Monday, October 22, 2012

Escaping the Culture: You Can't

That's funny; it's spelled just like "escape."
One talk at the CMA conference touched on something really important that I don't hear often enough in talk about the New Evangelization.

Mother Ann Marie Karlovic, O.P., of the Dominican Sisters of St. Cecilia in Nashville, TN, stood up to speak about "The New Commandment and the New Evangelization: Culture of Love - Culture of Life."

But she came to the podium and explained very simply that she felt prompted to scrap her prepared talk because it wasn't what was necessary. She said she hoped this was the Holy Spirit's idea.

At first excited by this development, I began to question her decision when she faltered a little in beginning anew. Was this the right choice? I stupidly thought to myself, forgetting all the advice to mind my business, trust in God, look for good in others, overlook apparent mistakes, and humbly look for benefit in all circumstances. I doodled in my notes, doubting the next hour would contain substance enough to fill all the lines.

My doubts came to a screeching halt shortly into the talk, because Mother Karlovic said something very important to the New Evangelization. "We need to ask," she said, "how has this culture affected me?"

Pause, and read that again.

We may think we are far away from this culture's influence; we may think we have a strong guard against its suggestions; we may think we have rooted it out of us with our dismissing bad habits and acquiring good ones. We are wrong. The culture is a complex animal and is not limited to new sins, new apathy, and old philosophical errors, from which we can be reasonably free.

We can't easily shed the way we think; however, this is part of our culture. I remember reading the early moderns at TAC and being embarrassed. Their works were easier to read than Arisotle's, even after correcting for language and temporal circumstances, simply because they and I tend to think alike about nature, man, and God, in an erroneous fashion hard to shed. Example: Descartes thought all science should be used for good. I immediately said, "yes!" before remembering that everyone from Aristotle to Pope Benedict XVI says "no" (knowledge is a good in its own right; this is a key truth important in  I hadn't realized how deeply I carried elements of our culture.

We can't easily shed the way we hope; however, this is also part of our culture. I tend to measure success in quantified productivity and progress, and my hopes are for success (e.g. more Planned Parenthood closures, fewer states capitulating on the definition of marriage, more young people becoming faithful, increased acceptance of NFP). Living a Catholic life and disassociating holiness from success has been a huge struggle. I hadn't realized how deeply I carried elements of our culture.

Have you realized how deeply you carry elements of our culture?

Saturday, October 20, 2012

I still cook

...just not as often. In fact, my diet has really declined due to a combination of unplanned spending (various extracurriculars not delivering compensation as expected) and food prep time depletion.

However, during the weekend between the cardiovascular block and the respiratory block, I cooked up a storm. My roommates and I bought two pumpkins: one for carving, and one for cooking.

Carving a pumpkin is halfway between a workout and an arts and crafts session.
Notice the artistic use of the sharpie (upper right) and the athletic use of the knife (lower panel). 

The finished jack o'lantern. We put an apple cinnamon candle inside it and it smells amazing.

We roasted the smaller pumpking and pureed it to make pumpkin bread....

...and pumpkin yogurt...
... and pumpkin soup (sooooo tasty).

And, of course, there were pumpkin seeds aplenty.

Friday, October 19, 2012

Cool Stuff

This post conforms to the blog rules.
Over my first preceptorship, I saw, heard, and felt a lot! This post has nothing to do with Catholicism, faith, holiness, dignity, or anything supernatural. It's just a list of amazing things the human body exhibits when something's wrong. If you're bored you should google some of these.
  1. patient frustrated with the wait time (this is actually a not-so-amazing thing the human mind does when something's wrong...)
  2. skin grafts
  3. screws bulging under the skin of old internal fixations
  4. inverted T wave on ECG (cardiac ischemia)
  5. arcus
  6. excessive bony transverse processes in cervical spine compressing nerve roots (shooting arm pain)
  7. omega-3 FA deficiency
  8. polycystic kidney disease
  9. glossitis
  10. puncture wound to foot
  11. fibromyalgia
  12. cherry angiomas
  13. polypharmacy causing fatigue
  14. sarcoidosis
  15. Bell's palsy
  16. possible new Ehlers-Danlos diagnosis?
  17. diabetes mellitus (type II)
  18. recurrent UTI
  19. diabetic neuropathy: hyperesthesia in hands and feet, anesthesia in feet
  20. pitting edema
  21. enlarged tonsil (making the uvula deviate)
  22. femoral bruits
  23. hemiplegic migraine
  24. mild clubbing
I also wrote my first two prescriptions! (I didn't sign them; that would be maybe we should say they weren't my first two prescriptions. But the drug, dose, number, and sig were all in my handwriting!) Wow, what an experience.

