The Purpose of Travel

This was written in my gridbook on the train from Madrid to Lisbon:

What is the purpose of travel?

We often speak of someone who has traveled extensively like we talk about those who are particularly wise or gifted. My liberal arts college even made travel experience a requirement for graduation. (It was call a “Cross-Cultural” requirement, but it almost always involved crossing a border.) What is all this importance given to traveling to distant countries? Isn't it just another form of recreation, in which the world becomes our source of amusement?

So today is the last day of our month in Europe. We have traveled across six different countries. I have seen some beautiful and amazing places. With such brief visits to each nation, however, we only got the smallest taste for the different cultures –mostly only in the form of differences in dress, mannerisms, and architecture. With a significant language barrier in each country, there weren't really opportunities to interact with people there in any meaningful way. I have been much more culturally enriched getting to know immigrants back in the United States.

I have a tendency to be cynical about tourism. I find the idea of going to some distant place and “paying people to stare at them and their homes” a bid degrading (both for the tourist and the native). My idealism, also, groans at the prospect of spending so much money and resources on my own edification which could be better spent on more “worthy” causes. I cannot help but wonder if the idea of the “world-traveler” is a holdover from Colonialism –the rich masters go touring around the world to gain notable experiences, oblivious to the sufferings their wealth and opulence cause.

But in spite of all my reservations, I am glad that we did it... glad I can say I have stood where Plato, Agamemnon, and Julius Caesar stood... glad I have hiked the Alps... glad I saw hundreds of places and works of art I have read about my whole life... glad I walked the streets of the same town in Italy where my grandfather grew up. I know these enjoyable experiences don't constitute a worthwhile apology for tourism, but it has been my experience. Right or wrong, I am glad I took a month of my life to ride the rails in Europe.

Seeing the World

Joya and I have packed our bags and we are off to see the world. We will be backpaking Europe while riding the rails for the next four weeks. I'll try to post some updates on where we are and what we are doing on Gridbook Notes when I am able to find affordable internet connections. I expect that the Gridbook Blog will be quiet for the next month, but hopefully afterwards I'll have some interesting thoughts inspired by different peoples and cultures to post here.

Leaving my Patients

When I finished my residency last week, I also left behind my panel of patients to other physicians who will care for them now. I am realizing it is actually my patients I will miss the most as I leave my residency behind. Three years ago I was terrified that a group of people would look to me as their doctor. I still see the doctor-patient relationship as one of the most solemn of responsibilities I will bear in my life. In some ways I feel closer to many of my patients than I do to people I have known for decades. The physician-patient relationship can lead to a level of human connection rare among today's interactions. Many of my patients have been with me for my entire 3 years in Kingsport. I often went home still carrying them in my mind. I rejoiced in their joys, recoveries, successes, and good news from their lives, and I bear the sorrow of their deaths, pain, failures, depressions. Strangely some of the people I was never able to “make better” by any objective standards were often the ones who said I was their favorite doctor, and some the ones that were my best medical successes didn't like me much. In the end, I think I learned more about being a physician from my patients than I ever did from my teachers.


But in the end the doctor-patient relationship is a business connection and not a friendship. I am hired by patients as a consultant on issues of their health. Glenda, the psychologist at our practice, pointed out that I was often emotionally over-invested in my patients. She is right and in many ways leaving the practice is probably good for me. On the other hand, patients do sometimes need a doctor who cares about them and knows them. Family Physicians are particularly focused on knowing their patients as individuals and not just diseases. I am still working on finding that balance. In some ways I wonder if being a physician is oddly like being a prostitute, required to connect intimately with others in her business and then forget them and move on. It makes sense that a lot of doctors are emotionally hard or distant after caring for patients and then having them die (or just simply move on to another physician). I don't want to be distant to patients who need me, at the same time my emotional energy belongs to my wife, family, and friends. I suspect this will be a balance I seek to create for my whole career in medicine.


So now my patients are with new doctors, and I am in another state. I wish them all well.

