Ministries of the Christian Medical & Dental Associations
®
Editor’s Note: This two-page section has been prepared for you to tear out and keep as an easy reference and contact list for CMDA’s resources, services, and ministry opportunities. Use it to show your colleagues what CMDA is doing and also as a guide for your prayers for our ministries and those who lead each effort. Go to www.cmda.org/ministryoverview for the latest revisions.
Transformation 1. Campus Ministries [ccm@cmda.org] A team of over 50 staff who have organized campus Bible Studies, mission teams, leadership training, and outreach functions on over 326 medical and dental campuses in the US. 2. Christian Dental Association® [Will Gunnels - wdgunnels@ charter.net] Encouraging and supporting dentists in living out their Christian faith in their professional and personal lives. 3. Chapel and Prayer Ministries [Debra Deyton - debra.deyton@ cmda.org] Mobilization of staff and members to pray on a daily basis. 4. Local Ministry Groups [ccm@cmda.org] An opportunity for members to connect with fellow members to provide mentoring and ministry resources to assist them in their educational and professional careers. 5. Saline Solution [Melinda Mitchell - melinda.mitchell@cmda.org] Training for healthcare providers via conferences or a small-group video series on how to appropriately and effectively help their patients with spiritual issues. 6. Side By Side [Cassie Porterfield - sidebyside@cmda.org] A Bible study based outreach ministry to female medical/dental spouses.
Services 7. Christian Doctor’s Digest [Rusty Sluder - digitalmedia@cmda.org & Margie Shealy - communications@cmda.org] Bimonthly audio magazine resource containing interviews on timely topics of interest to doctors and their families. 8. Center for Medical Missions [Susan Carter, BSN, MPH susan.carter@cmda.org] A CMDA department aiding in the recruitment, training, and retention of career medical missionaries, including pre-field orientation training for new medical missionaries. 9. CMDA Leadership - Board of Trustees [President of CMDA, George Gonzalez, MD - board@cmda.org] The Board of Trustees, which meets three times a year, is the governing body of CMDA. It makes policy, strategically sets the goals for the organization, and provides financial oversight. The CMDA House of Representatives (HOR) represents local councils, states, students, residents, missionaries, Commissions, and Specialty Sections. They meet annually to promote the mission, vision, and needs of CMDA. The HOR exists to provide a voice for all CMDA members.
10. Commissions [www.cmda.org] Continuing Medical & Dental Education (annual two-week CMDE conference in Kenya or Thailand), Marriage Enrichment (provides weekend retreats each year to help doctors strengthen their marriages), Medical Malpractice Ministry (prayer, resources, and encouragement to doctors experiencing malpractice suits), Pan-African Academy of Christian Surgeons (surgical residencies in African mission hospitals), Singles (networking, conferences, mission trips, and resources to meet the unique needs of single members), and Women in Medicine and Dentistry (conferences, resources, and networking to meet the distinctive needs of women in healthcare). 11. Global Health Outreach (GHO) [Sam Molind, DMD sam.molind@cmda.org] One of CMDA’s short-term mission programs, sending forty to fifty medical/dental mission outreach teams annually. Designed to disciple participants, grow national churches, share the Gospel, and provide care. 12. GAP Program [Sam Molind, DMD - sam.molind@cmda.org] A partnership with Prison Fellowship International to bring health and Christ to prisoners in foreign countries via GHO teams. 13. Global Missions Health Conference [www.medicalmissions.com] A medical/dental mission conference, co-sponsored by CMDA, and held the 2nd weekend in November at Southeastern Christian Church in Louisville, KY, to inform, train, and equip healthcare professionals and students to use their skills to further God’s kingdom. 14. Healthcare for the Poor [www.cmda.org/fourpercentsolution] InnKeepers (applying policies and providing care in a way that reflects God’s heart for the poor), Domestic Missions Outreach (partnership with Christian Community Health Fellowship to maximize efforts toward healthcare for the poor), and the 4 Percent Solution (a commitment of 4% of your time, talent, or treasure to the care of the underserved). 15. Intensive Care [Jamey Campbell - jamey.campbell@cmda.org] A newsletter dedicated to the reporting of changed lives as a result of the generous investment of our members and friends. 16. Medical Education International (MEI) [Shari Falkenheimer, MD mei@cmda.org] An academic teaching program used to spread the gospel to doctors in hard to reach countries. 17. Placement Service [Allen Vicars - allen.vicars@cmda.org] Recruiting service that brings together Christian physicians and practices throughout the US to enhance their ministry and advance the kingdom of God.
18. Scholarships & Grants [www.cmda.org/scholarships] Johnson Short-Term Mission (provides scholarships of up to $1,000 to residents doing rotations in mission hospitals), Owen Grants (for short-term missions for students at Southwestern Medical School), Risser Fund (training and ministry to Third World national orthopaedic doctors), Steury Scholarship Fund ($100,000 awarded annually to a medical student going into career missions), Tami Fisk Mission (for medical personnel desiring mission service in East Asia), and Westra Mission ($200-500 to medical students doing short-term mission trips or rotations overseas). 19. Specialty Sections [sections@cmda.org] Academic, Dentistry, Dermatology, Emergency Medicine, Family Medicine, OB/Gyn, Pediatrics, Psychiatry, and Uniformed Services. These sections equip, network, and provide a voice for CMDA members to their areas of specialty or service. 20. Today’s Christian Doctor [David Biebel, DMin - dbbv1@aol.com] A quarterly magazine with the goal of helping doctors become all that God has designed them to be.
Equipping 21. Affinity Program [www.cmda.org/creditcard] CMDA Credit Card, a rewards program that supports the ministries of CMDA. 22. Audio/Video/Print Resources [www.cmda.org] Just Add Water (DVD resources that provides an “instant” meeting), Life & Health Resources (a distribution service for CMDA-produced and recommended resources), CDD STAT (interviews on timely topics in an audio magazine format), and Life Support (Podcast audio magazine covering topics of interest for students and residents). 23. Conferences [Melinda Mitchell - melinda.mitchell@cmda.org] Annual National Convention and numerous topical, regional, and local conferences listed at: www.cmda.org/meetings. 24. Continuing Medical/Dental Education [Barbara Snapp barbara.snapp@cmda.org] AMA/ACCME and PACE accreditation for medical and dental education. 25. Ethics Committee [423-844-1000] Member volunteers that formulate CMDA’s ethical position statements for Board and House of Representative approval and also provides a bioethicist on-call program to assist members who face difficult patient care decisions. 26. Membership Services [Raquel McLamb - memberservices@ cmda.org] Assists members with information regarding the services and resources available through CMDA, membership renewals, as well as membership recruitment.
News & Views (biweekly public policy education on bioethical issues), Progress Notes (bimonthly regional news and developments at CMDA), SCAN (a summary of major medical journals for medical missionaries), and Your Call (produced bimonthly to encourage and equip those called to career missions). 29. Speaker Referral Bureau [Margie Shealy - communications@ cmda.org] An online self-referal speaker’s bureau of CMDA members. 30. Development/Stewardship Ministries [Jamey Campbell jamey.campbell@cmda.org] An educational service, teaching members to be good stewards of the resources God has given them. 31. CMDA Website www.cmda.org [Margie Shealy - communications@ cmda.org] The organization’s website with over 3,000 pages of resources – position papers, magazine articles, meeting calendars, audio and video files, and other information.
Voice 32. Amicus Curiae Briefs [Jonathan Imbody - washington@ cmda.org] A cooperative endeavor with Christian lawyers to develop legal briefs advocating for life and human dignity in important court cases. 33. American Academy of Medical Ethics® [www.ethicalhealthcare.org] A forum to help train and equip healthcare professionals to adopt the ethical tenets defined by the Hippocratic tradition. 34. Media Training [Margie Shealy - communications@cmda.org or www.cmda.org/mediatraining] Hands-on training to members so they can effectively communicate to the media. 35. News Releases [Margie Shealy - communications@cmda.org] CMDA’s response to breaking news on vital healthcare issues resulting in hundreds of media interviews each year. 36. Professional Testimony [Jonathan Imbody - washington@ cmda.org] Opportunities for CMDA experts to testify before the US Congress and state legislatures. 37. Public Service Announcements (PSAs) [Margie Shealy communications@cmda.org] Library of PSAs on ethical and healthcare topics available to radio stations each year. 38. Standards 4 Life [www.standards4life.org] Free web-based resource for the church or personal education that deals with the scientific and biblical issues surrounding tough bioethical issues in simple, easy-to-understand language.
27. Mission Management Consultation [Susan Carter, BSN, MPH susan.carter@cmda.org] Consultation service offered to international medical mission ministries.
39. State Public Policy Campaigns [Margie Shealy - communications@ cmda.org] Grassroots campaigns to promote life-honoring legislation/referendums at the state level on physician-assisted suicide, embryonic stem cell research, and other issues.
28. Newsletters [www.cmda.org] e-Pistle (monthly training/news for career missionaries), Gift Legacy (monthly stewardship information), Heartchanger Updates (monthly update for regular financial sponsors), Infusion (quarterly orientation for new members),
40. Washington Office [Jonathan Imbody - washington@cmda.org] A liaison with Congress, the administration, and policy organizations, presenting life-honoring perspectives through the national media, and publishing resources on vital issues.
Editorial
by David Stevens, MD, MA (Ethics) – Chief Executive Officer
Slam the Door It is sobering to get measured for a bulletproof vest. Those in the military have had that experience, but it was a new one for me. “Now the Kevlar vest won’t stop some rifle bullets, so you insert this thick metal plate in this pocket to cover the middle of your chest,” the man mentioned offhand. In a monotone voice he went on. “Do you know your hat size, or should I just try on some different helmets till we find one that fits?” It was the first time I wished I had a smaller head, i.e. target! I was heading into Kosovo on a UN plane to do relief work in the midst of civil war. “No helmet, no vest, no flight,” they said, so here I was. On the ground, almost everyone was armed. Not me. Instructions were to “hit the dirt” and “roll to cover” when the bullets started to fly. I found myself wishing they had used the word “if” instead of the word “when.” It was a sovereignty of God check moment – you know, those times when trust is all that can slam the door on fear. You ask, “Is God all powerful and in control of ever millisecond of my life? Is He going to do what is best for me? Is He adequate for this situation?” It is one thing to say you believe these things and another to act on them – to get on the plane, to bet your life on God. Psalm 91:5 says to believers, “You will not fear the terror of night . . . .” What is that terror for you? Is it the diagnosis of terminal diagnosis, news of a sudden accident, or fear of something God has asked you to do? Sadly, we live in world of death and sorrow. There is plenty to worry about, from war, to financial collapse, to our children going down the wrong path. Without a deep trust in God’s sovereignty and His love for us, we “lose it” – our peace and serenity evaporate. We don’t live as Christians snuggled in the lap of our heavenly Father, but as anxious and worried children. What is our problem?
It boils down to unbelief. We shamelessly push God off His throne and try to get on it ourselves. We try to take control of our life and through our human wisdom, effort, or abilities we try to prevent problems or get ourselves out of them. The harder we try to protect ourselves the more we lose our personal contentment and witness to others. As Matthew 16:25 states, “. . . whoever wants to save his life will lose it, but whoever loses his life for me will find it.” When we focus on our security instead of God’s sovereignty, we are not happy with ourselves nor are we attractive to unbelievers. We miss the adventure of a total dependence on God and a sense of His presence. For me and perhaps for you, it is easier to fall on my knees and trust God in tragic or particularly dangerous situations. My main problem is my daily performance on the stage of life. I get anxious about getting things done on time, dealing with a thorny problem, or about finances. Ridiculous isn’t it? God has numbered every (graying) hair on my head, yet I am worrying about what will happen when I speak at next week’s conference. For you it may be how you will deal with a difficult patient, a difficult colleague, or a difficult relationship. Good news! He has got that covered. He will be there and His power is sufficient. In this issue, we are going to explore the depth and breadth of God’s sovereignty. We will let Scripture impress on our hearts and minds that “We win,” because God is omnipotent and omniscient. He is constantly on watch, a faithful friend, and a sleepless guardian for us. He permits nothing to happen that He has not allowed. He sees the whole picture before any paint is applied to the canvas of our lives. How foolish to grasp the master artist’s brush. So read and meditate on the articles that follow. You could learn, like Paul did, “. . . the secret of being content in any and every situation . . .” (Phil. 4:12). ✝
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table of
CONTENTS
V OLUME 4 0 , N O. 4
Winter 2009
The Christian Medical & Dental Associations® – Changing Hearts in Healthcare – since 1931.