Wednesday, October 17, 2012

Vibrant Catholic Culture in Exam Rooms is Awesome

This post conforms to the blog rules.
Right now, my country is trying to shove my faith out of my work. How dare I bring my vibrant Catholic culture into the exam room? Recently, I was glad I dared to bring my vibrant Catholic culture in to see a patient.

I was working in the office of a Hindu physician, many of whose patients were from south/east Asia. I felt out of place until I saw a patient who was much like me: white, Christian, and Southern. She was applying for federal disability income and had a long story culminating in her current deep poverty. She cried as she said "I'm indigent," but dried her tears as she repeatedly professed faith in God's will for her.

If my preceptor had seen this patient, the patient would not have gotten so far as to mention God's will. Because my preceptor is adept at getting clinical information quickly, she probably would have listened to a few sentences of the patient's spiritual situation, would have nodded and produced a true but not supernatural platitude in a tone of voice implying closure, and asked another question about the patient's disability. Because I I know the truth of God's providence and the ultimate purpose of this life, I could nod with real understanding and begin to pray earnestly for this poor woman.

I love it when cultural competence, a humanities buzzword, actually refers to cultures to which I belong. In other words, I love it when cultural competence is something I already have, instead of something I woefully lack because I am not brown and, alas, something I will probably never acquire because I am not a liberal.

But this experience goes beyond, "I'm so glad I am a Christian and was there for a Christian patient."

Monday, October 15, 2012

Advice from a CMA NFP doc, or "Forward!"

As the CMA conference ended and I, with my rolled-up poster, went up the elevator to my hotel room I met an NFP-only family practice doctor who seemed interested in my work. (Yay!) He gave me his email; then, we spoke by phone. I forgot how awesome it is to get encouragement from mentors who really share one's ideals! The march toward being a doctor gets a little mindless at times.

His advice:
  1. You're in a culture that doesn't appreciate the dignity of the person, the excellence of NFP, etc., and medicine is at the height of this lack of appreciation.
  2. Keep the faith.
  3. Stay confident; you know you're over the target when you're fired on. NFP is good medicine, especially long-term. It is medicine that conforms to the body's physiology and pathology.
  4. Let the comments slide and pray for those who disagree or make life difficult.
  5. Don't wear yourself out trying to convince people; just witness.
  6. Meet people (patients and colleagues) where they're at. Listen (only when you listen, can you speak effectively) and they'll come back.
  7. DON'T participate in things that your conscience is uneasy with.
    1. If a patient comes in for birth control, you can still do the H&P. 
      1. If she has a boyfriend, sit down and talk with her about her boyfriend. "What happens if you get pregnant?" you might ask. "Are you sure you want to have sex with a guy who won't stick around?" If nothing else, this is informed consent. It doesn't take much time, but it may help her begin deliberating early about these major choices.
      2. If she is there because of a parent's wishes, ask her what she would like to do.
      3. If she does decide she wants birth control, complete the H&P and in the oral presentation, simply state, "...and she is here for OCPs, but because of my faith I cannot provide that."
      4. Or, in residency: "Okay, that's your choice; I am not able to help you with that, so I'll call in one of the other residents and she'll take care of you. I will always be here if you'd like to see me again."
    2. During a C-section with BTL, assist with the section and state, "I'm happy to assist at surgery, but during the tubal ligation I'll back away from the table, staying sterile, until you're finished." If the attending makes it clear that they will therefore close alone, simply say, "Okay, thanks for letting me assist. I'll let you know how the baby's doing."
    3. Go to the supervisor if an attending grades you badly because of this, stating, "I am willing to take a bad grade for something I did badly or didn't understand, but..." If the supervisor doesn't help, ADF will.
He also connected me with some awesome resources, including One More Soul, AAFCP, IIRRM, the Gianna Centers that St. Peter's in New Brunswick is hoping to place everywhere, and (of course) PPVI and FCCA. There are some names I should apparently know: Erik Odeblad, Kyle Beiter, Anne Notle (I've actually met her!), and Joseph Stanford. Joseph Stanford and IIRRM are doing a lot of research, notably on men's interest in NFP (93% was the number this doctor gave me, but I can't find the study), couple's month-by-month intentions (CEIBA), and effectiveness of miscarriage prevention and infertility treatment (iNEST).

