical school. In this episode, Zachary talks about his work as a CMDA student leader on campus. Transformed Doctors ➤ Transforming the World www.cmda.org 9
AFTER EBOLA
Confronting the Trauma
by Nancy Writebol, CNA, SIM Global Trauma Healing Coordinator, as told to Richard Greene
10 TODAY'S CHRISTIAN DOCTOR Spring 2020
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n the closing months of 1989, a brutal civil war erupted in Liberia and soon engulfed the small West African country. At the time, T. Abraham Browne was in high school, and the senseless killings forced him and his siblings to flee for their lives to escape the bloodshed. They reached a refugee camp where Abraham would spend the next 10 years. If that horror wasn’t enough for someone so young to experience, Abraham would face another country-wide crisis that swept through Liberia about 25 years later. This time it was Ebola. Abraham said, “Compared to the war, it was even more deadly because Ebola was an unseen enemy. It was just by touch and then you were infected and that was it.” So many family members lost their lives. They lost their loved ones. Abraham’s little sister contracted Ebola. When Abraham got word, he rushed to go see her. Her eyes were swollen when he arrived. Tragically, she died. “It was the most difficult part of our lives,” Abraham said. “We tried to withstand.” As he recalled this heart-rending period, tears welled in his eyes, and his voice cracked with emotion. Then he wiped the tears with his fingers. “I never thought I would have the strength and the courage to say, ‘Okay, I can still go ahead.’” Then Abraham discovered the Trauma Healing Program. The ministry was being offered as a collaborative effort between the Evangelical Church of Liberia (ECOL) and SIM, an international Christian mission organization that has been working in West Africa since 1893. “When I came to the trauma healing [training], there was a day for taking our pain to the cross and explaining from our heart what we went through,” Abraham said. “As I stood there and tears came to my eyes, it was like I had something on my head, and it was being removed. I believe I was detraumatized during that first phase of the training.” Abraham went on to say, “SIM touched my life through that program. I was a different man than before. I want to say, ‘thank you,’ because it made me and other people a new person, able to now withstand difficult circumstances.” We praise God for all He has done in Abraham’s life. Today he’s faithfully serving as the district secretary for ECOL. What an amazing testimony! God is using this powerful Bible-based Trauma Healing
Children going through sessions with the Trauma Healing Ministry in Liberia.
Ministry to enable men, women, youth and children to be restored through Jesus Christ. Trauma Healing provides training, resources and support to help the church respond to communities around the world suffering from trauma. In as much as God has used this ministry in the context of war, epidemics and disasters, He is also using it to engage with the “everyday” wounds of grief, domestic violence, addiction, sexual abuse, abandonment, ethnic conflict, infertility, abortion, HIV or crime. As the church engages meaningfully with people’s pain, we have seen lives changed. Built on a solid foundation of mental health best practices and biblical principles, Trauma Healing’s model leads to sustainable trauma care in any context, with reallife stories to help people connect the teaching with their circumstances. “Sadly, the body of Christ has often failed to see trauma as a place of ministry. If we survey the extensive natural disasters in our time—earthquakes, hurricanes and tsunamis, combined with victims who have suffered from human atrocities of violent inner cities, wars, genocides, trafficking, rapes and child abuse—we would see a staggering number. To look at suffering humanity would lead to the realization that trauma is perhaps the greatest mission field of the 21st century. The wounds of trauma are not visible, their effects are!”1 Transformed Doctors ➤ Transforming the World www.cmda.org 11
direct contact with patients, so my diagnosis came as a surprise. I was isolated at our home and then evacuated to the U.S., where I was cared for in a custom-built treatment unit at Emory University Hospital. I arrived there a few days after the world watched Dr. Kent Brantly, a medical missionary with Samaritan’s Purse, walk out of the ambulance!
A group of adults in Liberia going through trauma healing trainings.
The core program at SIM is adapted from the American Bible Society’s workbook titled “Healing the Wounds of Trauma.” The material came about when people who had terrible things happen to them asked the question, “Can God heal them?” These are the questions the authors of the book were asking in the late 1990s as they saw people suffering from war. They were all members then on staff with SIM, living and working in Africa. In 2001, a group of people met to write the lessons. The group included mental health professionals, Bible translators, Scripture engagement consultants and African church leaders who had experienced war. The lessons were tested in war zones and were first published in 2004. Trauma Healing is now in 94 countries with more than 8,000 facilitators. I personally became involved in trauma healing after surviving Ebola and before returning to Liberia in 2015. Five years after I contracted the disease and was healed by God’s amazing grace, my husband David and I visited Emory University Hospital in Atlanta, Georgia where I was treated in their high-level bio-containment unit. Upon arriving in Atlanta, I remember reflecting on those difficult days in Liberia and feeling thankful I was walking off the airplane instead of taking an ambulance ride and being wheeled into the unit on a stretcher. I was one of three Americans who contracted the virus at SIM’s ELWA Hospital in Monrovia, Liberia during the height of the 2014 epidemic. As a hygienist, I was out of 12 TODAY'S CHRISTIAN DOCTOR Spring 2020
We are extremely grateful for the Emory team of physicians, nurses and other staff who so graciously cared for us. It was a blessing that Kent and I were there at the same time. We talked with each other by phone, encouraging each other in our journey.
That God would heal me, and that I would walk out of the hospital on August 19, 2014, humbles me. I still remember holding David’s hand, our first physical contact in 24 days. As we recovered from the crisis in the Charlotte, North Carolina area, the Ebola epidemic raged on in Liberia. Despite all that David and I had endured, our hearts remained thousands of miles away, emotionally committed to our Liberian brothers and sisters who were fighting for their lives. At the time, I was reading Risk is Right by John Piper. I was struck by what he writes in the first chapter: “There are a thousand ways to magnify Christ in life and death. None should be scorned. All are important. But none makes the worth of Christ shine more brightly than sacrificial love for other people in the name of Jesus. If Christ is so valuable that the hope of his immediate and eternal fellowship after death frees us from the self-serving fear of dying and enables us to lay down our lives for the good of others, such love magnifies the glory of Christ like nothing else in the world.”2 “The early Christians gave their property and their lives for sake of others because they knew that on the other side of death Jesus would be their great reward.”3
That said it for us. We returned to Liberia, first, because of our love for Christ and then, second, because of our love for others. As we prayed, read God’s Word and sought counsel, we were reminded again and again of our calling by God to serve Him in Liberia. We were compelled by God’s great love to return, to live out the gospel in the power of the Holy Spirit, making disciples who trust Him and obey Him. I think that having gone through Ebola myself, there’s an identification with the people that I didn’t have before. Some Liberians have even told me, “If we had been you, we wouldn’t have come back.” Many times, we have heard, “Thank you for coming back.” David and I returned to Liberia in the spring of 2015, even before the crisis was declared over. David assumed the country directorship for SIM, while I went back as a trained trauma healing facilitator to help minister to Ebola survivors and the community at large, to confront deep emotional and psychological wounds from their encounters with the disease.
We have relationships we would not have had if this had not happened. Then there’s the outreach to an almost unexpected subset of people who have needed special attention—the dozens of men who labored in the national crematory during the Ebola crisis. Without question, the gruesome service these men performed directly reduced the deadly spread of the disease. Instead of being given a traditional washing and burial, the contagious bodies of the victims were received from the treatment units or communities and incinerated. As a result, the Liberian culture shunned these men, who were dubbed “Ebola Erasers.” To add to their shame, families and communities turned their backs on them. Many lost their jobs. To cope, some turned to alcohol and drugs. The Evangelical Church of Liberia reached out to these men and invited them to a special luncheon to honor their service and to thank them. We teamed and trained ECOL leaders to hold a trauma healing group for the men.
But not just from Ebola. We discovered countless numbers of patients, just like Abraham, who not only were suffering from the trauma of Ebola, but they were also suffering from the ravaging effects of 14 nightmarish years of civil war that claimed the lives of at least 250,000 people. My colleagues and I began leading trauma healing sessions while also training other facilitators. Though we are not trained psychologists, we are confident in the biblical resources we’re providing through the course. Identification, relationship and listening are vital. Most people need to say aloud what happened, how they feel and the hardest part of their trauma. Telling the story in a place they feel safe can lessen the hold of the traumatic experience. Sometimes, it’s the first opportunity to describe their experience. Then we get to witness miracles in the making! As the participants pray and give their pain to Christ, they begin to find healing. Hope returns as God mends their hearts. Grieving is a journey, and it takes courage to face the process. I genuinely believe the Lord has used my battle with Ebola to open doors to speak into the lives of hurting people, not just in Liberia but elsewhere.