Cover photo: “Earth Rise,” taken by the crew of Apollo 11 (Courtesy NASA)
Features 13 The Sovereignty of God by Richard A. Swenson, MD In times of such epic transition and complexity, peace is found in the One Who knows the end from the beginning
17 Lord, Is it You? by Georganne W. Long, MD (with Mary Z. Smith) In the face of life’s most difficult decisions, sometimes the most profound answer is, “Trust Me”
20 Professionalism in Peril Third in a Six-Part Series by Gene Rudd, MD “Professional” requires faithfulness to one’s patients
23 In the Unlikely Event of a Water Landing by Andrew Jamison, MD How surviving the crash of Flight 1549 has created opportunities for witness and personal growth
26 Clinical Ethics Case Consultation When should the family challenge the patient’s medical directives? by Ferdinand D. (Nick) Yates Jr., MD, MA (Bioethics) Column Editor
28 The New Testament is Reliable Eighth in a series of nine apologetics articles by Robert W. Martin III, MD, MAR
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Progress Notes Advertising Section
T o d a y ’s C h r i s t i a n D o c t o r
30 Lord, We Need to Talk by Dan Crabtree, MD Against all odds, this doctor keeps walking by faith, blogging as he goes
Editor: David B. Biebel, DMin Editorial Committee: Gregg Albers, MD; Elizabeth Buchinsky, MD; John Crouch, MD; William C. Forbes, DDS; Curtis E. Harris, MD, JD; Rebecca Klint-Townsend, MD; Bruce MacFadyen, MD; Samuel E. Molind, DMD; Robert D. Orr, MD; Richard A. Swenson, MD Vice President for Communications: Margie Shealy Classified Ad Sales: Margie Shealy 423-844-1000 Display Ad Sales: Margie Shealy 423-844-1000 Design: Judy Johnson Printing: Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). TODAY’S CHRISTIAN DOCTOR ®, registered with the US Patent and Trademark Office. ISSN 0009-546X, Winter 2009 Volume XL, No. 4. 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 © 2009, Christian Medical & Dental Associations ®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tenn. Postmaster: Send address changes to: Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Scripture references marked (NASB) are taken from the New American Standard Bible. Copyright© 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977 by the Lockman Foundation. Used by permission. Scripture references marked (KJV) are taken from King James Version. Scripture references marked Living Bible are from The Living Bible© 1971, Tyndale House Publishers. All rights reserved. Undesignated biblical references are from the Holy Bible, New International Version®. Copyright© 1973, 1978, 1984 by the International Bible Society. Used by permission. All rights reserved. Other versions used are noted in the text.
For membership information, contact the Christian Medical & Dental Associations at: P.O. Box 7500, Bristol, TN 37621-7500; Telephone: 423-844-1000, or toll-free, 1-888-230-2637; Fax: 423-844-1005; E-mail: memberservices@cmda.org; Website: http://www.joincmda.org. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product, or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice, or instruction.
National Conference Awards Editor’s note: The following awards are presented annually by CMDA. The award summaries are based on the actual statements involved, which can be accessed at: www.cmda.org/2009awards. Award presentation photos include CMDA outgoing President, Dr. Bruce MacFadyen (on the left in each photo).
Servant of Christ - Robert D. Orr, MD, CM Established in 1972, the Servant of Christ Award honors those whose careers have blended well the attributes of a commitment to Christ and service to others, and those who have demonstrated a remarkable commitment to excellence in the field of missions, research, patient care, or medical ethics. Dr. Robert Orr is Professor of Bioethics at Loma Linda University and Director of Clinical Ethics at Loma Linda University Medical Center. He has co-authored two books, co-edited three others, contributed eleven book chapters, and over 100 articles related to clinical ethics, the ethics consultation process, and issues in terminal care. Dr. Orr has given lectures on these topics in thirty states and on six continents. He chaired the Council on Ethical Affairs for the California Medical Association, and was Vice President of the American Society for Bioethics and the Humanities. He has been on the Advisory Board of the Center for Bioethics and Human Dignity since its founding in 1994. In 2006, Dr. Orr served as the first Scholar in Residence at the Kilns, the restored home of C.S. Lewis in Oxford, England, while completing a first draft of his forthcoming book, Medical Ethics and the Faith Factor (Eerdmans, 2009). Dr. Orr has been active in the Christian Medical & Dental Associations since 1968, serving on the Ethics Committee (chairman 1991-94) and on the Board of Trustees, lecturing frequently, and mentoring medical students. In addition, he has participated in numerous CMDA outreach programs including Medical Group Mission, and the Commission On International Medical Educational Affairs (now Medical Education International).
Missionaries of the Year Donald Duvall, MD, and Sarah Duvall, MD This award is presented to missionary doctors whose lives demonstrate a passion for reaching people with the Gospel of Jesus Christ. In 1973, Drs. Sarah Eddleman Duvall and Donald Graham Duvall began their journey teaching the people of Indonesia about the love of God. Both served at the Kediri Baptist Hospital, Donald as general surgeon, later becoming the Director of the Hospital and - Continued on Next Page I n t e r n e t W e b s i t e : w w w. c m d a . o r g
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Missionaries of the Year (continued) Sarah, in addition to her work in obstetrics and gynecology, home schooled their three children. As members of the Setia Bakti Baptist Church in Kediri, Sarah established a young people’s choir and led them in Bible studies. Don served as a deacon in the church, preached often in the mother church, as well as the missions of the church. Through the Duvalls’ service at the Kediri hospital, new churches were established, thus multiplying their outreach to the lost. Donald worked tirelessly in general surgery. As is common among medical missionaries, his responsibilities included
orthopedics, urology, plastic and reconstructive surgery, obstetrics and gynecology, trauma, radiology, oncology, and intensive care. Donald also taught anatomy, physiology, and general surgery at the Kediri Baptist Hospital. He designed and oversaw the construction of an X-ray facility and other construction projects. Sarah also taught midwives and nurses in the nursing school as well as trained Indonesian physicians in obstetrics and gynecology. With more than three decades of full-time medical missions the Duvalls created a legacy of exemplary service.
Educator of the Year - John D. Mellinger, MD The CMDA Educator of the Year Award is presented to medical professionals who are exceptionally dedicated to medical or dental education. These devoted individuals strive to provide the best education to those who God places in their path. They take the time to share their knowledge, integrity and compassion. They inspire others to not only academic excellence, but personal and spiritual excellence as well. Having been a CMDA member for nearly thirty years, Dr. Mellinger serves on the Commission for Medical & Dental Education as Academic Dean, and on the advisory council for the PanAfrican Academy of Christian Surgeons. He has presented eighteen times at the Continuing Medical Education Conferences in Kenya and Thailand since 2002. His teaching in surgery and medical education has been acclaimed in these venues. Dr. Mellinger’s contributions in medical teaching and research have also been recognized in universities over the last
two decades. He has received multiple Outstanding Teacher Awards, including from Wright State University, Michigan State University/Grand Rapids Campus, the Medical College of Georgia, and the Association for Surgical Education. He received the Best Doctors in America Award in 2007, 2008, and 2009. He serves in leadership and board roles with several national surgical and educational organizations. In addition to writing numerous abstracts, poster and video presentations, Dr. Mellinger has contributed to twenty-eight peer-reviewed publications, fourteen review articles, and he has written seventeen book chapters. Colleagues describe Dr. Mellinger’s leadership as academically excellent, pedagogically creative, personally warm, and spiritually sensitive. His deep faith permeates all of his life and serves as an inspiration to colleagues and students who admire and seek to emulate his gentle spirit and his outstanding professional achievements.
Did You Know? v Just in time for Christmas, CMDA Gift Certificates are available online at: www.shopcmda.org. Great gifts for family, friends, church, and staff. v CMDA is now on Twitter, follow us at: www.twitter.com/cmdanational. v CMDA has a new Facebook Fan page. You can find us via any search engine. v CMDA’s website (www.cmda.org) has over 3,000 pages of information from resources to mission opportunities, interviews on healthcare reform, and videos on right of conscience. v CMDA has a weekly devotional blog at: http://cmdadevotional.blogspot.com, and Jonathan Imbody, Vice President for Government Relations’ blog on healthcare right of conscience can be followed at: http://freedom2care.blogspot.com. v A great value! CMDA members receive 50% off of classified advertising and 30% off of display advertising in Today’s Christian Doctor. Additional web advertising is minimal cost. Contact Margie Shealy: 423-844-1000.
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CMDA Hosts First Webcast “Grand Rounds on Healthcare Reform”
Dr. Linda Wrede-Seaman Receives Award
“The Good, The Bad & the Ugly” webcast aired live on Tuesday, September 29 from our studios in Bristol, TN. Drs. David Stevens and Gene Rudd hosted the event with Congressman Chris Smith; Jonathan Imbody, CMDA VP for Government Relations; Douglas Johnson, National Right to Life; Claude Allen, Gerard Health Foundation (former Domestic Policy Advisor to the President, Deputy Secretary of the Department of Health and Human Services); and, David C. Christensen, Family Research Council joining them via telephone. For those who missed it, or those who may want to view it again (as well as other videos) go to: www.livestream.com/cmda. Plans are being made for other webcasts in the future with e-mail notifications. So, if we don’t have your e-mail address, go to: www.cmda.org/emailupdate or call Member Services: (888) 230-2637.
Linda Wrede-Seaman, MD, a 1981 University of Kentucky College of Medicine graduate, is the recipient of the UK Medical Alumni Association's Commonwealth Award. This award is the highest honor of the Medical Alumni Association and is given to an exemplary alumnus for contributions to and leadership in the field of medicine. Dr. Wrede-Seaman is triple-boarded in Family Medicine, Emergency Medicine, and Hospice and Palliative Medicine. She is known as an early pioneer in the field of palliative medicine, serving both as a board member and executive committee member with the American Academy of Hospice and Palliative Medicine. She has spent nearly two decades in active public speaking and policy development for improving an integrated management plan for better pain and other distressing symptoms common at end of life.
NEWS NOTES
CMDA Member Launches Radio Program
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David Fisher, MD, MPH, CMDA member, and graduate of CMDA’s “Voice of Christian Doctors” media training, has launched a one-hour live radio show in his hometown of Chicago on 560AM WIND. “House Calls” features Dr. Fisher’s opinions on the latest health news, and Dr. Fisher will answer health questions from callers and those submitted by e-mail. The show, which airs at 10 p.m. Central time on Sunday evenings, can be streamed live at www.560wind.com or podcast anytime at www.radiohousecalls.com.