The Resident

On Friday I finished my residency. I am now considered competent to practice medicine without supervision. It was rather anti-climatic. I filled out the last of my paperwork, gathered the last of my things, and said goodbye to the few people who were in the office and left. It is strange to realize that this ends nearly a quarter century of continual education, with almost a dozen of those years focused on the knowledge required to be a medical doctor. It is one of the longest and most rigorous educations in our society.

I cannot help but pause at this moment I have anticipated for so long and wonder what exactly becoming a doctor means. I have practiced medicine in residency enough to realize that being a physician isn't going to look like my childhood fantasies. I won't be able to save the world and despite how much I try my patients will have many problems that I won't be able to help. I also know that I haven't invested so much of my life and my energy into a profession just to make myself a dispenser of pills and health advice who lives in comfortable affluence.

You would think by now I should know what it means to be a doctor (especially with all the time I have spent on discussing doctoring on this blog). I try to avoid mentioning to casual acquaintances that I am a physician, because people often treat you so differently; almost as if you have some secret knowledge or honor inaccessible to others. Being a physician now and having spent much of my recent life around them I find the title of doctor no particular indicator of anything impressive in a person. It seems that there is a duty to patients (and perhaps to society in general), but what that duty implies about the type of human being I should be still eludes me. I actually feel much less like a doctor now than I did during residency, since I left all of my patients in Tennessee.

After all the long days and sleepless nights I have spent becoming a doctor, I would actually prefer to focus on all the other roles in my life that have often been neglected: husband, brother, friend, son, Christian, writer, etc. Of course, the role of physician is the one that I must use to pay the bills so I can't take too long a break from doctoring. I’ll have to learn who I should be as a physician on the job. My education is far from over.

Isolation and Community

Two weekends ago I exchanged heavy-heart for a heavy pack. My wife, several dear friends, and I disappeared into Jefferson National Forest for 3 days and 2 nights. What a joy it is to walk under trees and sky with those I love! We carried each other's burdens (sometimes quite literally when one of us became injured.) With my over-active imagination I envisioned us as a band of nomads as we sat huddled around our fire on Mt Rodgers. And now I am back to the weary work of human misery, medical bureaucracy, and heavy responsibility.


There is nothing magical about the wilderness except that it is removed from the rest of society. It is being both isolated and together with others that forces reflection. I realize that what occupies most of my time and energy to be of small worth in comparison to those I love. My community of friends and family is by far the greatest blessing I have known in my life. My friends are not perfect (and certainly they can say the same of me) but what they are is true. They have walked with me for years and I know that we will continue to stand beside each other all our lives. They love me even when I am foolish. They correct me even when I am stubborn. They listen to me even when I talk nonsense. They pray for me. They care for my wife and family. They travel to see me. They open their homes to me. They make sacrifices for me. And in my better moments I do the same for them. Who cannot feel blessed to have such friends?


Unfortunately in today's world a community of such friends or even having one such friend is rare. I imagine that many ills of the modern world are related to the death of such community. From my own experiences with isolation I can say that I fear the man I might have become without them.

Defending Domestic Rights

A "modest proposal" for defending domestic freedoms...

AMERICANS FOR DOMESTIC RIGHTS

Domestic choices are deeply personal and often agonizing. Imagine how much more traumatic these choices must be when the government threatens to invade every home’s privacy and condemn responsible household-heads as a criminals for personal choices made within private households!

As Americans our domestic rights are profoundly important to us. Our homes become expressions of who we are. For many years American adults have enjoyed domestic freedoms. The autonomy of our domestic space is personal and sacred. We have assumed our homes to be as safe from desecration by outsiders as our own bodies. Many American adults even allow minor dependents to develop within the inner-sanctum of their domestic space. Each adult chooses how to manage his or her own home environment, and all such choices are deeply private. Americans appreciate the diversity of domestic expressions individuals choose for their lives.