One of the many sessions helping Ebola survivors through the Trauma Healing Ministry.
Transformed Doctors ➤ Transforming the World www.cmda.org 13
Nancy Writebol helps Dr. Kent Brantly as he prepares to enter the containment unit at ELWA Hospital in Liberia during the Ebola epidemic in 2014.
They experienced huge grief. At first, they were reluctant to discuss their pain and dilemma. They bottled it up. About a year later, though, they approached us and were no longer hesitant. They attended the healing groups, and most are doing well. Please pray for these men as they process the painful situations they have experienced in their lives. Many are non-believers, and they need Jesus! In this last year, SIM asked me to step into the position of Global Trauma Healing Coordinator. My role now extends far beyond the borders of Liberia. This has involved helping train lay leaders and pastors in the Democratic Republic of the Congo (DRC), which is struggling to get on top of its Ebola outbreak. Countless issues make containment of Ebola difficult, including the rebel attacks on healthcare workers. We must raise the level of awareness and be willing to respond to the many heart wounds that those living in the DRC are carrying. Trauma Healing also seeks to reach oral communities, children, teens, refugees, those in prison and various others as the need arises. Wherever adults suffer, children suffer doubly. The workbook for the children is called Healing Hearts Club. Each of the 10 lessons includes a Bible story and a composite 14 TODAY'S CHRISTIAN DOCTOR Spring 2020
real-life story about the experiences of “Sami and Rose,” so children can see the effects of trauma, learn how to work through their emotional and spiritual pain, and experience God’s love for them. Lesson 1 is “I am Important to God.” The lesson builds an atmosphere where children feel safe and where they feel their needs can be shared and brought to God for healing. Children learn how special they are, and they learn that God sees them as individuals of worth and value created in His image. In a children’s group, six little girls were all crowded around their teacher sitting on the floor as she was telling the story. She explained to the girls that they were created in God’s image and they were special to Him, and she shared the story of creation and expressed that when God finished creating the world, He looked at everything and said, “It is very good.” She went on to tell the girls how much God loved them. When she finished talking, one little girl said, “Ahh, I didn’t know that God made me or that I am special.” “Yes,” replied her teacher, “He loves you very much,” to which the little girl replied, “NOBODY ever told me this.” As the week continued, it was a blessing to see how each lesson helped this young girl process the pain she was caring and meet Jesus as her Savior.
Pray for us as we continue to reach people like Abraham and Rachel. To learn more about SIM’s Trauma Healing Ministry, visit www.simusa.org/traumahealing. If you have questions and would like to connect, please contact me at intl.traumahealing@sim.org. BIBLIOGRAPHY 1 Langberg, D. (2015). Suffering and the heart of God: how trauma destroys and Christ restores. Greensboro, NC: New Growth Press. pg. 213. 2 Piper, J. (2013). Risk is right: better to lose your life than to waste it. Wheaton, IL: Crossway. pg. 97 3 Piper, J. (2013). Risk is right: better to lose your life than to waste it. Wheaton, IL: Crossway. pg. 110
I thank the leaders of CMDA for allowing me this privilege to let their members know of the importance of the Trauma Healing Ministry and the impact this initiative has been making for SIM and other global partners. Please join us in making a lasting difference around the world.
Nancy Writebol assists nurses with donning their protective gear prior to entering the containment unit at ELWA Hospital in Liberia during the Ebola epidemic in 2014.
NANCY WRITEBOL, CNA, and her husband David joined SIM in 2013. After 14 years of ministering to orphans and vulnerable children in Zambia and Ecuador, God led them to serve with SIM in Monrovia, Liberia. Nancy and David have two married sons and seven grandchildren. During the Ebola outbreak in March 2014, ELWA Hospital in Monrovia assumed the role of the Ebola Consolidated Case Management Center. Nancy volunteered as a member of the joint SIM/Samaritan’s Purse crisis team. Nancy was one of the first Americans to become infected with the Ebola virus in July 2014. Nancy and Dr. Kent Brantly, a physician who worked in the same hospital, were evacuated and recovered at Emory University in Atlanta, Georgia after receiving an experimental serum called ZMapp. Nancy and David returned to Liberia in March 2015. She served as the Personnel Coordinator for SIM (2013) and the West Africa Coordinator for Trauma Healing from 2015. Upon returning, Nancy met with Ebola survivors prior to their medical appointments and invited them to become a part of healing groups to process the trauma they had experienced. She and five other trained leaders led the inaugural Trauma Healing Training Workshops in Liberia. In July 2015, 80 leaders of churches, non-governmental organizations and other organizations were trained to lead healing groups. Through Nancy’s work alongside leaders from the Evangelical Churches of Liberia (ECOL), many others have been trained to lead Trauma Healing throughout Liberia and West Africa. In 2019, Nancy began serving SIM as the Global Trauma Healing Coordinator, and she represents SIM as an Alliance Member of Trauma Healing. Nancy’s contact with Ebola has given her a greater depth of oneness with Christ and others that could only be experienced through suffering. The truth is, in this world we will suffer. At the same time, Christ is there to give us His peace, encourage us, strengthen us and, yes, restore joy in our lives.
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THE
TEMPTATIONS Addressing Same-Sex Attractions by Christopher Yuan, DMin
S
ame-sex sexual expression is sinful, but what about same-sex attractions? As a new Christian, I had defined attraction to be equivalent to temptation. Therefore, I believed that all same-sex attractions were not sinful—because temptations were not sinful. However, I realized not everyone defined attraction the same. Does attraction mean temptation? Does attraction mean desire? Does attraction mean lust? Or is it a combination of these? This is where confusion arises. If we can’t even define attraction, how can we assert whether it’s sinful or not? Sin is a word found throughout the Bible. However, the word attraction is not. Instead, the biblical writers use other similar terms like temptation, desire, covet, and lust. To avoid further confusion, I’m not going to consider whether same-sex attractions are sinful; instead we’ll exam16 TODAY'S CHRISTIAN DOCTOR Spring 2020
ine whether same-sex temptations are sinful and whether same-sex desires are sinful.
TEMPTED IN EVERY RESPECT
The reality of temptation is found throughout the pages of God’s grand story. In Genesis 3, the cunning serpent successfully tempted Adam and Eve to rebel against God. In the New Testament, we see Satan tempting Jesus in the wilderness. But unlike the first Adam, the second Adam obeyed God perfectly, fully doing the will of God (Matthew 4:1–11; Mark 1:12–13; Luke 4:1–13). The writer of Hebrews speaks of the real temptations in the life of Jesus: “For we do not have a high priest who is unable to sympathize with our weaknesses, but one who in every respect has been tempted as we are, yet without sin” (Hebrews 4:15, ESV). Here in this verse, “our weaknesses” refers to our moral frailty and propensity to sin.
Yet Jesus’s sympathy for our weaknesses goes beyond a mere theoretical understanding. He offers actual assistance when we’re tempted. “For because he himself has suffered when tempted, he is able to help those who are being tempted” (Hebrews 2:18, ESV ). The Son of God’s sympathy derives from his full participation in humanity and his exposure to the same experiences as the rest of us. But this doesn’t mean Jesus needed to sin in order to sympathize. As the apostle John writes, “You know that he appeared in order to take away sins, and in him there is no sin” (1 John 3:5, ESV emphasis added). As God, Jesus did not sin and in fact is incapable of sinning (this is called impeccability). Therefore, the temptations of Jesus were not sinful. But then how can he sympathize with our temptations? Jesus’s inability to sin does not diminish in any way the reality of his real and intense struggle with temptation. In fact, his sinlessness in the midst of temptation makes him the ultimate example of struggling—because he never succumbed. Nineteenth-century British theologian B. F. Westcott provides the most lucid explanation of Christ’s sympathy: The power of sympathy lies not in the mere capacity for feeling, but in the lessons of experience. And again, sympathy with the sinner in his trial does not depend on the experience of sin but on the experience of the strength of the temptation to sin which only the sinless can know in its full intensity. He who falls yields before the last strain. Jesus struggled with temptation infinitely more than any sinful man or woman, yet he was victorious. The Son of Man was tempted in every respect; he fully and perfectly struggled, bringing his endurance to completion. This should be an extraordinary encouragement for all—particularly those of us who struggle with same-sex attractions. Yes, our Lord has struggled much more than we have. As a matter of fact, because we give in and yield to temptation and sin, we comprehend the struggle only in part. Jesus alone has struggled wholly, as he withstood heroically to the end. What an amazing Savior and friend we have in Jesus!