If we start a crusade, we could wear
long, white, matching outfits and carry
pointy things. Oh wait, doctors do
that anyway.
He also said that obstetrics/gynecology has, more than any other specialty, fallen behind. Cardiology is talking about calcium channel blockers in heart disease, but no one in gynecology cares what kind of channels the cervix has (apparently, the cervix also has important calcium channels?). He urged me to think about family practice (which I have, and don't want to again), but then urged that if I was going to practice OB/GYN, that I not get rusty--that I keep up with endocrinology, general health, etc--and not be a referral machine. (This is exactly my hope! People don't want six doctors.) He explained that the reason OB/GYN is behind is that it's imbued with a culture of death, which is wringing out any faithfulness and religion, even when it is detrimental to patients. A stat he threw out: in the 1950s physicians had an 80% pregnancy rate in women with PCOS; now we're at 23% with IVF. Doesn't that just make you want to preach a Crusade?

The march toward being a doctor just got  invigorating again. Forward!

Friday, October 12, 2012

The Priest and the New Evangelization

Rev. John Bartunek's presentation entitled Making All Things New: The Priest in the New Evangelization was arguably the best talk at the conference. (So if you haven't bought any recordings yet, now is the time.)

The priesthood, Fr. Bartunek stated immediately, is for the Church and for others. Rather than give a theological exposition of the priesthood, he instead listed three demands being made on priests now, and ways laypeople can help meet those demands.
  1. Priests will need to be ready for martyrdom.
    There were no analogies about "a kind of martyrdom." This is real death he's talking about. The springtime of the Church comes only after the planting of seeds, and the seed of the Church is the blood of the martyrs.

    Things laypeople should do: pray for priests

  2. Priests will need to work harder than ever. There are more souls in grave need than ever before due to increased population, decreased prevalence of Christiantiy, increased prevalence of ex-Christianity and new atheism, and new sorrows (abortion, drugs, porn). There are fewer priests in many places.

    Things laypeople should do: connect the spiritually and physically needy to the priests (keep the priests busy)
    . Things like the Legion of Mary, Regnum Christi, and dozens of other lay movements are terrific at this. New media initiatives are also excellent.

  3. Priests will need to renew their commitment to becoming experts in things of God. Priests should be examples of great holiness and they must be specialists in promoting the interior life or the encounter with God. They must pray, be men of God, and nourished by grace.

    Things laypeople should do: ask priests to do priestly things! It reminds them of their calling.
    Have a priest give a benediction to your group or bless your house/office/car/dog/wine (I'm serious)! Just like patients remind doctors of their vocation, laypeople remind priests. It's a brilliant setup.
The last one is my favorite, but I love it all. Bl. John Paul II said that the world looks to the priest in this time of turmoil. Let us look to the priest, strengthen him, and help others to find him, too!

Wednesday, October 10, 2012

The Call to Holiness = The Foundation for Catholic Health Care

St. Basil, one of the founders of the
Catholic hospital (a.k.a. one of the
founders of modern hospitals)
This was the title of the talk given by Fr. Joseph Johnson at the CMA conference last week (except he used a real predicate instead of an equals sign).