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In Awe of God’s Sovereign Grace
George Gonzalez, MD President – CMDA
Looking back over more than thirtyfive years since I came to know Christ, I am in awe of God’s guiding hand, His mercy, and grace. Even before I met Christ personally, seeds had been planted in my heart through believing friends and the prayers of my mother. When I was considering colleges at age 17, a friend I had first met in South America encouraged me to apply to UC Davis, where I later was accepted. When I arrived at UC Davis, I was assigned a dorm room with Christians on either side, one of whom led me to Christ my first week of college. I was introduced to CMDA during my first year at UCLA Medical School,
when I was encouraged through a difficult time by Joe Ludders, an area director of CMS (which later became CMDA) at that time. I had had what I thought was a divine appointment to talk to a dying teenager who had been interviewed in front of our medical school class. My heart went out to her, since she had expressed such hopelessness with a terminal illness. I, along with two other medical students, went to visit her to tell her of the hope there is in Christ. We learned, through our first and only visit, that she had a Jewish background but no understanding of Jehovah God and the promised messiah. She wasn’t ready to receive Christ, so I left her some Christian literature and our phone numbers if she would like to discuss this further. We also mentioned that we would be praying for her. My professional career as a physician practically ended before it ever got started, when the next day I was called into the Dean’s office and told the child’s parents were very offended by my actions. I was placed on probation for the rest of my years at UCLA,
to be suspended if I was ever to share my faith with another patient. I was also asked to meet with a psychiatrist for a specified number of sessions and to organize a seminar on medicine and personal faith - how to separate the two. This was but another example of God opening doors, as I was able to invite physicians of different faith and convictions. All but one ex-Christian missionary felt you could not separate your faith from your practice of medicine, while of course honoring the beliefs of the vulnerable patient. I learned much through that experience, especially how to be dependent and reliant on Christ. And I could clearly see the truth of Proverbs 16:9, “In his heart a man plans his course, but the Lord determines his steps.” We serve a mighty God who loves us, orchestrated our birth, salvation, the work we are called to do, and most importantly who has a place prepared in heaven for all who believe in His Son. Praise the Lord.
Regional Ministries
Global Health Outreach (GHO) God Sightings
Fellowship behind prison walls is “close to heaven”
“God Sightings” are a highlight for many GHO participants, as they learn to identify God’s manifestations during our clinic and outreach days. This concept comes from that marvelous passage in Matthew 25:31-46 when Jesus challenged His disciples to minister to the hungry, thirsty, strangers, naked, sick, and prisoners. Jesus said, “. . . to the extent that you did it to one of these brothers of Mine, even the least of them, you did it to Me” (Matt. 25:40, NASV). GHO has been blessed to partner for over a decade with Prison
by Ron Brown, GHO Associate Director
Fellowship International (PFI) as we have gone to Africa and Latin America to serve prisoners in over a dozen countries, where we’ve often found the King and His kingdom behind bars. Ironically, some of the most liberated believers I have ever met on GHO missions happen to live behind bars – totally set free within their souls and minds through the transformation of Jesus Christ. God has called some of our CMDA members to minister through medicine and dentistry among inmates here in the US. This is great preparation, though not required, for going on a GHO team to serve inmates in another country. My experience in serving inmates in Latin America and the Caribbean has shown me that, for the vast majority of the inmates, our service is greatly appreciated, which is expressed verbally, through gestures, and lots of smiles. Because of the appreciation felt by the inmates, as
For InFormatIon about GHo opportunItIes, VIsIt:
well as the security provided by the guards and prison officials, it is a relatively safe and secure setting. And when you are among inmate believers during their worship and praise times, you may agree with me that it is as close to heaven as you can get, living on this side of heaven, albeit inside a prison. So the next time you see that a GHO team is headed to a prison setting with PFI, or that one of our local churches is hosting such a trip (like in the Dominican Republic, where there is no PFI chapter) why not go with us? You may experience the ministry of a lifetime. Many GHO veterans (both men and women), who have participated in multiple prison GHO teams, have told me that these trips are among their best experiences of “God Sightings,” as God manifests Himself in very special ways behind prison bars. Of course, after reading the book of Acts, this should not surprise us!
www .cmda.orG/GHo
The Psalmist exclaimed, “The heavens declare the glory of God; the skies proclaim the work of His hands” (Ps 91:1). Dr. Richard Swenson asserts that, in fact, all of nature reveals a God who constantly nurtures and sustains His creation – including our own bodies – in ways that we can scarcely comprehend. Drawing on his background in medicine and the natural sciences, Dr. Swenson examines the wonders of creation and explains how they reveal a majestic God whose mastery of detail is evident everywhere, from the breathtaking complexity of living cells to the awesome grandeur of the cosmos. He shows us a God whose genius, power, sophistication, and artistry shout from every element of our Universe. With evidence from both science and Scripture, Swenson helps us see ourselves as God sees us – treasured creations with whom He desires intimate relationship. Dr. Swenson has a winsome way of describing God and His creation that will leave you breathless. You might also enjoy the DVD by the same name.
More Than Meets the Eye Fascinating Glimpses of God’s Power and Design by Richard A. Swenson
More Than Meets the Eye – book - $13.00 More Than Meets the Eye – DVD - $39.95 (two discs)
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Medical Education International (MEI) Rwandan Doctors Form a Christian Medical Fellowship by Dr. Jim Smith, Chair, MEI Advisory Council
Dr. Jim Smith teaching residents in Rwanda
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For two days prior to the SWB conference I was able to visit two rural district hospitals where Dr. Bardella has residents. Both have over 400 beds with ten to fifteen general medical doctors and only one or two general surgeons and/or OB/Gyn doctors. About half of the specialists were from Cuba. The clinical load was heavy, with limited resources available. The highlights of the trip for me were: • To see the Rwandan Christian Medical Fellowship born. • To work with an international group with a purpose similar to MEI. • To witness a country coming back from such a terrible tragedy via confession and forgiveness—two powerful Christian principles that are giving the nation and its people hope.
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Rwanda, which in 1994 suffered one of the worst genocides in recent history, is struggling to return to normalcy. Visiting one of the many genocide memorials, I was struck by the enormity of 750,000 people being killed in 100 days. Now fifteen years later the country is trying to reconcile the Hutu and Tutsi tribes. It is not politically correct (actually against the law) to ask a Rwandan their tribe. There is a concerted effort to forgive and move on. Medical Education International (MEI) was asked by Specialists Without Borders (SWB) to participate in a three-day conference on treating surgical emergencies. SWB is an Australian NGO which has worked in Rwanda for several years, teaching medical students and holding surgical conferences. With me on the MEI team were Dr. Inis Bardella, who is helping start a Family Medicine residency in Rwanda, and Dr. Bill Bevins, who works with the Kenya Christian Medical Fellowship to provide advanced life support courses. Over 100 medical personnel from all areas of Rwanda attended the conference. Each day of the conference ended with a two-hour session with a Christian emphasis. The keynote speaker was Dr. Jean Kigia, East Africa regional representative for the International Christian Medical Dental Association (ICMDA). Dr Bardella spoke on how to incorporate our Christian faith in clinical practice. I discussed clinical medical ethics. The Rwandan Christian physicians wanted to start a Christian Medical Fellowship. Dr. Kigia came to help them with this and to incorporate them as part of the ICMDA. It was touching to see Rwandan medical leaders come forward and ask the visiting Christians to pray for this new group.
For InFormatIon about meI opportunItIes, VIsIt: www.cmda.orG/meI
by Richard A. Swenson, MD
In the midst of chaotic times, it’s essential to remember Who is in control
E
instein’s life began badly and kept getting worse. At birth, his parents were alarmed about his malformed head. They prayed his brain was not damaged. He was slow to speak, raising fears of retardation. “Classmates regarded Albert as a freak,” said a friend. “Teachers thought him dull-witted because of his failure to learn by rote and his strange behavior.” When his father asked what profession suited the boy, the headmaster said, “It doesn’t matter; he’ll never make a success of anything.” When Einstein was 15, his father experienced financial problems – again – and went bankrupt. This necessitated a move to Milan to be near his mother’s prosperous family. Albert remained in Munich for his education. He was miserable. He felt trapped in a despised boarding school, couldn’t get along with his teacher, and was horrified by the possibility of Prussian army duty. Impulsively, he fled the school to Italy and surprised his family. His parents were baffled by their “draft-dodging, high-school dropout with no skills, no profession, and no future.” His father advised engineering; Albert wanted philosophy. It was decided he should attend the rigorous Zurich Polytechnic Institute, partly because it didn’t require a high school degree – you only needed to pass the impossible entrance exam. Young Albert flunked French,
chemistry, and biology, but he did so well in physics and math that the principal promised him entrance the following year. He spent the interim at a relaxed high school in nearby Aarau and renounced his German citizenship. Entering the Polytechnic, he was intelligent but incorrigible. He often skipped classes to work in the lab or read books, then scanned classmates’ notes. Professor Weber, who initially thought well of Albert, withdrew his support. Another physics instructor gave him the lowest grade, saying, “You’re . . . hopeless in physics. For your own good, you should switch to something else, medicine maybe, literature, or law.” A math professor called him a “lazy dog.” Albert decided to play it safe after that – falling in love with the intense, dark, brooding Serbian classmate, Mileva, who was four years older and walked with a congenital limp. His mother hated her. In 1900, at age 21, he graduated with degrees in physics and mathematics, then discovered he was the only one not given a teaching assistantship – an intentional insult. Additionally, Professor Weber sabotaged his references across Europe. Albert applied for Swiss citizenship, but that required employment. He thought of busking with his violin. “I am nothing but a burden to my relatives,” he wrote. “It would surely be better if I did not live at all.”
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His father, after spending his wife’s inheritance and much of his in-laws’ money, was again bankrupt. With no prospects for support, Albert searched out tedious teaching jobs. From 1901-1902 he taught in schools but was fired. He was close to starvation and thought of switching to insurance. Mileva twice flunked her final Polytechnic exams, ending her physics career. She returned to Serbia and wrote Albert she was pregnant. He was thrilled, but never saw the baby who died (apparently) a toddler. Out of the blue, in 1902, a friend found him a job with a miniscule salary as a patent clerk in Bern. Soon thereafter, he learned his father was dying. Albert rushed to Milan, where the elder Einstein gave him permission to marry Mileva; but Albert was stricken with the lifelong feeling that he’d failed his father and family miserably. Completing the Biography If we stopped here, Albert Einstein would seem an irredeemable mess. But, of course, we know the rest of the story. Jump forward to 1905. Einstein’s brain continuously engaged the problem of light, where science contained irreconcilable conflicts. One evening, after discussing the problem for hours, he finally gave up. Totally exhausted and depressed, he admitted defeat. On the streetcar home, he glanced at the Bern clock tower and wondered what would happen if the streetcar raced away at the speed of light. “A storm broke loose in my mind,” he said. Instantly he understood – his own clock would continue normally, but the Bern clock
would stop! “The solution came to me suddenly.” He had tapped into “God’s thoughts.” For six weeks he furiously worked out the “Theory of Special Relativity,” wrote it down on thirty-one pages, handed it to Mileva to check the math, and went to bed for two weeks. In that “one miraculous year,” Einstein single-handedly upended the entire scientific world, publishing five papers dealing with relativity, time, space, light, photons, energy, speed, and E = mc2. Any one of these would have secured his place in history forever. “The level of genius,” wrote one observer, “is practically incomprehensible.” He returned to Zurich as Professor Extraordinary, won the Nobel Prize for physics, and, in 2000, was Time magazine’s Person of the Century.1 Why is Einstein’s life important for our purposes here? Because our current era is much like his initial twenty-five years – almost hopelessly messed up. Just as Einstein seemed a complete failure and his prospects nonexistent, so we are confronted by a myriad of seemingly insurmountable issues. Perhaps it would help to change the channel, to step back, to contemplate a larger perspective, to consult God. Humans live on two tracks – the temporal and the timeless. It’s just we don’t realize it. We see into the temporal well enough, but the timeless track is only dimly perceived2 and, sadly, is largely discounted. Sadly, I say, because it is by far the most significant and abiding. We see only in “real time” (actually, a misnomer). God, however, sees from the beginning to the end. This means He “outsees” us by infinity to one. We know only a tiny narrow swathe of reality. God, however, knows the Eternal Reality. This means He “outknows” us by . . . let’s just say it’s like the Milky Way compared to an air molecule. We operate out of our temporal narrative, but God operates out of the completed script of His own finished infinite, redemptive, glorious purposes. Still, we resist. We dig in. We feel trapped. We sit in our distresses, our worries, our parochial views, and we resist the simplicity of surrender. Our Situation, God’s Sovereignty
Albert Einstein calculating,1921
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Humanity today finds itself upon a launch pad of unprecedented challenge. It is a time of epic transition. The global experience has grown massive in scope and nearly incomprehensible in complexity.