A WAY OF ESCAPE
Paul reminds us in 1 Corinthians 10 of the tragic example of the Israelites in the wilderness and sternly warns us to flee idolatry and sexual immorality. In the midst of these
strong words, he also provides an encouraging and empowering promise: “No temptation has overtaken you that is not common to man. God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it” (verse 13). The Greek verb peirazo can be translated as “try, test, trap, or tempt.” The difference between a test and a temptation lies in the motivation of the tester. For example, God can allow believers to face a trial to test and sharpen their character ( John 6:6). On the other hand, Satan tempts people to sin and disobey God (1 Corinthians 7:5). A test or temptation can build us up or tear us down. Puritan John Owen explains it best: “Temptation is like a knife, that may either cut the meat or the throat of a man; it may be his food or his poison, his exercise or his destruction.” Sometimes it’s obvious whether the test or temptation arises from God, from Satan, from another, or from within. Yet in other instances, the word peirazo can generally refer to both test and temptation without excluding either—as it does in 1 Corinthians 10:13. Paul is reminding us that our trials and temptations aren’t exceptional, unique, or even unbearable. Satan wants us to think that no one else can understand our struggles. This is a lie. One of the devil’s best weapons is isolation. The truth is that we’re never alone in our fight. The comfort of Paul’s message in this verse finds its source in three words: “God is faithful.” Our confidence in the midst of temptation lies not in our own finite abilities but in a faithful and powerful God who never encounters anything he cannot resolve. God provides assurance that each temptation will be in proportion to the capability of the tempted, along with the promise of a “way of escape.” Please catch what Paul is saying here! Superhuman capacity or even great faith is not required to endure temptation. Even the weakest of believers has an escape hatch. This is a comforting salve for the feeble and even for those with little faith. Every temptation always falls within the ability of the one tempted to persevere. The true test may not be in our ability to endure temptation but in the depth of our belief in the sovereignty of almighty God. Unfortunately, a serious fallacy runs rampant in our churches that a good Christian is somehow immune to temptation. Transformed Doctors ➤ Transforming the World www.cmda.org 17
LEARN MORE
This is an excerpt from Christopher Yuan’s book Holy Sexuality and the Gospel: Sex, Desire and Relationships Shaped by God’s Grand Story. Copyright ©2018 by Christopher Yuan. Used by permission of Multnomah, an imprint of Penguin Random House LLC. Christopher is a plenary speaker at the 2020 CMDA National Convention. To register, visit www.cmda.org/nationalconvention.
have little faith because it’s quite ordinary and human to be tempted. The truth of the matter is that temptations are not sinful. However, we must be careful not to take temptation lightly. It is not sin per se, but it also isn’t benign, as it quickly leads to sin. Therefore, we should always be vigilant in our response to it. No temptation to sin is trivial or inconsequential, and that’s indeed true for same-sex temptations. James provides a sober warning that temptation is tantalizing: “Each person is tempted when he is lured and enticed by his own desire. Then desire when it has conceived gives birth to sin, and sin when it is fully grown brings forth death” ( James 1:14–15, ESV). Although this is not meant to be a step-by-step timeline for sin and temptation, in verse 13 James explains that God does not tempt us to sin and warns us that temptation leads to sin, which leads to death. There is nothing innocent or sanctifiable about same-sex temptations. They are a stark reality of the distorting effects of original sin. And everyone’s sexuality has been distorted by the Fall. Therefore, resisting, fighting, and fleeing temptations must be a vital and normal aspect of a mature Christian’s life. The heart of the matter is not whether we’re tempted but how we respond. Do we resist temptation, or do we allow it to turn into sin? It’s not a matter of if we’re tempted but when.
This simply isn’t accurate. Scripture doesn’t promise that faith in Jesus results in an eradication of temptations. If Jesus himself was tempted, what makes us think we won’t be? The Christian life doesn’t mean you won’t be tempted; it means you’ll have the Spirit-wrought ability to be holy even in the midst of temptations. What matters most is not that we are tempted but how we respond to temptation. If you’re wracked with guilt for simply having same-sex sexual temptations, hear these words from John Owen: “It is impossible that we should be so freed from temptation as not to be at all tempted.” Being tempted doesn’t mean you
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But rest assured: Jesus is able to sympathize and help. And God is faithful, apportioning temptation according to our ability to resist while always providing a way out. In our struggles, we are never alone.
CHRISTOPHER YUAN, DMin, has taught at Moody Bible Institute for more than 10 years, and his speaking ministry on faith and sexuality has reached five continents. He is the author of Out of a Far Country (co-written with his mother Angela Yuan) and Holy Sexuality and the Gospel: Sex, Desire and Relationships Shaped by God’s Grand Story, from which this excerpt was taken.
April 16-19, 2020 Northern Kentucky Convention Center Covington, Kentucky (Cincinnati area)
PLENARY SPEAKERS
BE STRONG AND COURAGEOUS Rev. Bruce Boria Devotion Speaker
Ryan Kennedy Kay Arthur
Award-winning author
Mike Chupp, MD
Chief Executive Officer, CMDA
David Levy, MD
Neurosurgeon, author, speaker
Register online at www.cmda.org/nationalconvention
Christopher Yuan, DMin
Worship Leader
Speaker, author, Bible professor
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THE MOUNTAINTOP by Scott Conley, MD
B
urnout is the current buzzword in healthcare, the subject of endless articles and editorial commentaries. Fatigue, depersonalization and cynicism characterize this happiness-ruining and career-destroying disease, which has reached epidemic levels among healthcare professionals across the country. Yet all I know was that my heart, despite pumping heavily as I climbed the steep trail on an unusually warm April day, felt dead. The rebel in me had decided to skip the next lecture at the 2018 CMDA National Convention in North Carolina and get some fresh air. “I prefer the hike up Rattlesnake Mountain,” the front desk attendant had quippped. “There are no snakes up there, but its name sounds cool and the view is great.” That was enough for me. Just near the summit, the well-trampled dirt trail gave way to large boulders, slowing my ascent. The sweat was worth it. Though rocky, giving the mountain a bald and bumpy head, the summit was perfect. My guide had been right— I could see 360 degrees around and straight out for miles. And the view was as lumpy as the summit. Green-carpeted mountains filled the landscape, occasionally nestling homes in their laps. A cloudless sky arced down toward the horizon, ending abruptly at the most distant mountains. A gentle breeze cooled my skin as I leaned against one of the bigger rocks and breathed in deeply. No one else had made the hike, leaving me alone on the hill to take in the view and be still. But as my gaze into the distance finally returned to my mountain, the totality of what I saw startled me, even though I had begun to see evidence of it on the hike up: burnedout trees surrounded the summit and extended down the mountainsides, the blackness a stark contrast to the verdant hills nearby. Rattlesnake Mountain had endured a fire three years ago, the unintended consequence of a harmless debris burn by a local neighbor.