I completely agreed with his thesis before Fr. Johnson ever stepped behind the podium. Ever since reading How the Catholic Church Built Western Civilization and being floored repeatedly by the chapter on the Church and healthcare, I've agreed with this thesis.

Thomas E. Woods, author of the above, chronicles saints' work to build hospitals and fill them with the sick, especially the poor, the family-less, and the homeless. Importantly, Woods emphasizes that this work stemmed directly from the saints' understanding that their faith demanded it. Becoming holy required God-like deeds which (for a religion proclaiming a God who was Mercy itself and had exhibited that Mercy in countless healings and acts of supreme self-sacrifice) meant works of mercy.

(This makes me want to spiral off into a discussion of love, and how true Love is only had by mirroring Christ and anyone who agrees should readily understand the doctrine that there is not salvation outside the Church...but we'll stay on-topic.)

Medicine, Fr. Johnson said, is elevated from a career to a vocation because healthcare workers earn their daily bread by touching Christ in their patients and being Christ to their patients. Asked what the solution was to the healthcare crisis, Fr. Johnson simply said, "we need saints." We need people who will restore compassion to healthcare and repair the patient-doctor relationship to the Love with which it was inflamed in the first hospitals.

A Catholic doctor wishing to become such a saint seeks more than good bedside manner; he seeks a sincerity that stretches him and makes him more Christ-like.

Isn't it naive, an objector might ask, to approach the culture of death (so many problems!) with only these scant recommendations?

Hardly, Fr. Johnson retorts. The above is a full-bodied prescription for sainthood. Here are its ingredients:
  1. Formation. Nemo dat qui non habet, and action follows contemplation just as it did for the saints Woods discussed. Prayer and study of Scripture and theology fill us and motivate us to love others and teach others. Without prayer and study, all our frenetic activity lacks meaning!
  2. The Sacraments, especially the Eucharist and Confession.
  3. Sacrifice, which allows us to learn to love as He loves.
  4. Adherence. Never excuse yourself from this! This represents a change in the spiritual diet, but be a compliant patient of the Divine Physician. Remember that your patients need a doctor who is Christ-like.
A crucifix in Vilnius. (The triumph of love.)
Simple, but not easy. We need to learn to love better, or we need to learn to allow Christ to love for us. Luckily, medicine presents constant opportunities for the physician to increase in love, Fr. Johnson said. The need of others becomes an opportunity to serve Christ. In fact, some of those early hospitaller saints would call patients "my Lords, the sick and the poor." This reminds me of the additional Divine Praise that Missionaries of Charity say at Benediction: "Blessed be God in his most distressing disguise," meaning that each poor person they serve is God.

To become a saintly doctor, Fr. Johnson concludes, is exciting. It is to realize St. Teresa's poem; it is to become a lover, not a fixer (because Jesus is a lover, not a fixer); and it is to triumph, because we already know that Love has triumphed.

Monday, October 8, 2012

The Crisis of Modernity: The Past two Popes and the Church of the 21st Century

The first speaker of the CMA conference last week was George Weigel; this was probably vital since the conference had stolen its title right from Weigel's 1999 book A Witness to Hope: The Biography of Pope John Paul II.

Still being in student-mode, I took copious notes. Mr. Weigel, alluding to Alisdair MacIntyre, began by saying that our culture possesses the language of morality without theoretical or practical comprehension of what the language expresses. I vehemently agree! Post-Christian healthcare as it insists on human dignity and simultaneously affirms unbridled human autonomy doesn't realize what it's talking about.

To discover how we got into this situation, Weigel next reviews Marx, Bentham, and Hume: Marx, who thought that the good was some glorious society of men, the pinnacle of evolution; Bentham, that the good was the benefit to the greatest number; Hume, that morality could not be derived from reality. Granted, each of these develops into a different dystopia (for Marx, see 1984 or your history book; for Bentham, see Brave New World or the newspapers; for Hume, see both).

But all three had direct political and practical effects: morality, unrelated to reality, became arbitrarily or socially derived. Politics, unrelated to reason, became a business or utility. The purpose of life collapses into social or hedonist utility and the long-asked, bigger questions about beauty, goodness, and being become irrelevant.