The Sovereignty Perspective
“The Eye of God,” from the Hubble Space Telescope (NASA)
Mathematics has slipped its leash and was last seen going vertical. One editorialist remarked, “I’ve lost track of the zeros.” Exactly. It is a day so unprecedented that even those who realize how unprecedented it is don’t have a clue how unprecedented it is. It is exciting. Historic. Destabilized. We have a destabilized healthcare system and a destabilized economy within a destabilized society within a destabilized world. Nothing can continue to change in this kind of trajectory. This is not to say we are in trouble, but it is to freely admit that we are troubled – and so we ought be careful. Since this world system has never been here before, we do not know what is around the next bend. With a mixture of anticipation and anxiety, many of us swallow a tranquilizer and then, on tip-toes, slip an eyeball around the corner straining to get a peek. For three decades now, since 1982, watching the unfolding story of history has been my privilege. It’s always been a fascinating business. But what’s coming at us now – what’s just now rising above the horizon and headed our way – well, never before have I seen anything like it. This is disorienting. People are not confident about the future of the nation, of their profession, of their retirement, of their children. Actually, people are not confident about next Tuesday.
1. He cares Only God can say, “Never will I leave you; never will I forsake you.”3 Our jobs can’t, our houses can’t, our bank accounts can’t, even our families can’t. Only God.
Surrendering to Sovereignty
God, however, never worries. He never lacks confidence. He is not proud in an egotistical way, but He is completely self-assured. This is called sovereignty – He is sufficient unto Himself. And He knows it. God remembers what it was like before the universe was created. He knows what it will be like after the curtain is brought down. He knows that God - universe = God. He is God; we are not. We need to hear His thoughts and see His timeless perspective. For us to live in God’s reality is vastly superior to stewing in our own juices.
2. It’s all grace We didn’t create the air we’re breathing. We didn’t create the food we eat, nor the ground in which it was grown, nor the ability of the seed to germinate. We didn’t instruct our GI tract to digest. We didn’t ask our retinas to perform non-linear differential equations in one third of a second that would take a Cray-1 supercomputer 100 years to do. We didn’t tell our brains to acquire language. We didn’t tell the DNA in our initial single cell to grow us. We didn’t create the 1028 atoms in our body. “From the fullness of his grace we have all received one blessing after another.”4 3. It’s about love, not productivity God spoke and 1050 tons showed up, otherwise known as the universe. Obviously, He doesn’t need help with productivity. Yes, He wants us to be active in healing, but, in the end, it’s all for love’s sake, not productivity’s sake. 4. We’re not so smart The human brain is the most complex and densely organized matter anywhere in the universe. But 96 percent of the universe has gone missing and we don’t even know what it is or where it went. Actually, we don’t even know how our toaster works. “Everything is a miracle,” said Einstein. God is our source of truth, wisdom, and understanding.
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5. Our lives are vaporous Einstein said, “The distinction between the past, the present, and the future is only an illusion, even if a stubborn one.” Scripture says our lives are a mist, a vapor, a breath. That means our problems, too, are vaporous. “For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all.”5 This is not a trick of science or semantics – it’s the truth. And it’s a pretty good deal, when you think about it. 6. We do not manipulate God – we only yield Only God can act in history whenever He wishes to accomplish whatever He pleases. “And he is not served by human hands, as if he needed anything . . . .”6 7. Don’t call it a failure until God has spoken We dare not label our practices, our lives, our kids, our churches, or our world as failures until God pounds the gavel. Massive surprises await us, perhaps in this life, surely in the next. God knew, for example, that Einstein was an unparalleled genius even when Albert was at his lowest. And God smiled when that streetcar approached that clock tower. We labor for His purposes, not our own. We use His power and wisdom, not our own. We harvest a timeless glory, not our own. We live by faith, don’t worry about tomorrow, never lose heart, and seek to rise above – not because of the temporal evidence, but because of timeless truth. When we finally see clearly, we will understand. And we will be so very glad. ✝ Bibliography Einstein material from many sources, particularly Einstein’s Cosmos (2004) by Michio Kaku 1 Corinthians 13:12 3 Hebrews 13:5 4 John 1:16 5 2 Corinthians 4:17 6 Acts 17:25 1 2
Richard A. Swenson, MD, is author of seven books, including the best-selling Margin and The Overload Syndrome, both award-winning. His works have been translated into five languages and have been distributed to over 150 countries. His latest book, In Search of Balance, is due out in February, 2010. He has presented widely on the themes of margin, stress, overload, life balance, complexity, societal change, healthcare, and future trends. He has given presentations to national medical conferences such as the American Academy of Family Physicians, the American Association of Occupational Medicine, the American Society of Prospective Medicine, the general medical staff of the Mayo Clinic, as well as hundreds of other national, regional, state, and local medical settings. He also has researched extensively and written on the future of healthcare, helping to initiate a national multidisciplinary group examining the healthcare crisis and exploring new paradigms. Dr. Swenson and his wife, Linda, live in Menomonie, Wisconsin. They have two sons, Matthew and Adam, daughters-in-law Suzie and Maureen, and a granddaughter Katja.
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LORD, Is It You? by Georganne W. Long, MD (with Mary Z. Smith)
“It’s a girl!” I cried, sweeping the infant into my arms as the labor room filled with tiny wails. Glancing over at the radiant faces of the new parents, I couldn’t help remembering the births of our own three children. As a Christian, I embraced each and every healthy delivery as a gift from God. I’d delivered over 7,000 babies during the past twenty years of being an OB/Gyn. Delivering the news to a patient that she had cancer was a different story. My own dear mother had lost her battle with breast cancer the previous October. I still missed her so. I rejoiced that she was in heaven with God. Still, it occurred to me from time to time that I might one day be delivered unsettling news about my own health, well aware of the fact, especially as a physician, that we humans are not the ones in control . . . God is. I looked out the window, noticing the buds forming on the trees. A warm breeze drifted through the office window. A year earlier I’d had a mammogram that looked suspicious. A biopsy was taken. The results came back with everything appearing to be normal. A year later in 2004, I was called back for a follow-up after another mammogram report. The radiologist had just begun to go over the report with me when he was paged for a phone call. Being a physician, I was permitted to study the X-ray films myself while my colleague was out of the room. I admitted to feeling a little bit alarmed at the calcifications I observed. The radiologist returned shortly. I immediately shared my concerns, offering to get an old fashioned biopsy. He reassured me that he felt everything was all right for the time being; a biopsy wasn’t needed at present. I trusted his judgment, knowing his reputation and valuing his expertise. I felt no anxiety as I headed home that evening to be with my husband and three children; however, I did whisper a prayer asking God to help me trust His perfect plan for my future. While driving down the interstate, I suddenly felt a powerful presence encompassing me. My hands gripped the steering wheel in anticipation. “Lord, is it You?” I asked. The reply came as a gentle nudging . . . unspoken but just as profound.
Sometimes an unexpected diagnosis can open doors for ministry
“Georganne, go ahead and get a biopsy taken as soon as possible.” I pondered over what had just occurred. My husband, also a physician, anxiously awaited my arrival. As we prepared dinner for the kids, we discussed the report as well as the radiologist’s opinion. Over dinner we prayed together asking God to guide our steps according to His purpose, something we always strove to do as a family. We shared a pleasant evening, retiring early. I had no idea just how anxious my dear husband was. The next day he took the films with him to VCU, the hospital where he is a physician, having decided it wouldn’t hurt to have a second opinion. The radiologist immediately recommended a biopsy. When Steve explained to me what he had done, I responded in a very cavalier manner. Was this really the way I was feeling inside? I found a quiet corner in our home, reading my Bible and praying. I came away from that prayer corner with the reassuring confirmation from a sovereign God that He already had things under control. He was asking me for total submission so that He could accomplish His will in my life. As a Christian, I knew that’s what I wanted for my life as well.
After cancer, expeditions with the family have a special meaning
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Lord, Is It You?
I informed my husband that I would make an appointment for a biopsy in a week or so. After all, I had my patients to think of. My husband wouldn’t hear of it. As we stood on the soccer field Saturday observing our son play, my husband got on his cell phone, making the arrangements necessary for the biopsy. The radiologist at VCU recommended having the biopsy the stereotactic way, which is the method of choice today. Steve accompanied me that Monday when I was to have the procedure. Again I felt God had things under control, and even wondered why Steve felt the need to be by my side. When we arrived at VCU, I soon discovered just why God had sent Steve along. A friend in the same Bible study I attended was seated in the waiting area. She’d just been given the news that she had breast cancer. She was devastated. Steve was there to pray with her, while I disappeared down the hallway for my own biopsy. God’s timing is always perfect. As we continued on with family life and hectic work schedules, the week breezed by. We prayed together as a family, leaving our concerns in the Lord’s hands.
My advice to women colleagues: 1. Spend one on one time with God each day, whether it be digging deeper into His Word or seeking His presence through prayer. These things keep us walking righteously, and more open to His leading. 2. Make sure to get those yearly examinations. God is in control, but He expects us to use the brains He’s given us, and to apply the same health principles to ourselves that we recommend to our patients. 3. Make sure you understand all the options that are available for someone having to undergo treatment. Do not be afraid to ask questions or pursue a second opinion. 4. Gather as much information as possible. You have a right to know as much about caring for yourself as any physician treating you. 5. When loved ones offer their support and presence, don’t turn them away. They are the physical hands and feet of our Creator. We all need the healing power of physical touch. And they may be there for other purposes we may not be able to understand at the time. After all, it’s not always about US. 6. Desire to trust God and do His will and to use the gifts and talents He’s given us. As a result, we will become the godly women He intended us to be all along. 7. Reach out to other women. They need to know they are not alone as they meet the challenges women must face today. Pray together and be a good listener. 8. Don’t forget that your children are watching you and learning from your example. Teach your kids that inner beauty comes from God. Physical beauty is fleeting and isn’t as important as Madison Avenue would have us believe. 9. Raise your children to love their Creator so much they’ll want to glorify Him by living up to their fullest God-given potential. 10. Practice good prevention. Eat well. Rest enough. Exercise daily, whether it be a long walk and talk with God under a clear blue sky or a vigorous swim at the local Y. Our bodies are God’s temple. We need to keep them healthy and fit. And most of all . . . remember that you are never alone in your journey. The greatest physician of all is waiting to surround you with His presence and sustain you with His peace.
When you’ve conquered cancer, you feel on top of the world
Friday afternoon the radiologist called, asking me to meet her in her office at 5:00 p.m. I pondered why she would need to see me on a Friday evening. Sinking into the chair in her office, I attempted to read the expression on Ellen’s face. She explained that the biopsy showed that I did in fact have ductal carcinoma in situ. She went on to explain the many options available for treating the cancer.