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That’s me, I thought as I stared at one of the charred corpses just off the summit—burned out, lifeless, a smoldering remnant of a doctor, torched by a wildfire in medicine that was certainly unintended but that has spread across the land. I’ve been scalded by the escalating demands of pro-
careers for physicians. Maybe I could find happiness on another hill…. But then a gentle breeze lifted a divine whisper through those scorched branches to my mind as I stood in solitude and reflection: Remember, you are still on the mountaintop. I live in one of the richest countries on earth. And though I may not technically be a part of the infamous 1 percent (I am a family doctor after all), I would be in the top 5 percent of incomes in this country. I practice medicine at a wonderful family practice with coworkers I enjoy and respect, in a healthy and forward-thinking hospital system. My patients are good folk and have trusted me with their lives. I am healthy and my family is thriving. My daughters won’t have to worry about college debt. And even as I write this, I zip through the Italian countryside on a Frecciarossa headed to Rome during a two-week holiday (as they call it here). I am still on the mountaintop. But really, while I am thankful for all those blessings, they are base-camp stuff. All are temporary and could vanish in a heartbeat. True summit-level realities spring from my relationship with God and are described so well in one of my favorite songs:
ductivity and quality. I’ve been choked by the thick smoke of administrative busywork. And the worst part? I am so busy trying to contain the fire and not get burned in the process that I am losing the ability to be present with and compassionate for patients. I can barely remember those early years of zeal and idealism and pure medical care before the inferno started. Ideas on how to contain the fire have emerged. Sweeping changes are needed, the experts declare, from the individual clinician to the national level. Yet those of us closest to the flames fear the tempest has gotten too far out of hand to ever see clear sky again. I looked out a second time from the top of Rattlesnake Mountain, this time covetously, at the other mountains still vibrant and full of promise. A corollary of the familiar proverb about grass being greener came to mind. Certainly, I had wondered, even internet-searched, about alternative
I was blind, now I’m seeing in color I was dead, now I’m living forever I had failed, but you were my redeemer I’ve been blessed beyond all measure I was lost, now I’m found by the Father I’ve been changed from a ruin to treasure I’ve been given a hope and a future I’ve been blessed beyond all measure I am counting every blessing, counting every blessing Letting go and trusting when I cannot see I am counting every blessing, counting every blessing Surely every season you are good to me (“Counting Every Blessing” by Rend Collective). I am still (and will be eternally) on the mountaintop. Early in residency I shadowed an orthopedic surgeon who spent most of our day together whining about how medicine was changing for the worse. Resentment quickly flooded my mind as I pictured this surgeon getting into his Porsche after work and driving home to his million-dollar mansion. I vowed at that moment to never be like him when I grew up. Transformed Doctors ➤ Transforming the World www.cmda.org 21
On that rocky peak nearly 20 years later, I realized I had broken my vow. I need to constantly remind myself I am still on the mountaintop. This discipline, the practice of gratitude, douses the flames and provides relief from the heat. It rehydrates and produces life, even in charred places. Gratitude remembers. Before brushing my teeth each morning, I have embarked on a new routine: to wake up on workdays and reflexively think of all that I have in Christ and all that is right and good in my life and career, rather than slap the snooze button with a groan and pull out of my mental nightstand the list of reasons why I dread going to work. Then, during my commute, I often play the Rend Collective song like it’s my theme song. And during the day, when I feel the searing from the flames that surround me, I go back in my mind to the mountaintop for lessons learned that April day and practice gratitude again.
Gratitude is not denial hidden behind a smiley-face mask; instead, it is a choice to remember, to focus on the eternal and to not allow external circumstances to poison my inner condition. Besides, I am roused by Jesus’ promise in Matthew 25: “…whatever you did for one of the least of these brothers of mine, you did for me” (Matthew 25:40). In his book Gracias, Henri Nouwen writes of this Scripture passage, “A grateful life is a life in which we come to see that the Lord himself is the gift. The mystery of ministry is that the Lord is to be found where we minister… Our care for people thus becomes the way to meet the Lord.” It’s easier to practice gratitude knowing I am going to meet and serve God each day at work when I care for my patients, even when it doesn’t feel like it.
22 TODAY'S CHRISTIAN DOCTOR Spring 2020
SCOTT CONLEY, MD, has been a board certified family physician for more than 16 years. Currently, he practices in a large family medicine office in Central Pennsylvania and precepts young doctors at a nearby residency clinic. Dr. Conley is the author of Through the Watches of the Night, a collection of spiritual reflections for medical students and residents, published in 2017. He lives in the Lancaster, Pennsylvania area with his awesome wife and two favorite daughters.
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I realize that simply to count your blessings sounds like a TV preacher answer or a Mr. Rogers quip. But what is the alternative? Will I truly find what I am looking for on one of those other hills? Will I make my day any better by incessantly complaining about it? Instead, I aspire for my thoughts to be like David’s, who wrote in Psalm 16: “The boundary lines have fallen for me in pleasant places; surely I have a delightful inheritance” (Psalm 16:6).
I will fight alongside my brethren in healthcare to make medicine better and resist anything that threatens the physician-patient relationship, which is under constant attack. But even if nothing changes in healthcare, even if the wildfire continues to engulf, even if the best-laid plans to improve healthcare and reduce physician burnout fail, I need tools to survive—no, thrive, shining like a city on a hill—for another 20 years in this profession. Remembering I am still on the mountaintop has helped.
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Gifts & Miracles My Unexpected Journey into Addiction Medicine by Timothy Allen, MD
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W
hen I entered my family medicine residency, I had a cohort of marijuana-smoking pregnant women to care for. They drove me crazy. Many nights I would come home to my wife and tell her, “If I ever really hate myself, I will figure out a way to treat adolescent, obstetric addiction.” I would ask my professors for help and direction in caring for these women, and generally I only received shrugs and funny looks in return. Despite my failures in residency, 10 years later I embarked on a path of treating pregnant women who struggle with addiction, and I have found it to be an amazing opportunity to see God change the lives of people who struggle with addiction, to show the love of Jesus and to see Him provide in miraculous ways. Opiate abuse is currently the number one cause of death for adults 18 to 60 years of age in the United States. During the worst years of the HIV epidemic, 45,000 people per year died in the U.S. In 2016, 62,000 people died from opiates. If someone injects heroin once, there is a 56 percent chance they will ultimately die of complications of heroin abuse, with a 2.5 percent to 5 percent per-year mortality depending on the study.1,2 My opiate treatment career started in 2014 when I saw a young woman in my office who had been my patient since she was in second grade. She was now in high school, had gotten into trouble and started using drugs, and she was now pregnant and on heroin. A quick search on UptoDate said that you could not stop or wean opiates in pregnancy, since doing so would quadruple fetal mortality (current recommendations say you can safely wean slowly, but not stop suddenly.) So, I started calling around to try to find a methadone clinic or suboxone provider for her, but I had a hard time finding one. It seemed that most providers did not want to work with pregnant women, and there was a huge shortage of providers overall. I have learned that, as of now, 60 percent of U.S. counties have no suboxone or methadone providers. Frustrated that I could not find help for this girl, I did further searching and found that if I took an eight-hour online course, I could start prescribing suboxone for one patient emergently, then 30 patients at a time for the first year, followed by 100 patients at a time thereafter. I went home, logged onto the internet, spent eight hours learning the basics and then started her on suboxone the next day. As I read more about caring for pregnant women who struggle with addiction, I was convicted by this: if you ever really want to be treated badly in a healthcare setting, be a pregnant woman who struggles with addiction. There is a special sort of condemnation for women who “don’t care Transformed Doctors ➤ Transforming the World www.cmda.org 25
enough about their babies to stop using drugs.” I wondered how Jesus would care for these women, and I thought of Matthew 25:40. I realized that pregnant, addicted women definitely qualify as “the least of these.”