Utility (not dignity) became the measure of a man's worth, because to dismiss these questions (as part of a dismissal of higher purpose, need for salvation, etc.) is to dismiss man's nature, designed to appreciate created and uncreated truth, goodness, beauty, and being. A dismissal of such a particular rational nature includes all that comes with it, including dignity, since man's nature alone (among material creatures) was made in the image of God.

This leads to "a pulverization of the fundamental uniqueness of each human person" (Henri de Lubac). Fortunately, the cure is well-known and easy, if long: we must daily confirm the richness of each person, founded on the Incarnation* and defended by true philosophy. Practically speaking:

  1. By applying Christ, our Remedy, we can heal. Therefore, promote the Sacraments and Scripture and transform our lives to be Christ to others.
  2. The culture is not neutral or permissive to passing on the faith. But don't just sit there pouting about it and feeling all righteous. Convert the culture, with a return to virtue ethics!
Long story short: great talk.

Sunday, October 7, 2012

CMA Conference Debriefing

Cathedral of St. Paul, St. Paul, MN.
Last week I attended this year's annual CMA conference, held in St. Paul, Minnesota! It was a very good conference. At first, I was captivated by the excellent lectures by speakers such as George Weigel and Rev. Michael Keating. (Recordings available in the CMA online store.)

But soon, I was very surprised to realize that there was very little medical content in the talks. There were a dozen talks about philosophy, history, law, diabolical forces, vocations, the Vatican, politics, new media, the priesthood, personal holiness, and beauty. There were only three or four talks directly related to medicine: Rev. Robert Sirico of the Acton Institute lectured on allocating scarce resources; Dr. Lester Ruppersberger shared how he went from prescribing contraception to using NFP only; Dr. Wes Ely discussed end-of-life ethics; and Jere Palazzolo shared his work toward a stateside Casa Sollievo della Sufferenza.

I was also amazed by the number of people attending the conference (six hundred), which was much larger than the 2008 attendance. The medical student number had doubled or tripled.

Is this the same CMA?? I wondered. I liked that many of the talks in 2008 were medically-driven and given by physicians, and I'd been amazed and pleased that ethics was consistently dicussed about every medical question, not just the hot-button issues. (For instance, there was a talk on when plastic surgery is morally appropriate; the surgeon giving the presentation described how the body is an important part of us and can affect our esteem, health, and peace. Any surgery advancing could be defensible. He especially focused on rhinoplasties and breast reduction.) In addition, physicians were very thoughtful of their patients and of the human person. (Another example: there was a talk about sexuality in the older patient, and questions to ask to ensure that he or she was undergoing the aging changes well or needed help in this weighty area.) I spoke to several of this year's attendees who remarked that even last year's conference was more medical.

But after a little thought, I realized that this year's conference was very necessary, and very good. The explicit political-commercial healthcare crisis the Church in the U.S. is facing exposes the need to confront the culture more than ever and dramatizes our call to holiness. This might explain the high attendance and the shift in topics.

Imitation of the Pieta, Cathedral of St. Paul.
Like 2008, this year's conference didn't skimp on the perks: the Rosary was prayed each morning, Holy Mass (with bishops, ten priests, chanted introits, and an organ!!) followed, the Blessed Sacrament was continually available for veneration, confession was offered almost constantly, and the conference culminated in the White Mass held at St. Paul's beautiful Cathedral.

Like 2008, there were many religious there, including the Religious Sisters of Mercy and some Little Sisters of the Poor, both of whom I love.

Unlike in 2008, this conference was made an indulgenced act (there was an indulgence granted to all who attended and who met the qualifications to receive it)! The Church and her Master are so, so good! Imagine: I can gain a plenary indulgence for a soul by spending a day at a professional conference, receiving Our Lord, praying for his Vicar, and being free from sin. Talk about making ordinary acts holy....

I'd like to spend a few posts reflecting on the talks I think were the most content-rich, necessary, and effective. Until then: this has been your shameless plug for the CMA.