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Being a physician, my first concerns were for my family and patients. I didn’t have time for months of recuperation. Ellen advised me on the many qualified surgeons in the community as well as plastic surgeons for the reconstruction. While she spoke, I was aware of that all encompassing Presence speaking to my heart once again. “Trust Me, Georganne.” I made my decision. “Ellen, I want to go ahead and have a bilateral mastectomy and surgical reconstruction,” I said. “Being a physician, a Christian, and knowing my family’s history of breast cancer, that’s the way I want to go.” Ellen was astonished. Did I dare explain to her that the decision had already been written across my heart by the Great Physician Himself? Driving home once again, I placed a Sarah Brightman CD into the player. The song entitled, “Time to Say Goodbye,” saturated my spirits like marshmallows soaking in hot chocolate. Glancing down at my chest, I murmured, “It’s time to say goodbye all right . . . goodbye to these things . . . .” And there it was again . . . that feeling of peace that
Lord, Is It You?
passes all understanding . . . that only our heavenly Father supplies if we are willing to obey. Monday morning we arrived at the hospital for surgery. Before I knew what was happening, I was being wheeled out of surgery and into the recovery room. A week later I was back in my office seeing my beloved patients. When they asked me what I thought of the hand I’d been dealt, I answered them honesty. It had been quite an adventure, but I’d survived and beaten the cancer. I’d trusted God, knowing that He had all the facts concerning my prognosis, not I. I’d grown leaps and bounds in my medical profession. My practice was enhanced, knowing I had trod where many of my patients would someday tread, and loving them even more because of it. Since then, I have received calls from many women who have been diagnosed with breast cancer. I am happy to call them my friends as they ask for advice and guidance. I invite them to my home, not only to share my own experience but to lend a compassionate ear and share God’s love. I warn them that I am a paradoxical physician. I am biased by my faith-based decisions. I tell them they must make their own decisions on what to do. But then, as a Christian who loves her fellow earth travelers, I go ahead and try to sway them anyway. ✝
Georganne W. Long, MD, attended the University of Alabama School of Medicine in Birmingham, where she graduated with honors in 1984. Dr. Long continued her postgraduate training at the Medical College of Virginia, where she completed her internship and residency in Obstetrics and Gynecology in 1988. She is a Fellow of the American College of Obstetrics and Gynecology and is Board Certified by the American Board of Obstetrics and Gynecology. In her more recent years of practice she has devoted extra time to the issues of menopause and pelvic relaxation and its accompanying surgical and nonsurgical management. She anticipates her future medical career will involve mission work abroad and within the US, as well as teaching and mentoring young physicians.
Mary Z. Smith is a freelance writer. When she’s not penning for her favorite inspiring publications such as Guideposts, Angels on Earth, and Chicken Soup for the Soul, she can be found volunteering her time with those in need, working in her garden, or walking her rat terrier, Frankie.
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Editor’s Note: This article is the third of six in a series focused on “Professionalism in Peril.”
PROFESSIONALISM IN PERIL Part 3 – Professional Adultery by Gene Rudd, MD
When I went into the examination room that morning to see Mrs. Hagerty, we were not alone. Dena, my nurse/chaperone, was there, but there was also another “presence.” I had just been informed that Mrs. Hagerty’s insurance carrier had declined approval of a procedure necessary to treat her disease. Rather than spending time attending to her needs, I had to explain, with apologies, that my attention would have to be diverted to her third party payer. Sound familiar?
What it Means to Be a “Professional” This series is entitled “Professionalism in Peril.” Thus far, we have addressed “liabilities and limits of autonomy,” and, in light of the fall issue’s theme, “unjust scales in healthcare.” Before taking on this article’s subject directly, let me stop and ask: Is professionalism in peril? To answer this question we should begin by defining professionalism, or its root word, profession. Edmund Pellegrino rightly points out that among its varied applications, modern use of the word “professionalism” often connotes the concept of elitism. Even more problematic is the use of the word to identify those who make money (professionals versus amateurs), or simply those skilled at a task. In those contexts, physicians and dentists may be sadly lumped together with professional wrestlers! More appropriate to our profession (and to this series of articles) is the original meaning. Pellegrino attributes the origin of the word professio to the first century physician of Claudius. The Emperor’s physician used it to refer to a commitment – his oath to be and act a certain way. We may also understand it as a moral obligation. While professionalism may include skill, advanced education, certification, standards, legal recognition, and membership in a guild, we will apply the original meaning of profession to be our public commitment or moral obligation.
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Professional Adultery One of the traditional tenets of medical ethics (core values) is beneficence, a commitment to the primacy of patients – to do good and avoid evil. While most healthcare professionals embrace and practice this principle, what happens when the doctorpatient relationship is overly influenced by others? “Third parties” have come to play a significant role in healthcare. Third parties may or may not have the same commitment to this critical tenet of professionalism. There are certain relationships that are not likely to remain sound when wrongly influenced by a third
Professionalism in Peril
In general, professionals make a commitment (i.e., take an oath) to seek the best interest of those they serve (not their own), to be truthful, to keep confidence, to be expert in their trade, and to protect the good name of the profession. Medicine, law, and the clergy are recognized as the traditional professions. While the word professio originated in the first century, the concept of commitments and oaths by healthcare professionals predates that era. Greek society in the third century B.C. was commonly corrupt. So were the practitioners of healthcare in that day. Trust was scarce. However, in the midst of that darkness, Hippocrates and those he influenced foresaw a better way. They developed an oath that constrained them to act by certain standards. The standards they professed were so attractive to the patients they served that even physicians not morally inclined to these standards had to change their ways in order to maintain a viable practice. Those standards guided Western healthcare for over 2,000 years. So why is allegiance to standards so important? Is it just to attract patients? Many of us are familiar with the elements of strategic planning. The process begins with defining the mission of an organization (its reason for being). From there a vision for the future is cast and then elements are added for how to accomplish the mission and fulfill the vision (keys result areas, goals, and strategies). Those familiar with this planning process will recognize that an important element was left out of this list. Along with the technical aspects, a good plan must include the principles or ethos that will guide individuals as they strive to fulfill the plan. These principles are commonly called core values. The Enron debacle of recent history is a reminder of what happens when core values are either not defined or when they are ignored. Failure is the inevitable result. Other examples abound, from business to athletics to politics and even to the church.
party. Just ask the former governor of New York. In 2008, the governor’s involvement with a mistress brought havoc to his marriage and his public career. Again, certain relationships, by the very nature of their intimacy and sacredness, are such that the introduction of third parties leads to loss of trust and an erosion of beneficence. Such is the case of modern medicine. We not only involve third parties, sometimes there are fourth or fifth parties. Medicine can become a regular orgy! “How?” you might ask. Nearly every time you enter an exam room to fulfill your moral obligation to a patient, another party enters the room with you. (I am not referring to a chaperone.) The third party may be the government (e.g., Medicare and Medicaid), your HMO, your employer, or the patient’s health insurance provider. Despite claims to the contrary, these third parties may not have the patient’s best interest at heart. Too often the third party is more interested in the economics of the patient visit than the healthcare outcome of that visit. While it is possible for the doctor to also succumb to this temptation, it is easier for the distant, inanimate “third party” to be more influenced by other motives. Even if the third party were fully committed to the beneficence of the patient, their very presence causes the exam room to become crowded, affecting the efficiency of providing quality and compassionate care.
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Professionalism in Peril Paid Advertisement
The mistresses in healthcare are those whose very presence tends to undermine the sacred relationship that professionals pledge to have with their patients. Moreover, these mistresses can be very demanding, threatening the doctor with economic blackmail and sanctions if the doctor does not heed their wishes. What is the solution? It will not be easy. I am not naive enough to think these mistresses will just go away. We will have to continue dealing with their temptations and demands. But in keeping with our moral obligation, our job is to prevent the third parties from sabotaging what is in the best interest of our patients. Some doctors have gone as far as creating a cashonly payment system - “third parties not allowed!” For most of us, we must go the extra mile to defend the patient’s interest against systems that may have intrinsically wrong motives or administrative hindrances in place that might prevent our providing the care that the patient really needs. For our professional commitment to mean anything, we cannot allow busyness, fatigue, or inattention to permit third parties to compromise patient care. For our profession to avoid the peril of adultery, we must keep our vow of faithfulness to our patients.
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• • • • • Back to Mrs. Hagerty’s visit: The distraction was not so bad this time. A phone call to the “mistress” required only ten minutes away from the patient. Though rather cold-hearted, “she” allowed me to continue with the procedure since it was the standard of care and in the best interest of Mrs. Hagerty. Sometimes, “she” is not so reasonable. ✝
Gene Rudd, MD, co-author of Practice by the Book, serves as Senior Vice President of the Christian Medical & Dental Associations. A specialist in Obstetrics/Gynecology, Dr. Rudd has experience in maternalfetal, medical education, and rural healthcare. He has garnered numerous awards including the Gorgas Medal. While working with World Medical Mission, he established the Christian Medical Mission of Russia, directed the rehabilitation of the Central Hospital in Kigali, Rwanda, and served in Belarus, Bosnia, and Kazakhstan.
Editor’s Note: You saw the pictures and were in awe that cold day in January 2009 when US Airways Flight 1549 made an emergency landing on the Hudson River, and all the passengers and crew survived. What you may not have known is that a CMDA member, Richard (Andrew) Jamison, MD, was on that plane. This is his story.
In the Unlikely Event of a Water Landing by Andrew Jamison, MD Photo courtesy of Greg Lam Pak Ng
Flying Standby Toward Charlotte On January 15, 2009, I was in New York City for a residency interview. I had a ticket on a 9:30 p.m. flight, since there didn’t seem to be a chance of catching the earlier 2:45 flight, but when the interview ended early, I got on standby for Flight 1549. Like any other plane trip, I wasn’t paying much attention, at the start. I had been reading two books during this trip: The Sovereignty of God, by Arthur W. Pink, and Prince Caspian, by C.S. Lewis. As we sat on the taxi-way waiting for the plane to take off, I kept on reading my books and didn’t even hear the flight attendant explain that in the unlikely event of a water landing, our life vests were under our seats. I still think reading The Sovereignty of God probably prepared me better for what I was about to experience than knowing where to find the life vests. The takeoff seemed to be going normally, when about a minute into it there was a loud thud, and the plane lurched a little bit. My first thought was that this was just a little turbulence, but just to make sure I glanced at the flight attendant, because that has always been my gauge as to whether or not I should be worried. She was visibly concerned. I was in the very back of the plane, but somebody a little further forward saw the engine spark and start to smoke, so that got my attention and I put the book
down. I could smell the smoke coming in, and at the time I thought it was just the right engine, since that was the side of the plane I was sitting on. With my limited knowledge of aircraft, I knew we only needed one engine to fly, which is what I told the lady sitting beside me. I said, “We can get all the way to Charlotte on one engine if we have to.” Next Stop – Hudson River Then it was quiet, too quiet, and I realized that both engines were out. In reality, it all happened very fast, but within thirty seconds I knew we were going down. The flight attendant was digging around the seat behind me, looking for a transponder or something, so it was very clear that whatever was happening was not normal. At about that moment, it hit everybody and stunned us that we were going down. I tried to call my wife, Jennifer, to say goodbye, but my cell phone wouldn’t work. Then I turned to the lady beside me, and maybe from working in a context where you have to always ask permission to pray with somebody, I asked her if it was okay if I said a prayer. And she looked at me like I was crazy and said, “Of course.” So the lady and I and the guy who was sitting beside us, who leaned in, bowed our heads. I don’t remember what I said, word for word, but since I was reading The I n t e r n e t W e b s i t e : w w w. c m d a . o r g
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In the Unlikely Event of a Water Landing
Sovereignty of God, it was something like this, “God, we know that You are sovereign . . . and that You are in control of planes, even planes without engines. We pray that Your will be done. And I ask for a peace that surpasses all understanding to descend upon all of us. And God I pray that if there is anyone listening who doesn’t know, that You would make it clear to them right now what Your Son has done for us.” There wasn’t much panic. Some passengers were saying “Hail Mary’s,” and you could hear some sobbing and crying, but no screaming or carrying on like you might expect. About the time we finished that prayer, the captain came on over the speakers and said, “Brace for impact.” What happened next was to me the greatest miracle that occurred that day. I experienced a peace that I can’t fully explain. I fully expected to die in a few seconds and yet it was ok. I was enveloped by a remarkable comfort and peace even as we braced for impact. Then we hit the water. I am often asked what it was like when we hit and I honestly cannot give a great answer. At that time I was expecting to get ripped to pieces, so anything short of that was pretty outstanding. What I remember most about the landing was the almost immediate rush of extremely cold water I felt at my feet. It started at my ankles, and by the time the plane came to rest, there was water up to my knees. So all of a sudden a new fear crept into my mind: I’m going to drown. I can’t get off the plane. Can’t see the exits. However, when I stood up, I could see that the nearest exit was behind me at the back of the plane, where somebody was struggling, in chest-high water now, to get it open and they couldn’t. With the rate the water was rising, it seemed clear that we didn’t have much time. But suddenly the water stopped rising, and the
people ahead of me were able to open other exits, so everyone was able to get off in an orderly fashion. I was one of the last ones off, through the left front door. And when I got into that raft, with a great sense of relief and praise, I asked if I could say another prayer, this one a prayer of thanksgiving. Then the captain and co-captain got into the same raft. They were talking about the very small number of prior successful water ditchings, and as they talked it really hit me: This truly was an extraordinary event. God, and Our Pilot, are So Great! Immediately after the crash, I had a range of emotions and feelings. Maybe the most overwhelming was that I should actually be feeling more. In fact, when I finally did get to call Jennifer, she wondered if I was in my right mind because I had just survived a plane crash, and all I really wanted to say about it was: “God is great. God is great!” The psychological shielding that the Lord has provided is significant. The night after the crash, I had one of the best nights of sleep I have ever had. To this day I haven’t had any nightmares or troubling dreams of being in plane crashes. One of the biggest surprises immediately after the crash was the media blitz. When I flew back to Charlotte after the crash, an interviewer asked me what I thought about the crash and the pilot and I said the first thing that came to mind, “God was certainly looking out after all of us.” What I didn’t expect was the reaction that that statement attracted on the Internet afterwards with several atheist blogs. I never expected to be put in the spotlight and ridiculed (albeit on a small scale) for just saying God was looking out for us. The fact is, He was doing a whole lot more than just looking out for us. Short-term Effects
Mementos of the crash, courtesy of Andrew Jamison, MD (here and on page 25)
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Less than two weeks after the Hudson River landing, a plane crashed going from New York to Buffalo, killing everyone on board. I remember watching the news coverage of that crash and thinking: Why wasn’t that me? Why did God save flight 1549 and not this one, too? I was faced with the most difficult question: If God is sovereign, why do bad things still happen? I had wrestled with this question before and was always reassured on an intellectual level with theological answers. However, this question takes on new life when you find yourself in the middle of it. The other question was: What am I doing with my life now? God must have some plan for me. Then I would correct myself: God has always had a plan for me and this crash doesn’t change that, necessarily. The
The Long-term Impact I had gone through a period in high school when I really wrestled with the reality of God and if He really
In the Unlikely Event of a Water Landing
process of answering these questions certainly led to a reassessment of my life and what I was doing, especially since this came right during match season. I kept asking myself if dermatology was really what God was calling me to do. The net result was that I became more sure of where I am and where I’m heading in life. Probably the most immediate effect I felt was peace during the matching process. My wife and I were going through a very difficult couples match, with most of the odds stacked against us. I had carried that burden throughout interview season, depending upon everything I had done during medical school and my interviewing skills to get me a spot. Two days after the crash I was on another plane heading to another interview; that’s just how that time in life was. Everything seemed to revolve around these interviews, and it was a fulltime job that even a plane crash really didn’t slow down. But after the crash I had this great peace, that my God is big, really really big, and He is faithful. It wasn’t even a peace that we would match, it was a peace that God is in control and if we don’t match God has something better in store. In the end, we did match together in Texas, at one of our top choices at Scott and White. After being in Texas only a few short months, we realized just how sovereign God is to put us where we are as He continues to provide.