“And the King will answer them, ‘Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.’” —Matthew 25:40, ESV
I continued studying, and once I got my feet under me and felt I had learned enough, I contacted some of the local obstetric healthcare professionals and told them I would be happy to see any women they had who struggled with opiate problems. I received enthusiastic responses and heard over and over that it was nice to have someone who actually wanted to see their patients. The pregnant women were usually less than enthusiastic to meet me—terrified would be a better description. The fear usually dissolved quickly, though, as I was able to show them the love of Jesus and tell them that I only treat addiction because I care about them, I want them to have a healthy pregnancy and a healthy baby, and I want to help them keep their baby. This is where the miracles start to come in. In the four years I have been caring for pregnant women with addiction, only one of my 30+ patients does not have custody of her child. I saw I had a tremendous opportunity to speak into these vulnerable young women’s lives. Countless times I have had patients miss appointments, and when I ask them why they didn’t come, they tell me they were called into work. Out of fear of losing their jobs, they never want to tell their employer that they have a doctor’s appointment. This gives me the opportunity to tell them that they won’t be fired (that would be against the law with pregnancy being a protected health class), but, even more importantly, it gives me the opportunity to tell them they have value and it is ok for them to stand up for themselves. Many young women have welled up with tears at this point, telling me that I was the first person in their lives to tell them they have value. Addiction treatment gives me numerous opportunities to share my faith, as addiction treatment relies heavily on 12step programs and other forms of spiritual support. As an addiction doctor, I am required to talk to my patients about their spiritual lives. God had already provided for that need, as my church has an active Beyond Addictions program to which I can refer my patients. “You go to a church that likes addicts?” I am often asked. Yes, I do. Moreover, spiritual treatment has been shown to be an incredibly effective treatment for addiction. 26 TODAY'S CHRISTIAN DOCTOR Spring 2020
As part of my training in becoming a board certified addictionologist, I watched a recorded breakout session about 12-step programs like Alcoholics Anonymous (AA). During the session, there were multiple paper presentations on why 12-step programs work, followed by a roundtable discussion. The papers went over many possible ways 12-step programs could be effective. Perhaps it was the peer support, perhaps the groups attract the more motivated people or perhaps the 12-step participants might have less severe addictions to begin with, have less severe psychiatric comorbidities, are more motivated or have better social support. One by one, the studies showed that each of these possibilities was not the cause for the success of AA. Overall, 30 percent of people who show up to AA or other 12-step programs find long-term sobriety, but one subgroup brings almost all the success: those who have a “spiritual transformation” have a 92 percent long-term success rate. After much discussion on this point and the panel lamenting over their inability to find any other reason for the success of AA, the moderator closed the session by stating, “It is obvious that we will need to continue to work on researching this subject or else we will be at risk of endorsing religion.” I, for one, have no problem endorsing religion or, more specifically, Jesus as the ultimate treatment for addiction. Simply endorsing Jesus to my patients is not enough, though. I learned long ago the benefit of intentional prayer, so starting with my first addiction patient, I kept a list of the first names of every addiction patient I have treated, and I pray over that list every day. God has been faithful. In the
five years I have been practicing addiction, not one of the 500+ patients I have treated for addiction has died. According to the national mortality statistics, somewhere between 35 and 75 of those patients “should” have died. Just before writing this article I double-checked, and all my patients are still alive. Only God can bring such success. After building on a foundation of Jesus’s ability to change lives and covering my addiction ministry with prayer, I must earn the right to speak into my patients’ lives. I have found that the love of Jesus expressed in genuine concern for my patients’ well-being earns me the right to tell them about my relationship with Christ. I begin by telling my patients that my first priority is keeping them alive, since live patients are the best type. Suboxone reduces the risk of death from opiate overdose by 70 percent. I also explain that it evens out their brain chemistry so they can start thinking normally again. Next, I tell them that I am going to help them with their anxiety and depression (1 percent of the general population has bipolar disorder, but 70 percent of addiction patients have bipolar.) By treating their psychiatric needs, I show my concern for them as people. I then explain how, once I have met their physical, emotional and psychiatric needs, I will begin to help them build a new and better life. I tell them that I do not treat
addiction because I take any joy in taking away anyone’s joint or beer—I treat addiction to give people better lives. As I cast a vision of a better life, I can introduce them to true life in Jesus. As I seek to introduce my patients to Jesus, I have had the opportunity to build relationships with other local churches and refer people who struggle with addiction to their Celebrate Recovery and God-based 12-step programs. In return, they end up sending new patients back to me. Further, I have been given the opportunity to support the local crisis pregnancy center, CareNet, by fielding calls to talk to addicted moms. No matter how busy my schedule looks, I am amazed how God always clears that schedule to take a call when CareNet needs me. If I had been told in residency that God would have called me to the very thing I hated—adolescent obstetric addiction medicine—I would have taken that as a curse or cruel joke. However, now I see it as a great gift from God, a gift that has come with countless blessings and miracles. I hope this article has shown how exciting and fulfilling addiction treatment can be. If you are interested in treating people who struggle with addiction and opening amazing doors to ministry, you can visit the American Society of Addiction Medicine (ASAM) website at www.asam.org and look at the buprenorphine waver course. Many local ASAM chapters also offer free buprenorphine waver courses for interested physicians. BIBLIOGRAPHY 1 https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1. htm?s_cid=mm675152e1_w 2 https://www.who.int/bulletin/volumes/91/2/12-108282/en/
TIMOTHY ALLEN, MD, practices family medicine and addiction medicine with his wife Nikki Allen, MD, at their clinic, Allen Family Medicine, in Cudahy, Wisconsin. They have been members of CMDA since starting medical school. He attended California State University Sacramento prior to graduating from the Medical College of Wisconsin in 2001, completed St. Luke’s Family Practice Residency in Milwaukee, Wisconsin in 2004 and was board certified in addiction medicine in 2015. He and Nikki have been married for 20 years, and they have four children and one grandchild.
Transformed Doctors ➤ Transforming the World www.cmda.org 27
CMDA Ethics Statement on Advance Directives
Whereas modern medicine has made available technologies that can prolong life, medical science alone cannot answer questions of whether life-sustaining technologies should be used in particular circumstances or whether such technologies are consistent with patients’ goals of care, values, and beliefs about health, life, and death. Therefore, patients should have the opportunity, while they have capacity, to indicate their desires about the use or nonuse of specific treatment modalities and to designate a surrogate (sometimes called healthcare proxy or agent) to make decisions on their behalf if they become incapacitated.
DEFINITIONS:
1. Advance Care Planning: the ongoing process whereby the patient, in conversation with family and healthcare professionals, receives information about the types of life-sustaining treatments that are available, shares personal values, and makes decisions about medical care the patient would want to receive if no longer able to speak for himself or herself. Advance care planning may lead to completing a written advance directive. EARN CE CREDIT You can now earn continuing education credits through Today’s Chris2. Advance Directive (or Advance Medical Directive): tian Doctor. Two hours of self-instruction are available for this article. See a patient’s medical directive, which may be a dispage 31 for more information. cussion, a written statement, or an audio or video recording, specifying what medical actions should be taken for the patient if, because of incapacity, the patient e. DNI (Do Not Intubate): a physician’s order, placed with is no longer able to make decisions for himself or herself. An the patient’s or surrogate’s consent, specifying the withadvance directive is a legal document. An advance directive holding of endotracheal intubation and ventilatory suphas inherent limitations; as a static document, it may not port during cardiac arrest or non-arrest circumstances. anticipate all developing clinical scenarios as medical cirf. POLST (Physician Orders for Life-Sustaining Treatcumstances change, and it may not reflect the nuances of a ment): actionable physician orders, signed also by the patient’s preferences or choices in every potential context. patient or surrogate, that support other forms of advance Types of advance directives include: directives and are transferrable (implementable) across a. D urable Power of Attorney for Health Care: a legal docuhealthcare settings and the home. These vary in terminolment that authorizes someone the patient trusts to be a ogy and application from state to state, including signature surrogate decision-maker, that is, to make medical deciby APRN or PA rather than physicians only, some examsions on behalf of the patient in the event that the patient ples being: becomes incapacitated. i. POST (Physician Orders for Scope of Treatment) b. Living will: a written statement detailing a person’s desires ii. MOST (Medical Orders for Scope of Treatment) regarding his or her medical treatment in circumstances iii MOLST (Medical Orders for Life-Sustaining Treatin which he or she is no longer able to express informed ment) consent, especially an advance directive. iv. DNR/COLST (Do Not Resuscitate Order / Clinician c. AND (Allow Natural Death): a positive medical term deOrders for Life-Sustaining Treatment) fining the use of life-extending measures that emphasize v. TPOPP (Transportable Physician Orders for Patient comfort rather than life extension. Preferences) d. DNR (Do Not Resuscitate): a physician’s order, placed g. VSED (Voluntarily Stopping Eating and Drinking): the with the patient’s or surrogate’s consent, directing the decision of a patient who has decisional capacity to stop withholding of cardiopulmonary resuscitation (CPR) eating and drinking by mouth for the purpose of hastening and advanced cardiac life support (ACLS) in the event death in the setting of unrelieved suffering. It may include of cardiac or circulatory arrest. DNR means that electria directive not to be hospitalized. cal therapy, chest compressions, external cardiac pacing, or In formulating and applying advance directives, the followany medication intended to reverse cardiac arrest will not ing areas should be considered: be provided to an unresponsive pulseless patient.
28 TODAY'S CHRISTIAN DOCTOR Spring 2020
A. BIBLICAL
1. God who gave us life is ultimately sovereign over the timing of our death. a. There is an appointed time for death (Gen 6:3; Eccl 3:1-2; Psalms 89:48, 116:15, 139:16). b. God is able to intervene in human affairs using natural or supernatural means. He frequently chooses to accomplish his purposes through human hands or medical technology, but he is not limited by those means. c. God may allow suffering at the end of life to accomplish his inscrutable purposes. An advance directive should not be interpreted as seizing that control from God ( Job; 1 Peter 4:19; Romans 5:3-5; 2 Corinthians 12:9). d. The whole counsel of Scripture, as expressed preeminently in the healing ministry of Jesus Christ, endorses the merciful relief of suffering in anticipation of the final defeat of evil, when Christ will wipe away every tear and make all things new (Revelation 21:4-5). e. Death for the Christian is not failure but victory through Christ (Romans 6:8, 14:7-9; 1 Corinthians 15:54-56; 2 Corinthians 5:8; Philippians 1:21-23). 2. We as beings created in the image of God have moral responsibility. Scripture provides guidance on how Christians should view the end of their lives, which is important as a basis for making good decisions regarding healthcare choices. a. We are stewards of our bodies, our health and our resources, and therefore we are responsible to God for our lifestyle and healthcare choices (1 Cor 3:16,17, 6:19-20). b. Scripture provides a moral basis for making healthcare decisions on behalf of others (Mark 12:28-34; Luke 10:25-37; Phil 2:4; Gal 6:2; 1 Tim 5:8). c. O ur inevitable decline in health is never fully within our control ( John 21:18; 2 Cor 4:16). d. There is in Scripture a tension between viewing death as an enemy and as a defeated enemy through Christ. Death is our enemy (1 Cor 15:26,57; Phil 1:21-26). However, death is not the ultimate evil. As Christians we are freed from the fear of death (Heb 2:15).