existed or did religion exist as a crutch for those who can’t deal with the reality of death. One of my greatest fears in dealing with this has been the thought: When I’m lying on my deathbed, will I doubt the reality of Christ in that crucial moment? Yet when I was faced with what I thought was certain death, I experienced the reality and closeness with Christ as never before. I now hold on to a much stronger assurance of my salvation. The accident has also served to vividly show me flaws in my character and faith. During the ride down, I had an amazing peace. I had no control over the situation; I wasn’t the one in the cockpit. But after we landed, and the icy cold water came rushing in, my mind quicky reviewed my options for trying to save myself from drowning. I thought that maybe I could hold my breath long enough to swim to the back exit, or maybe I could kick out a window (a ridiculous thought in hindsight). This was the most terrifying part of the whole experience, because I was relying once again upon my abilities to get out of the situation and not so much upon God, even though seconds before I had completely relied upon Him. Like many other times in life, I was willing to give God the big stuff that I couldn’t control, but I wanted to hold on to the other stuff that I thought I could influence. But to the degree that I rely on my own abilities for the things I think I control, to that degree the small stuff becomes just as nerve racking as the big things. Even on that plane God had begun to do a work in me to give Him even the small things, and He continues to teach me more and more about this. ✝
Editor’s note: This article is based, in part, on an interview of Drs. Andrew and Jennifer Jamison, conducted by CMDA CEO Dr. David Stevens. This interview can be accessed via the CMDA website at: www.cmda.org> publications> CDD STAT.
Andrew Jamison, MD, is a firstyear intern at Scott and White Hospital in Temple, Texas, doing a preliminary internal medicine year before starting a dermatology residency, also at Scott and White. Dr. Jennifer Jamison is in her first year of family medicine residency at Scott and White. They met in medical school in Charleston, SC, and have been married for two years. They share a passion for medical student ministry.
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BIOETHICS SERIES
Clinical Ethics Case Consultation “When should the family challenge the patient’s medical directives?” by Ferdinand D. (Nick) Yates Jr., MD, MA (Bioethics) Column Editor The goal of this column is to consider a problematic medicalethical situation that patients, families, and healthcare professionals may encounter. The medical case herein is often the real predicament that was encountered, and some details have been changed to preserve the privacy of the patient. The discussion intends to illuminate the actual problem and present some of the thought process demanded by the medical situation, and the recommendations are consistent with biblical standards. This particular case reflects a peculiarity in the state’s healthcare law that produces additional burden for the family at the time of serious family strife, and it demonstrates the need of a fluid ethics consultant process that is not mired by committee procedural process. The decision-making process must go forward, and sometimes, a particular treatment decision is necessary to identify the medical prognosis.
NARRATIVE: The patient is a 46-year-old male who presented to the local emergency room with severe chest pain and dizziness. He was diagnosed with a type-1 dissection of the ascending aorta, and initially the extent of the dissection could not be identified. The patient underwent extensive surgery consisting of repair of the aortic arch, aortic valve replacement, reimplantation of the left main coronary artery, and bypass grafting of three coronary arteries. He subsequently required the evacuation of an expanding mediastinal hematoma and a right lower lobe pulmonary wedge resection. The operation and subsequent time necessary for achieving hemodynamic stability required approximately twelve hours, and the patient was in extremely critical condition post-operatively. The patient remained on ventilator support after surgery, and the surgeon was skeptical that the patient would be weaned from ventilatory support. In addition, the blood chemistries revealed evidence of early acute renal failure, and the medical team suspected that renal dialysis would be needed within a short period of time. The patient was under medical sedation following surgery, and it was not known when he would be able to authorize his own decisions. Of significant interest, the patient’s mother had died from complications of aortic dissection.
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The medical ethicist was called for a consultation to assist with the decision-making process and ascertained that the immediate family had already held numerous discussions; even though there was no Health Care Proxy (no one has decision-making authority), the family was in agreement regarding the issue of substituted judgment (the patient had previously spoken in very specific terms regarding end-of-life care that might be used to keep him alive if he could not speak for himself). Specifically, the patient: 1) did not want to be in a nursing home for a prolonged time period, 2) did not want his life to be maintained by a respirator if he could not breath, and 3) if there was no reasonable hope of recovery, he did not wish to be maintained by various life-sustaining treatments (renal dialysis, for example). The ethicist requested that the family provide a written statement(s) to document these prior conversations. (In this particular state, if there is no Health Care Agent and the patient cannot speak for himself, then the family may provide “clear and convincing evidence” of statements documenting the nature of discussion or directives that the patient made when competent at prior times.) Once provided, these written documents might suffice as applicable patient directives for end-of-life decision making and for the discontinuation of life-sustaining medical treatments. Of immediate import was a decision regarding tracheostomy for the purpose of long-term ventilator support and pulmonary toilet and the placement of a feeding tube for nutrition and hydration. These procedures were appropriate and necessary for long-term care and better medical support for the patient who seemingly required extended care. ASSESSMENT: This case demonstrates the serious dilemma of whether or not to offer and perform invasive procedures such as a tracheostomy tube placement (for respiratory support) and a feeding tube placement (for nutrition and hydration) in a patient with very severe heart damage who is in an extremely fragile medical condition. In such a patient, even these reasonably simple procedures carry substantial risk and may aggravate the underlying critical cardiac condition. Furthermore, the patient has apparently made very clear statements regarding the implementation and continuation of medical treatments under certain scenarios requiring aggressive medical treatment decisions. How should the family and physicians proceed? In the
effort to assess the patient’s overall condition, should the family employ these medical recommendations in light of the patient’s statements? Furthermore, once the medical-surgical procedures have been performed, should the patient worsen or show no substantial improvement, would the family be hesitant to permit the discontinuation of these treatments as apparently requested by the patient’s prior directives? COMMENT: In watching a loved one endure an acute illness leading to care that requires end-of-life decisions or aggressive life-sustaining treatments for an unknown period of time, members of the family often feel the oppressive weight of medical decision-making. The family typically exhibits sincere compassion and longsuffering, but will often demand prolonged periods of time to understand the medical details and to process the medical ramifications. In this case, the family was in a position of medical decision-making where the family attempted to ascertain how and when they should honor the patient’s prior-made directives. A family leans heavily on the explanations and advice offered by the medical team. (The trusted long-term family physician is often of great benefit in a case such as this but, in this particular situation, was unavailable.) Often, the family persists in waiting and watching for some miraculous improvement or some disastrous terminal event. Afraid to make a particular treatment decision, or unable to do so, they may unwittingly slip into an amorphous haze of uncertainty. However, failure to make a decision under these conditions should be avoided if the family has sufficient information to act on the patient’s behalf. NARRATIVE CONTINUED: The medical team continued aggressive care (renal dialysis and sedation), allowing time for the family to assemble and to produce the requested documentation of the patient’s prior statements, and it appeared that the family was seemingly in favor of placement of the feeding tube and the tracheostomy tube in order to better assess the patient’s medical condition and progress. Over the next several days, the patient began to show signs of neurologic improvement – starting to make facial movements, eye contact, and responding to voices. The ethics consultant suggested that it would be ethically permissible to proceed with placement of the tracheostomy tube and a gastric feeding tube, as these modes of therapy would be appropriate and necessary for long-term treatment and care. The ethicist cautioned, however, that even though placement was presently warranted, the patient’s prior-standing verbal statements still must be considered (even though the family never presented the requested documentation). FOLLOW-UP: The patient continued to demonstrate remarkable medical improvement, and he was moved to a rehabilitation unit about two weeks after the initial ethics consultation.
Subsequently, the patient was weaned from the respirator, and the feeding tube was removed. He slowly began to ambulate, and was soon able to navigate a few stairs. He was discharged about two months after hospital admission. EDITOR’S COMMENT: Joint decision-making between the family (representing the patient’s directive) and the physicians (making recommendations based on medical experience) is the goal of the ethics process. In this capacity, end-of-life medical decisions are made even though particular medical details are unknowable at the time of decision-making, and much is based on the medical expectation of the physician. In this particular medical situation, it is ethically permissible to allow the placement of the tracheostomy tube and the feeding tube for a short while – even in the face of the patient’s prior statements. This medical plan is allowable as the patient is very early in the post-operative course, and the prognosis is unknown. These medical-surgical procedures often are quite helpful in the initial recuperative course of many medical conditions. The consequence of this medical-ethical pathway, however, is that the family may have the difficult decision of discontinuation of these life-sustaining treatments. In compliance with the patient’s directives, the family would encounter this scenario should the patient fail to show substantial improvement – or indeed – signs of increasing dependence on these life-sustaining treatments. Appropriate decision-making advances the care of the patient, and the goal of the medical team is to ethically assist in this procedure. The patient, family, and physician entering into the decision-making process with an active religious faith may have a more broad understanding of the interaction of faith and healthcare; often, this awareness eases the decisionmaking process. Sometimes during the process, as in this case, there are miraculous and unanticipated medical events and even unexplained medical recovery. In these situations, one can only stand in awe of the events as they unfold and give brave testimony as a witness. ✝
Nick Yates, MD, MA (Bioethics), is Associate Professor of Clinical Pediatrics at the State University of New York at Buffalo, and is Adjunct Professor of Bioethics at Trinity International University. He is a member of the Executive Committee for the Section on Bioethics for the American Academy of Pediatrics. He also serves as the Chairman for the Ethics Committee for the Christian Medical & Dental Associations, and is the Interim Consultant for Clinical Ethics at the Center for Bioethics and Human Dignity.