B. BIOLOGICAL
Aging, illness, and death are inevitable.
C. SOCIAL
1. The expanding powers of medical technology to extend life have contributed to cultural anxiety over the reality of natural death while also presenting patients, their families, and healthcare professionals with difficult decisions. 2. There are many reasons why advance care planning conversations do not occur: a. discomfort in discussing death, b. lack of appreciation of importance, c. lack of understanding of terminology and options, d. a sometimes overwhelming number of potential decisions to be made, e. breakdown in communication because of unresolved family conflict, f. the belief that God will direct the time of death, so we dare not intervene,
g. assumption that the medical system will do what is right, and h. patients’ inability to reflect on or express their values to their surrogates. 3. Decreased interpersonal connectedness, geographical separation of families, divorce, and greater social isolation have contributed to a shift to emphasizing individual autonomy in lieu of authorizing a trusted surrogate decision-maker.
D. MEDICAL
1. CPR is unique among medical procedures in that it is the default, not requiring a patient’s permission. Choosing to forego CPR by electing a DNR is one of the most important decisions a patient and his or her physician can make. If this discussion has not taken place, initiating CPR on a patient who would not desire it can cause considerable end-of-life suffering. 2. Healthcare professionals and patients’ surrogates are frequently faced with difficult end-of-life treatment decisions on behalf of patients who do not have an advance directive or who have not communicated their goals of care. 3. W hen patients opt not to communicate their preferences, once incapacitated, others will decide for them. The ultimate decision-maker may be someone the patient would not have chosen: it may be someone unfamiliar with the patient, or it may not even be a family member; it may be someone whose values the patient would not embrace. 4. The complexities of end-of-life medical choices necessitate naming a surrogate who can speak on behalf of the incapacitated patient as medical circumstances change. 5. Using a patient’s advance directive to limit interventions at the end of life can relieve moral distress of the surrogate decision-maker. 6. POLST orders are actionable across medical settings; as such, they have the benefit of decreasing patients’ moral distress by removing the need to ask patients repeatedly about their end-of-life decisions as care settings change. 7. A limitation of POLST orders is that they are not designed to accommodate context-specific medical decision-making. Additionally, in some states a POLST could be void if it contradicts a pre-existing advance directive. A broad directive to decline resuscitation does not take into account changing clinical circumstances in which, for example, a brief course of mechanical ventilation or cardioversion might enable to the patient to return to his or her previous state of health.
E. ETHICAL
Implementing Advance Directives 1. Advance directives are an important aspect of ethical care. It is imperative for patients and their physicians to discuss goals of care in an unhurried, uninterrupted, and thorough manner. Out of respect for the patient’s dignity, it is essential that the patient understand the potential benefits and burdens of aggressive end-of-life treatment before decisions are made. 2. The benefits and burdens of CPR will vary with the clinical context and, therefore, should be reviewed with the patient or surrogate as the disease context changes. For
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example, CPR performed after a primary cardiac event in an ICU will have far greater benefit and less burden than when attempted outside of the hospital or when the cardiac arrest is caused by a noncardiac process. 3. The patient who has an advance directive has the obligation to communicate it to the potential surrogate and to medical caregivers. 4. The surrogate who is chosen must be willing and able to speak on behalf of the patient and to make difficult decisions when necessary. 5. The designated surrogate is obligated, within legal constraints that may vary by jurisdiction, to follow: a. a “substituted judgment” standard: what he or she thinks the patient would choose if able, or, if that is not possible, b. a “best interest” standard: what a reasonable person in a similar situation would choose.
Treatment and Nontreatment Decisions 6. W hereas suffering can produce strength of character (Romans 5:4), no patient is obligated to forego analgesic interventions. Medical professionals should offer any palliation possible to relieve their patients’ pain and suffering, to the exclusion of intentionally hastening death. 7. When natural death approaches, the option of withholding or withdrawing treatment should always be considered. 8. Patients have the right to refuse any medical treatment. Honoring a patient’s advance directive for nontreatment does not equate to euthanasia. 9. A suicide attempt is not an indication for medical nonintervention. A request by an individual (or surrogate) for discontinuation of life-sustaining treatment shortly after surviving a suicide attempt should not be automatically honored. In these situations time may be needed to allow the patient to transition beyond the coerced state of depression and despair that led to suicidal ideation in order to engage in informed consent about treatment options. Once the medical evaluation is complete, the patient is no longer actively suicidal, and the patient or surrogate has had an opportunity to receive adequate information to make an informed and uncoerced decision, it may be appropriate to carry out a refusal, expressed at the time or through an advance directive, of ongoing treatment of the underlying disease or the medical consequences of the attempted suicide. To discontinue therapy prior to such an evaluation risks making the physician or healthcare team complicit with suicide rather than allowing natural death. 10. A decision to withdraw a medical treatment should not be interpreted as withdrawal of care. Even when nothing more can be done medically to treat a patient’s illness, there is still much that can be done for the patient. While treatments may be discontinued, care should always remain. 11. A DNR status does not mean “do not treat.” 12. Medical technology is inherently expensive, but treatment decisions should not be based primarily on economic considerations. 13. A patient with an advance directive may be a potential organ donor, but treatment decisions should not be based primarily on preserving transplantable organ viability.
30 TODAY'S CHRISTIAN DOCTOR Spring 2020
14. W hen medical indications are unclear or the patient’s prior wishes are uncertain, a medically appropriate time-limited intervention may be an ethical alternative to committing prematurely to an ongoing treatment or nontreatment decision. 15. W hereas the intent of an advance directive is to honor the patient’s autonomy, autonomy is not an absolute principle. Healthcare professionals also have responsibilities not to harm but rather to do good, as well as to listen, to educate, and to provide compassionate care. Making a nontreatment decision in accordance with an advance directive that did not take into account a current unforeseen clinical context, or making a default treatment decision for a patient who did not understand an advance directive document well enough to fill it out, is not necessarily to honor the patient’s autonomy. 16. Not all treatment requests, at the time of care or in an advance directive, are ethically appropriate. In situations where the patient’s request violates the healthcare professional’s moral or religious values, then the healthcare professional should discuss this with the patient and allow transfer of care if the conflict cannot be resolved. (See CMDA position statements on: Assisted Suicide, Euthanasia, Right of Conscience in Health Care) VSED (Voluntarily Stopping Eating and Drinking) 17. Patients have the right to refuse oral eating or drinking and to change their mind. 18. W hether patients should be allowed to request physician assistance in VSED through an advance directive has been a subject of controversy. The decision whether to offer palliation to symptoms of dehydration or starvation needs to be made in the immediate context consistent with the physician’s right of conscience. 19. An ethical dilemma may arise when a cognitively impaired patient who requests food or drink has previously signed a VSED advance directive requesting that healthcare professionals withhold spoon feeding and orally administered hydration. In these situations, it is ethically appropriate to honor the advance directive in regard to medical interventions such as intravenous fluid or tube feedings. However, it is ethically impermissible to withhold ordinary food and water to the patient who requests them, as these represent normal human care and interaction and are not considered medical treatment. Healthcare professionals have the right to offer spoon-fed nutrition and orally administered fluids to all patients who desire them and to whom they can be provided safely. A previously stated desire for VSED should not overrule a conscious patient’s expressed desire for oral feedings. (See CMDA position statements on Artificially Administered Nutrition and Hydration; Double Effect; Euthanasia and Assisted Suicide) POLST (Physician Orders for Life-Sustaining Treatment) 20. Patients may elect to sign a POLST document as an advance directive in the event of serious illness with limited life expectancy. POLST forms should be filled out only after a meaningful discussion with the patient and family or surrogate. The discussion should be doc-
umented in the medical record. These documents are most appropriate for those patients who are terminally ill, are likely to have multiple or frequent interactions with the healthcare system, and have significant chronic or life-limiting illness. 21. Standing orders dictating future treatment decisions are ethically appropriate only if the patient’s preferences are stable over time and across foreseeable clinical contexts. Some forms require review and renewal at least on an annual basis. 22. W hereas POLST is appropriate in regard to CPR, decisions about the use or nonuse of fluids and nutrition and about time-limited treatment trials are better addressed through the patient’s advance directive or discussion of goals of care with the patient’s surrogate than through the automatically invoked POLST form. 23. It is important that physicians whose practice involves end-of-life considerations and consultations be aware of the extent to which these orders are legally binding. 24. Many iterations of POLST orders are exceptionally detailed and complex, and it is incumbent upon healthcare professionals to ensure that the patients and their surrogates have an adequate understanding of the implications of the orders, to the end that the vulnerable are not placed at risk. 25. Efforts to provide comfort care and pain management are always appropriate, and most variations of POLST address this imperative.