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APOLOGETICS SERIES
The New Testament is Reliable by Robert W. Martin III, MD, MAR Note: This is the eighth article of nine in our series on apologetics. The pages are designed for ease in copying for personal study, discussion in a group setting, or for distribution to colleagues and staff. For the sake of space savings, notes refer to books listed in the bibliography in each case.
I. Introduction “The Bible is just one of many useful religious books . . . . The first-century church intentionally created myths about Jesus because of its religious needs and interests . . . . There are too many errors and contradictions to trust the New Testament.” You’ve heard such arguments before. As Christian physicians dealing with unbelievers, the quintessence of our apologetic is the reliability of the New Testament. If the New Testament is a historically reliable document written by honest eyewitnesses, then the events written therein actually happened.
II. New Testament Reliability Norman Geisler (BECA 381-385, 527-538) has argued for the reliability of the New Testament based on document authenticity and author reliability. Three elements establish an ancient document’s authenticity: 1. Bibliographic Test examines the existing manuscript copies – How many? How Early? How Accurate? 2. Internal Test asks, “Are there inconsistencies, errors, and contradictions in the text?” 3. External Test asks, “Is there any contemporary extra-biblical writings that confirm the information in the New Testament?” A. Bibliographic Test 1. How many? The trustworthiness of the New Testament text comes from three sources. First, there are 5,686 hand copied, Greek manuscripts from the 2nd through 15th centuries. Second, there are 9,000 major early translations in other languages. Third, there are 36,289 quotations from 2nd and 3rd century early church fathers constituting the entire New Testament except eleven verses! 2. How early were the books written? William F. Albright concludes, “Every book of the New Testament was written by a baptized Jew between the forties and the eighties of the first century A.D. very probably sometime between A.D. 50 and 75.” Liberal scholar John A. T. Robinson, redated Matthew between 40 to 60, Mark at 45 to 60, Luke before 57 to after 60 A.D., meaning that one or two gospels could have been written as early as seven to ten years after the crucifixion! Further, the gospels must have been written in the 1st century because early Christian writers between 95-150 A.D. cited Bible verses! 28
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3. What is the earliest copy of text? There are eighty-eight undisputed manuscripts dating twenty-five to 200 years after they were originally written. The John Rylands Fragment of John dates from 114, just twenty-five years after it was written. The Bodmer Collection’s complete copies of New Testament books dates to within 150 years after they were written. The ChesterBeady papyri contain nearly the complete New Testament from 250. Having copies of an ancient book within twenty-five to 200 years of the original is an astoundingly short period of time compared to secular works from antiquity that survive in a handful of manuscripts copied about 1,000 years after they were composed. 4. How accurate are the translations? Sir Fredrick Kenyon wrote, “The number of New Testament manuscripts, early translations, and quotations from it by the Church Fathers is so large that it is practically certain that the true reading of every doubtful passage is preserved in some one or other of these ancient authorities.” Biblical scholar Bruce Metzger found that the New Testament has been transmitted with 99.5 percent accuracy. The 0.5 percent does not affect any major doctrine; it is not missing text, but scribal notes subsequently incorporated into the text. The Bibliographic Test shows that the New Testament is by far the best-attested text of any ancient writing in the world. B. Internal Test 1. “What about all those errors?” There is widespread misunderstanding about the 200,000 “errors” in the biblical manuscripts. First, these are not “errors” but variant readings, the vast majority of which are strictly grammatical. Second, these readings are spread throughout 5,686 manuscripts, so that a variant spelling of one letter of one word in one verse in 2,000 manuscripts is counted as 2,000 “errors.” Christians admit that with all those manuscripts, there are a lot of little differences. But none of these affect the message of the Bible. Furthermore, the variant readings actually confirm the original text! To illustrate, consider the following telegrams, each one received on subsequent days: 1) “Y#U HAVE WON TEN MILLION DOLLARS CALL 555-1234.” 2) “YO# HAVE WON TEN MILLION DOLLARS CAL 555-1234.” 3) “YOU HAVE WON TNE MILLION DOLLARS CALL 555-1234.” 4) “YOU HAVE WON TENMILLIONDOLLARS CALL 555-1234.” Even if we received only the first telegram we know what the exact message is despite the error. And if we received twenty telegrams, each one having a similar mistake in a different place, we would say that the message is beyond all reasonable doubt. In contrast, the New Testament manuscripts have a much smaller percentage of significant copyist errors than these telegrams. Further, with 5,686 manuscripts, compared to a few telegrams, the real mes-
sage of the New Testament is no more affected than is the message of the telegram. 2. “What about all the contradictions?” The Bible is without mistake, but the critics are not. Except where scribal errors and extraneous changes crept into textual families over the centuries, all the critics’ allegations of error in the Bible are based on interpretation errors of their own (see Geisler and Howe, 11-27). When one considers the “Big Picture,” even the loosest English translation of the Bible conveys clearly that God sent Christ to redeem man.
B. How Many? There are nine eyewitnesses who either wrote or superintended what was written of Christ’s miraculous life and teachings! Paul, writing twenty years after the resurrection, mentions 500 witnesses who had seen the resurrected Christ (1 Cor. 15:6,7). C. How honest? The writers of the New Testament taught and died for what they believed in. Eleven of twelve apostles were martyred, an unmistakable sign of authenticity (2 Tim. 4:6-8; 2 Pet. 1:14). Further, no one ever refuted the apostles’ claims; opponents only attempted to silence them.
C. External Test 1. Secular and Jewish Confirmation Extra-biblical sources substantiate the historical reliability of the New Testament. At least seventeen non-Christian writings, dating from twenty to 150 years after Jesus’ resurrection, record more than fifty details concerning Jesus and the early church. These sources include Roman and Greek historians, Roman government officials, Jewish sources, and a Syrian Father. Dr. Geisler summarizes that these contemporary non-believing sources inform us that: Jesus was from Nazareth. He lived a wise and virtuous life. He was crucified in Palestine under Pontius Pilate during the reign of Tiberius Caesar at Passover time, being considered the Jewish king. He was believed by his disciples to have been raised from the dead three days later. Jewish leaders charged Christ with sorcery and believed he was born of adultery. Nero and other Roman rulers bitterly persecuted and martyred early Christians. These early Christians denied polytheism, lived dedicated lives according to Christ’s teachings, and worshiped Christ. (384-385) This picture from non-believers conforms to the view of Christ presented in the New Testament! 2. Archaeological Confirmation of Biblical History More than 25,000 sites confirm, in clear outline or exact detail, historical statements in the Bible. Archeologist Nelson Glueck wrote, “No archaeological discovery has ever controverted a biblical reference.” Archeologists have found the bones of a first-century crucifixion victim confirming the accuracy of the New Testament writers. The “Nazareth Decree,” issued by Emperor Claudius between 4154, threatens tomb robbers with death instead of the usual fine, possibly because rumors were still circulating about the body of Christ being stolen! Colin Hemer’s text confirms hundreds of archaeological finds that support specific persons, events, and facts presented in Luke and Acts alone. The confirmation of historicity for Acts is overwhelming.
III. The Reliability of the New Testament Writers Dr. Geisler invokes skeptic David Humes’ criteria for testing the credibility of witnesses. These four tests are: How early? How many? How honest? How accurate? (779-781) A. How early? There is overwhelming evidence that the New Testament was written or superintended by eyewitnesses of the events with one or two gospels written within seven to ten years after Christ’s resurrection. Even if the books were written thirty to fifty years after Christ’s resurrection, there is not enough time for legends about Jesus to develop. It takes at least two generations and isolation for myth to develop. Neither was applicable.
D. How accurate? The post-resurrection witnesses were in most cases independent of one another. There were at least ten different appearances over forty days (Acts 1:3). There are details only eyewitnesses would know such as the “blood and water” from Jesus’ pierced side, and His bloody sweat in the Garden. The somewhat different, yet compatible, accounts of the resurrection appearances argue strongly for the independence and integrity of the witnesses and against collusion.
IV. Conclusion The authenticity of the New Testament documents is firmly established today. Eyewitnesses wrote or superintended the New Testament. There are more manuscripts, earlier manuscripts, better copied manuscripts, and manuscripts written by more people who were closer to the events than for any other work in ancient history. Archaeology continually confirms details of their writing. Secondly, the integrity of the New Testament writers is beyond reproach. They taught and died for what they believed. Twelve scared, scattered, skeptical disciples suddenly became the most aggressive and effective peaceful evangelical missionary force the world has ever known. Eleven of the twelve died martyrs for what they taught. Despite persecution, Christianity spread by peaceful means throughout the Roman Empire. Only the truth of the resurrection could explain the rapid spread of Christianity by peaceful means. ✝
Bibliography Geisler, Norman L. Bakers Encyclopedia of Apologetics. Grand Rapids: Baker, 1999. ________ and Thomas Howe. When Critics Ask. Wheaton IL: Victor Books, 1992. Habermas, Gary. The Historical Jesus. Ancient Evidence for the Life of Christ. Joplin MO: College Press, 1996. Hemer, Colin. The Book of Acts in the Setting of Hellenistic History. Winona Lake, IN: Eisenbrauns, 1990.
Robert W. Martin III, MD, MAR, lives in Lafayette, Indiana, where he practices Dermatology and Dermato-pathology. He is married, with four children. He has served on the faculty of Johns Hopkins, Case Western Reserve, and now Indiana University and Purdue Pharmacy School. He has a Masters in Religion from Southern Evangelical Seminary. His Just Add Water (Volume 3.1: Apologetics for the Health Professional), available via CMDA’s Website, utilizes Norman Geisler’s twelve-point “Classical Apologetic” approach fashioned after Paul’s apologetic in Acts 17. Dr. Martin may be reached by e-mail at: martinr@arnett.com.