CONCLUSION
• The role of the physician is to affirm human life, relieve suffering, and give compassionate, competent care as long as the patient lives. The physician as well as the patient will be held accountable by God, the giver and taker of life. • Advance directives are biblically, medically, and ethically appropriate. Advance directives should be recommended to all adult patients regardless of health and reviewed and updated periodically. • An essential part of an advance directive is the patient’s discussion with designated family or other close associates and the healthcare team about the patient’s values and wishes. • Healthcare professionals should assist patients with advance care planning in accordance with patients’ beliefs, values, and preferences, particularly when they are clearly and consistently expressed. • Conversations about death, dying, and end-of-life medical care should be a routine part of church ministry, focusing not just on eternal destiny, but also on how Christians’ end-oflife decisions should be consistent with their belief that death has been defeated through Jesus Christ. • Advance directives should never be used as a means to physician-assisted suicide or euthanasia. • Healthcare professionals should honor their patients’ medically appropriate advance directives and recognize this as an opportunity to respect their dignity as made in the image of God. Approved by the CMDA House of Delegates Passed Unanimously May 2, 2019 • Ridgecrest
EARN CONTINUING EDUCATION 1 HOUR NOW AVAILABLE
We are now offering continuing education credits through Today’s Christian Doctor. One hour of self-instruction is available. To obtain continuing education credit, you must complete the online test at https://www.surveymonkey.com/ r/2020CMDAstatementAdvDir. • This CE activity is complimentary for CMDA members. • The fee for non-CMDA members is $50.00. For payment information, visit www.cmda.org/cepayment. If you have any questions, please contact CMDA’s Department of Continuing Education Office at ce@cmda.org. Review Date: December 4, 2019 Original Release Date: February 28, 2020 Termination Date: February 27, 2023
EDUCATIONAL OBJECTIVES •A rticulate the nature and intent of an Advance Directive, including the ideal time and circumstance to establish an Advance Directive. • L ist the various types of end-of-life orders, for example, DNR, DNI and POLST. • I dentify the pivotal role for a Durable Power of Attorney and surrogate decisionmakers. •D escribe the biblical, social, medical and ethical considerations surrounding end-of-life planning from a Christian standpoint. ACCREDITATION The Christian Medical & Dental Associations is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
PHYSICIAN CREDIT The Christian Medical & Dental Associations designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
NURSE PRACTITIONER The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines. Nurse practitioners may receive up to 1 credit for completing this activity.
PHYSICIAN ASSISTANT AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit(s)™. by an organization accredited by the ACCME or a recognized state medical society. Physician assistants may receive up to 1 credit for completing this activity.
DENTAL CREDIT CMDA is an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 1/1/2018 to 12/31/2022. Provider ID#218742. 1 Hour Self Instruction Available. No prior level of skill, knowledge, or experience is required (or suggested).
DISCLOSURE None of these authors, planners or faculty have relevant financial relationships. Allen H. Roberts, II, MD, MDiv, MA, FCCP, FACP; Mandi Mooney, CMDA Today’s Christian Doctor Editor; Barbara Snapp, CE Administrator; Sharon Whitmer, EdD, MFT; and CE Committee Members. CMDA CE Review Committee John Pierce, MD, Chair; Jeff Amstutz, DDS; Trish Burgess, MD; Lindsey Clarke, MD; Stan Cobb, DDS; Jon R. Ewig, DDS; Gary Goforth, MD; Elizabeth Heredia, MD; Curtis High, DDS; Bruce MacFadyen, MD; Dale Michels, MD; Shawn Morehead, MD; Michael O’Callaghan, DDS; and Richard Voet, MD THERE IS NO IN-KIND OR COMMERCIAL SUPPORT FOR THIS ACTIVITY.
Transformed Doctors ➤ Transforming the World www.cmda.org 31
REFERENCES
Ache K, Harrold J, Harris P, et al. Are advance directives associated with better hospice care? J Am Geriatr Soc 2014; 62(6): 1091-1096.
Redmann AJ, Brasel KJ, Alexander CG, et al. Use of advance directives for high-risk operations. Ann Surg 2012; 255(3): 418-423.
Bischoff K, O’Riordan DL, Marks AK, et al. Care planning for inpatients referred for palliative care consultation. JAMA Intern Med. 2018; 178(1): 48-54.
Silveira MJ, Kim SYH, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010; 362(13): 1211-1218.
Hickman SE, Keevern E, Hammes BJ. Use of the physician orders for lifesustaining treatment program in the clinical setting: a systematic review of the literature. J Am Ger Soc 2015; 63: 341-350.
Sleasman MJ, Cox M. Special Report: Examining POLST (Physician Orders for Life-Sustaining Treatment). Dignitas 2015; 22 (4). The Center for Bioethics & Human Dignity. Accessed at: https://cbhd.org/Dignitas/Winter-2015-polstsupplement
Ivanović N, Büche D, Fringer. Voluntary stopping of eating and drinking at the end of life – a ‘systematic search and review’ giving insight into an option of hastening death in capacitated adults at the end of life. BMC Palliat Care 2014; 13: 1. doi: 10.1186/1472-684X-13-1 Kaldjian LC.. Erekson ZD Haberle Terre Haute, et al. Code status discussions and goals of care among hospitalized adults. J Med Ethics 2009; 35: 338-342.
Tolle SW, Moss AH, Hickman SE. Assessing evidence for physician orders for life-sustaining treatment programs. JAMA 2016; 315: 2471-2472. Tolle SW, Teno JM. Lessons from Oregon in embracing complexity in end-oflife care. New Engl J Med 2017; 376(11): 1078-1082.
Kapp MB. Overcoming legal impediments to physician orders for life-sustaining treatment. AMA J Ethics 2016; 18: 861-868. Kendra AM, Rubin EB, Halpern SD. The problems with physician orders for life-sustaining treatment. JAMA 2016; 315: 259-260. Olick R. Defining features of advance directives in law and clinical practice. Chest 2012; 141(1): 232-238. Quill TE, Byock IR. Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of food and fluids. ACP-ASIM End-ofLife Care Consensus Panel. American College of Physicians-American Society of Internal Medicine. Ann Intern Med 2000; 132(5): 408-414.
2 7 TH A N N U A L C O N F E R E N C E
Bio ethics & the Bo dy
JUNE 25–27, 2020
IN PARTNERSHIP WITH: American Association of Pro-Life OB|GYNS American College of Pediatricians Americans United for Life Charlotte Lozier Institute
Join us as we examine foundational concepts and bioethical considerations related to the myriad ways in which we view, interact with, manipulate, and analyze our physical bodies. This conference has been approved for up to 40.75 CME Credits and offers preconference, conference, and postconference courses and seminars.
SPONSORED BY: Christian Legal Society Christian Medical & Dental Associations Nurses Christian Fellowship
Albert Gnaegi Center for Health Care Ethics Saint Louis University Alliance Defending Freedom Bioethics Defense Fund
Joni and Friends Pellegrino Center for Clinical Bioethics The Ohio State University Center for Bioethics
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32 TODAY'S CHRISTIAN DOCTOR Spring 2020
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maker insertion) and support is provided by a broad network of North American cardiologists who visit Tenwek regularly. Two to four cardiologists could “job-share” this position if not filled by a single candidate. Tenwek is a 350-bed multi-specialty facility located in the beautiful highlands of Kenya. It has a comfortable climate and is nearby the Masai Mara reserve. For further information, please contact Ron Johannsen at ronandcolleenjohannsen@gmail.com. Affiliate Reproductive Endocrinologist — Protect life and bring joy into the lives of couples unable to carry a pregnancy to full term. The National Embryo Donation Center (NEDC) has reached maximum capacity and needs an affiliate who shares the same Christian worldview and can provide the full range of services currently offered at the NEDC. Over 900 children have been born through embryo adoption at the NEDC since it was founded in 2003, and the program has garnered an outstanding reputation with a success rate above the national norm. Affiliate physician must be a reproductive endocrinologist (REI) who is board certified/board eligible. Contact Dr. Jeff Keenan at 865-777-0088 or email jkeenan@ baby4me.net. Go to www.embryodonation.org.
Disciple-making Physicians — Do you long to see God work through your medical practice? We are the largest vasectomy reversal practice in the U.S. We plant God’s field for new birth in body and spirit. We train physicians spiritually and medically. If you proficiently enjoy simple skin suturing; if you want to make disciple-making disciples of Jesus among your patients; and if God is calling you to this work, we can train you in this medical ministry to fulfill the Great Commission. Come join us at our Warwick, Rhode Island location. We are also eager to talk with medical students about future clinic locations. Contact drdavid@thereversalclinic.com.
Family Medicine — Family medicine opportunity in Watertown, South Dakota. Sanford Clinic Watertown is a multi-specialty clinic seeking three BC/BE family medicine physicians to join the current practice. Practice details: OB is optional; start with an already built practice; FP office visits average 5,000+ per year; peds call only - hospitalists are utilized for adult admits and in-patient care (pediatricians do all of the high risk neo-natal delivery calls); office hours typically 8:30 a.m. to 5 p.m. with a Saturday morning urgent care held from 8:30 am to 11:30 am; staffed by a physician on a rotating basis that is the same weekend as your weekend call to allow the physician more personal time away from the clinic; you can also expect a full complement of ancillary services. This position offers an excellent compensation/benefit package with a retention incentive and relocation allowance; malpractice and tail coverage; and CME time and allowance just to name a few. Watertown, South Dakota provides a high quality of life, affordable living, safe environment, superb schools and the ability to experience the beauty of all four seasons. For more information contact, Physician Recruiter Deb Salava at 605-328-6993 or debra.salava@sanfordhealth.org. Internal Medicine Hospitalist — A mazing internal medicine hospitalist opportunity in Alabama. Established 14-physician hospitalist group. Loan assistance packages available! Strong churches in both communities. Several members of the group are believers with a missional focus. International and local missions opportunities through local CMDA chapter. Full service 314-bed regional referral center, unbeatable quality of life. Bedroom community to Auburn University. Auburn-Opelika is rapidly growing yet maintains the charm of a small town. SEC sports, national golf trail, outdoor activities (hunting, lakes, rivers, hiking/biking). Superb school systems. Proximity to major metro areas (Columbus and Atlanta, Georgia; Montgomery and Birmingham, Ala-
34 TODAY'S CHRISTIAN DOCTOR Spring 2020
bama) and equidistant from the Smoky Mountains and Florida Gulf Coast! Day positions (hybrid and 7-on/7-off options) and nocturnist positions available. Base pay of $260,000 for day and $290,000 for nights. Performance and productivity bonus packages. Excellent benefits package including the following: professional liability insurance, generous vacation schedule, continuing medical education, subject to a cap of $3,500 per contract year, 401(k) plan, subject to a cap equal to 4% of salary, professional licensing fees, dues, subscriptions, cell phone expenses, subject to a cap of $2,000 per contract year. Contact: Steven Presley, MD, MMM, Medical Director, IMA Hospitalists@EAMC, steven.presley@eamc.org. OB/Gyn - Southwestern Medical Clinic, Center for Women’s Health in Niles is seeking a full-time OB/ Gyn to join our multi-disciplinary team. Competitive compensation package with initial salary guarantee, signing bonus and opportunity to earn productivity bonuses. Preferred candidate will provide a full range of services including antepartum, intrapartum, postpartum, well-woman care and gynecological care. Epic EHR. Join a team of providers that is passionate about providing Christ-centered medicine at home and participating in medical missions abroad. Over the past 50 years, Southwestern Medical Clinic of Lakeland has proudly served residents of Southwest Michigan and underserved communities all over the world! Spectrum Health Lakeland, ranked a 15 Top Health System in 2019 by IBM Watson Health, is a teaching hospital, offering residency program in a variety of specialties. Recruitment and benefits package: competitive market-based compensation and benefits; relocation assistance; interview expenses covered. Southwest Michigan is one of the most affordable places to live in Michigan, offering access to excellent public and parochial schools and a variety of outdoor and cultural activities only 90 minutes from Chicago. To learn more, contact Chad Simcox at csimcox@lakelandhealth.org or 269985-4485.
Pediatrician — S eeking a pediatrician for a group practice in Montgomery, Alabama. A busy general pediatrics group of four doctors looking for a fulltime pediatrician to replace a retiring physician in Montgomery, Alabama. Four-day work week, attractive call, three hours from the beaches and solid patient base. Practice was established 37 years ago. All pediatricians are believers and are seeking a likeminded partner. Contact Den Trumbull at TrumbullD3@gmail.com or 334-273-9700.
Pediatrician — Opportunity available in Watertown, South Dakota. Sanford Watertown Clinic is seeking a board certified/board eligible pediatrician. Practice details: multi-specialty group with pediatrics, OB/Gyn, radiology, family medicine, internal medicine and general surgery; traditional practice including newborn nursery; you can also expect a full complement of ancillary services. This position offers an excellent compensation/benefit package with a retention incentive and relocation allowance; malpractice and tail coverage; and CME time and allowance just to name a few. Watertown, South Dakota provides a high quality of life, affordable living, safe environment, superb schools and the ability to experience the beauty of all four seasons. For more information contact, Physician Recruiter Mary Jo Burkman at 605-328-6996 or mary.jo.burkman@sanfordhealth.org.
Psychiatrist — B iola University Student Health Center seeks part-time board certified psychiatrist. Join our team of dedicated Christian healthcare professionals serving college students! Hourly pay, no billing, flexible hours. Job description and application available at https://biola.csod.com/ats/careersite/ JobDetails.aspx?site=1&id=1315.
CMDA PLACEMENT SERVICES
BRINGING TOGETHER HEALTHCARE PROFESSIONALS TO FURTHER GOD’S KINGDOM We exist to glorify God by placing healthcare professionals and assisting them in finding God’s will for their careers. Our goal is to place healthcare professionals in an environment that will encourage ministry and also be pleasing to God. We make connections across the U.S. for physicians, dentists, other healthcare professionals and practices. We have an established network consisting of hundreds of opportunities in various specialties. You will benefit from our experience and guidance. Every placement carries its own set of challenges. We want to get to know you on a personal basis to help find the perfect fit for you and your practice.
P.O. Box 7500 • Bristol, TN 37621 888-690-9054 www.cmda.org/placement placement@cmda.org
“Our practice has a long history with CMDA. One of the partners in our practice was presented to us over 20 years ago by CMDA. Since we are a faith-based practice, we are looking for healthcare professionals with the same vision we have. The recruiters at CMDA have taken the time to understand our mission/vision and have worked with us to recruit Christian physicians and mid-levels for over 20 years. It has been my pleasure to work with various employees and recruiters with CMDA. In my position, I have had the opportunity to work with various recruiting agencies through the years, and CMDA has been and still is one of our most preferred agencies.” —Donna J. Warner Human Resources Manager Family Medical Center of Rocky Mount
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CMDA Podcast Network www.cmda.org/podcasts
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CMDA Matters
Dental Soundbytes
Host: Mike Chupp, MD, FACS
Host: Bill “Griff” Griffin, DDS
A weekly podcast with the latest news from CMDA and healthcare
A regular podcast from CMDA’s Dental Ministries with topics for dentists
3 Healthy Doctor
A monthly podcast from CMDA’s Center for Well-being Host: Steve Sartori, MD
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Let’s Go GHO
Student Pulse
Host: Trish Burgess, MD
Host: Bill Reichart, MDiv
A podcast from Global A podcast for healthcare Health Outreach, a shortstudents from CMDA’s term missions program National Student Community
In His Image provided me with excellent medical training and also showed me how to use medicine as a ministry and see each patient as Christ does. Through the Spiritual Curriculum, Counseling Track, mentorship of exemplary faculty physicians and fellowship with like-minded residents, my heart continued to grow for those in need around me. My husband and I were encouraged and challenged to grow as a couple through weekly Bible Studies, conferences and retreats sponsored by IHI. We believe that IHI helped equip and spur us on toward a calling God placed on our hearts serving the underserved! I am currently working at a rural federally qualified health center in a diverse community, serving for God’s glory.
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