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Lord, We Need to Talk by Dan Crabtree, MD
Dr. Crabtree in a perfect setting for reflection
Today was not a fun day – the fever and chills started earlier than usual, accompanied by worsening fatigue and nausea that would not respond to the usual medication. My abdomen is tense, bloated by the expanding cancerous growths in the liver, resulting in more pain, complete loss of appetite, early satiety, constant nausea, and frequent (painful) belching. To swallow even a bite of food is like stuffing a grapefruit into a barrel of gravel. Adding to this misery, the medications given to ease the pain have resulted in severe constipation. So I told the Lord, “We need to talk. . . .” A month earlier, in the middle of a busy day at the office, I had received an unexpected call from my primary care physician: “Dan, I hate to tell you this, but the CT shows you have lesions scattered throughout your body. . . .” For several weeks I had been experiencing episodic chills, low grade fever, and a flare of irritative voiding symptoms, which had prompted a visit to my urologist to rule out obstruction or a septic prostatitis. The CT urogram, and a subsequent liver biopsy, revealed the true nature of the problem: stage IV malignant melanoma. Multiple subsequent imaging studies disclosed a harsh reality. In spite of a lack of any detectable primary site, renegade melanoma cells had spread to my brain, lungs, liver, spleen, lymph nodes, ribs, long bones, every vertebra of my spine, pelvis, and even my salivary glands. My CT scan lit up like a Christmas tree! I rapidly became anemic and asthenic, with bone-wracking pain and breathlessness due to a significant pleural effusion. The oncologist estimated less than six months to live, without treatment. Within two weeks I had lost nearly thirty pounds, and the occasional rigors had progressed to a daily pattern of severe flu-like symptoms (fever, chills, soaking night sweats, weakness, and generalized musculoskeletal pain 30
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One doctor’s journey toward deeper faith and trust in the sovereignty of God
involving ribs, back, sacrum, hips, shoulders, forearms, and thighs). These symptoms arrived predictably each afternoon, lasting about twelve hours and making sleep nearly impossible. The periods of respite during the day were marked by extreme fatigue and the persistent nausea. Sleep came only in sporadic and brief interludes. In the mirror there appeared an emaciated stranger with sallow complexion who consciously forced a smile in an effort to reignite a flicker of life within. I was referred to Dr. William Grosh at the University of Virginia Medical Center for consideration of high-dose Interleukin-2 therapy, but due to the brain tumors and concerns about possible concomitant pneumonia, treatment was delayed for several weeks. This period of waiting was punctuated by several trips to the emergency room prompted by either intractable pain or intractable nausea. Each passing day diminished the chances of tolerating and/or responding to the IL-2 therapy. In retrospect, I suspect my physicians were wavering between a recommendation for hospice care versus aggressive hospital care. It was during this dark time, trudging through “the valley of the shadow of death,” that I got alone with God one day and we had a conversation. I want you to understand I have not been privileged to hear an audible voice from God, but somehow He makes His thoughts known, sometimes by reminding me of truths from Scripture, sometimes by silence, and sometimes by deep-seated impressions that speak to my spirit. His first response: “Of course we need to talk. I’ve always wanted you to feel free to speak with Me at any time. You know I love you very much.” I thanked Him for His love, acknowledged that I was counting on that, and simply pleaded for some glimpse into what He wanted me to learn through all of this, ask-
however, I had to admit that these perceived rights were built on a false premise. Because we are created beings who have rebelled against a loving and holy Creator, we have lost all claim to any rights or expectations that would otherwise accompany an unbroken relationship with Him (see Romans 3:23). As this same God is also full of grace and mercy, however, He often showers on us seasons of comfort, peace, and prosperity – and we begin to think that somehow we deserve these blessings. As Linda read on, the Lord further reaffirmed to us both that we were cherished and He would faithfully provide us with all the grace we would need to continue on this journey. Simultaneously I felt strengthened, the nausea subsided, and Linda and I enjoyed a bowl of ice cream! This wasn’t a right, but a great privilege. In subsequent days He has been faithful to answer my other question: “What do you want me to learn?” Although I have survived far beyond initial expectations, the battle is not over and I continue to seek the lessons I have yet to learn about His character and my circumstance. I have attempted to share those lessons through a blog at dancrabtree.blogspot.com. Allow me to present here just two:
Lord, We Need to Talk
ing for a little break from the weakness and nausea so I could comfort my wife, Linda. Then there was silence. I felt His presence, but He did not speak. Later that evening Linda read me a passage from a book entitled The Shack, sent by an old friend. In this allegorical novel, the central figure is a Christian who suffers the death of his daughter through the horrifying violent act of an evil man. He is scarred for life with what the author calls “the great sadness.” Prompted by a mysterious letter that appears in his mailbox one day, he travels to a remote cabin where the crime took place – the “shack.” Here he is confronted by all the pain, anguish, and anger that have been festering inside him. His enormous loss shakes his faith in a loving God to the core. Just as he is in the midst of railing against this God, he suddenly finds himself in His very presence . . . and everything changes. As he interacts with the characters who represent God the Father, the Son, and Holy Spirit, he is confronted with the tension between his experience (or his interpretation of that experience) and the incontrovertible evidence of God’s true character: “The God who is – the I am who I am – cannot act apart from love.” Through the thoughts and images of this inspiring novel, the Lord reengaged our earlier conversation. He gently reminded me that the basis of my question stood on a false (and doggedly persistent) assumption that I have RIGHTS. As difficult as it is (for all of us) to accept, all such rights are an illusion and a reflection of our inexorable tendency to want to wrest control of our lives out of someone else’s hands, even God’s. The unspoken thoughts were: I have a right to grow old with my wife; I have a right to see my grandchildren grow up; I at least have a right to a few hours of relief from this progressive disease – don’t I? Upon reflection,
God’s character does not depend on my circumstances: The starting point for understanding the true character of God is not my circumstances, but rather that which He has revealed about Himself in His Word and through the example of His Son. When I begin with my circumstance, my vision may be distorted by my pain. Rather, I choose to affirm His true character as revealed in Scripture: For the word of the LORD is upright, And all His work is done in faithfulness. He loves righteousness and justice; The earth is full of the lovingkindness of the LORD (Psalm 33:4-5, NASB). Jesus Christ is the same yesterday and today and forever (Hebrews 13:8, NASB).
Dr. Crabtree with his wife, Linda
God cares more about my character than my comfort; He values purity over prosperity, longsuffering over longevity: In order to reconcile my experience with the true nature of God, I must gain an eternal perspective and look back on my circumstances from that perspective. I now find myself seeking to understand that which He is trying to teach me through my experience in light of His proven character and undeniable love. With the hammer and chisel of this devastating disease, He has been reshaping my character, realigning my priorities, and adding new definition to my values. Through this difficult journey with cancer, I have been unalterably changed. I n t e r n e t W e b s i t e : w w w. c m d a . o r g
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Lord, We Need to Talk Dr. Crabtree surrounded by seven of his eight grandchildren (photo taken shortly after diagnosis of Stage IV Melanoma)
“Now I rejoice in my sufferings for your sake, and in my flesh I do my share on behalf of His body, which is the church, in filling up what is lacking in Christ’s afflictions” (Colossians 1:24, NASB). “And He has said to me, ‘My grace is sufficient for you, for power is perfected in weakness.’ Most gladly, therefore, I will rather boast about my weaknesses, so that the power of Christ may dwell in me. Therefore I am well content with weaknesses, with insults, with distresses, with persecutions, with difficulties, for Christ’s sake; for when I am weak, then I am strong” (2 Cor. 12:9, NASB).
so as to live the rest of the time in the flesh no longer for the lusts of men, but for the will of God” (1 Peter 4:1-2, NASB). My ongoing interactions with God regarding this devastating disease have resulted in a relationship with Him that is more intimate, honest, and ardent. This is an ongoing conversation. As a result of this experience, I have learned to let go of my perceived rights, affirm the proven love and faithfulness of my God and, with Job, declare: “Though He slay me, I will hope in Him. Nevertheless I will argue my ways before Him” (Job 13:15, NASB). ✝ Bibliography
“And not only this, but we also exult in our tribulations, knowing that tribulation brings about perseverance; and perseverance, proven character; and proven character, hope; and hope does not disappoint, because the love of God has been poured out within our hearts through the Holy Spirit who was given to us” (Romans 5:3-5, NASB). “Consider it all joy, my brethren, when you encounter various trials, knowing that the testing of your faith produces endurance. And let endurance have its perfect result, so that you may be perfect and complete, lacking in nothing” (James 1:2-4, NASB). “Therefore, since Christ has suffered in the flesh, arm yourselves also with the same purpose, because he who has suffered in the flesh has ceased from sin,
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Young, William P. The Shack, (Windblown Media; Newbury Park, CA, 2008) p. 102.
Dan Crabtree, MD, is a Family Physician and CMDA member in practice since 1976, father of three married daughters, grandfather to eight children, who currently lives in Norfolk, VA, with his wife, Linda. On January 23, 2008 he was diagnosed with advanced stage IV Malignant Melanoma (without known primary), which forced him to give up practice. He is currently under the care of the Melanoma Center at the University of Virginia Medical Center. His journey with cancer and lessons learned along the way are chronicled in a blog at dancrabtree.blogspot.com.
CLASSIFIEDS Overseas Missions Missionary dentist needed for active dental department of United Mission Hospital Tansen. For details, contact Dr. Roshan Kharel, dentist and donor relations officer, Tansen Mission Hospital at: rosekharel@yahoo.com.
Positions Open Dental – Associate for thriving general and prosthodontic dental practice. Christian dentists, in-house lab, no insur. Great experienced staff, area needs dentists. 2.5 hrs to NYC, safe, beautiful, stable area, low housing costs. Long established practice with excellent reputation. Partnership opportunities. Contact: jboyd13168@gmail.com. Dentist – Be your own boss! Work your own dental office with option to buy in. Associate wanted to replace owner/dentist retiring, ASAP. This is an incredible opportunity, a real win/win situation. We are a 4 op medicaid/insurance practice in Piqua, Ohio. Furnished apartment upstairs incl. with a minimum base pay of $175,000 plus commission. Practice hours are Mon.-Thurs. 9-6 pm. Contact Dr. David Kuhre at: liladave@earthlink.net.
Neurologist – North Carolina. Sandhills Neurologist, PA is seeking two BC/BE Neurologists, exclusively out-patient practice. This practice is interested in the physical and spiritual needs of the patient. Located in south central NC. World-renowned golfing
Orthopedic – Well-established practice of three orthopedists and one podiatrist committed to providing care with compassion as well as excellence. Time off for short-term missions. Would like to talk with general and subspecialty orthopedists about the possibility of joining us in practice. On-site surgery center; local hospital within walking distance. Located in a family-oriented city where many recreational and cultural activities are available. Less than a 10 minute commute from any area of the city. Low malpractice rates and cost of living. Vacation at the mountains and the beach; live here and enjoy all four seasons. Please contact our Medical Director, Dr. Chris Wilkinson at: 308-627-4664 or cwilkinson@ kearneyortho.com. Our clinic manager, Vicki Aten, can be reached at: 308-8652512 or vaten@kearneyortho.com.
salary and benefits; call 1:4. High priority on family life. Position available July 2010. Please contact Bonita Lancaster at: 866-507-3385 or e-mail your CV to: blancaster@baptistfirst.org. Podiatry – Busy podiatric practice in beautiful Portland, Oregon is seeking a podiatrist. Great area for those who love the outdoors. Contact Julie at: 503-244-7894, or e-mail at: shrddhayes@yahoo.com. Psychiatrist – Fast growing psychiatric clinic in Plano, TX seeking Christian psychiatrist. Clinic offers brain SPECT Imaging and full service outpatient services. Competitive compensation and benefits. E-mail or fax your resume to: sall@clementsclinic.com or 972-781-0203.
Otolaryngologist – Beautiful North Cascades area of Washington State. Located between Seattle, Washington and Vancouver, BC. The area offers quick access to the San Juan Islands or the Cascade Mountains for hiking, fishing, kayaking, to name just a few of the exceptional outdoor recreational opportunities available. An excellent partnership opportunity to join a well established five-man physician practice in Washington State. We are seeking a board eligible or board certified physician. Please contact Brooke Herzberg, Director, Human Resources Department, Cascade Medical Group at: brookeh@cascademedicalgroup.com or 360-336-2178.
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Internal Medicine – Beautiful Hendersonville, western NC! Hospital-employed opportunity for BC/BE Internal Medicine physician general outpatient IM practice. Hospitalist program coverage if desired. Growing medical community with wide range of specialist physicians. 222-bed community hospital serving diverse patient population located in city of 12,747 pop., 102,142 county pop. Great quality of life! Competitive salary & benefits/incentive package. Visit our practice opportunities page: www.pardeehospital.org. CV to Lilly Bonetti at: lilly.bonetti@ pardeehospital.org or 828-694-7728.
resort, family-oriented community with large draw area. Approx. 2.5 hrs from beaches and mountains. Contact: voss.sandhillsneuro@gmail.com.
Pediatrician – Seeking Christian pro-life pediatrician; board certified or board eligible to practice with four other pediatricians. Full or part time work available; location is central rural and semirural Pennsylvania. Contact Dr. Elam Stoltzfus at Lewisburg Pediatrics at: 570-490-2569. Pediatrician – Montgomery, AL. Seeking a BC/BE pediatrician to join a group of four Christian pediatricians. Competitive
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