In recent years, however, domestic rights foes who aim to usurp individuals’ private domestic choices and replace them with state-mandated moral codes have been gaining a foothold in government. Every American’s domestic freedoms now stand in jeopardy! Right now there are opponents of domestic rights in Congress who seek to label men and women’s personal choices as “morally intolerable” and “child abuse” and use that excuse to give the government the right to invade your private domestic space. Their anti-privacy agenda even goes so far as requesting that neighbors and health care workers become informants, reporting individuals’ personal home choices to governmental agencies that would have the authority to invade your home if your domestic choices on the management of your pre-adults doesn’t conform to official state-legislated morals.

Moralist zealots and political special interests seek to thwart the private choices of responsible adults and subvert your domestic freedoms to the alleged rights of dependent domestic minors, although the law does not recognize them as developed enough to be adults, and study after study has established that most minors (particularly the younger pre-adults) are incapable of self-sustainment independent of a domestic environment.

As the government ominously threatens to legislate puritanical morality and restrict even more domestic freedoms, many Americans do not speak up because they themselves would not choose to roughly handle or terminate their own domestic minors. What well-meaning Americans must realize is that criminalization of any adult's choices in the inner-sanctum of his or her own home is a violation of the privacy and domestic rights of every one of us! If we stand by silently the Constitutional right to privacy, the right to own property, the freedom to choose, and the protection against unlawful searches and seizures will be completely eroded in order to legislate the scruples of religious fanatics, social extremists, and special interest groups.

Please stand up for your courageous fellow Americans who even today face public humiliation, confiscation of their private homes and minors, and even imprisonment for exercising their right to make difficult domestic decisions! Educate yourself and those around you about your constitutional domestic rights and the ongoing crusade by politicians and special interests to restrict those rights. Let people know that you trust American adults to make domestic choices without government violating their homes. Write your congressman or congresswoman to let them know that you support domestic rights and urge them to oppose any legislation that would allow the government to dictate the personal choices of men and women in the privacy of their own homes. Join Americans for Domestic Rights today and let you voice be heard!

My home.
My choices.

Covenant Confession

Seven years ago when I was graduating from Covenant College I was elected to give a “senior talk” at a student assembly. What I gave was a confession. I wish that I could say I have matured so much that none of this still applies to me, but most of it does:

Four years ago I decided to go to a little Presbyterian college on a mountain. I was convinced I had chosen the best Christian college in the country, and the school was even willing to give me a scholarship for being a "Christian Leader."

Now 4 years later I am graduating from this school. I am more intelligent and more thoughtful than when I arrived. I have a better conception of my faith and I am much more capable of giving reasons for that faith intellectually. My actual faith in Jesus Christ, however, is weaker after four years at Covenant College. My “first love” has dwindled into weak flicker, well-concealed by intellect and apathy. I have not been alone in this coldness. I have sat with some of you and laughed at the naive idealists within each incoming freshmen class. We assure ourselves that Christian zeal must be a sign of either stupidity or hypocrisy, embarrassed that once we were that naive as well.


Yes, I have contributed to this attitude here on campus. Covenant’s goal of producing intelligent, thoughtful Christians gives us the perfect opportunity to feel self-righteous. We look down on our zealous, conservative evangelical brethren and label them as unintelligent or intolerant. We look down on the rest of the world as heathens and sinners, although we envy their ability to sin so freely. Our tolerance and open-mindedness is not the Christ-like sort, but a justification for excusing our own sinfulness. When we are forced to acknowledge our own apathy toward truly loving and serving Christ, we turn Reformed theology into a scapegoat, and blame those who teach us for our own sinful attitudes.


I have fallen into the common mistake of forgetting that our project of making Christ preeminent in our thinking is only a small part of our calling to love and serve Christ with our entire being and live a life of total dedication to Him. Too often at Covenant we are intellectual Christians for the sake or our own pride rather than to truly glorify God. The intellectual mission of the college is not the problem. The problem is that we are usually either hypocritical or apathetic (pick your poison). It is no wonder that so many among us have lost their faith, when we try to stand up before each other by our own power rather acknowledging our total dependence on Jesus.


So did I choose the wrong college? No, I chose the right college. I still believe that Covenant is one of the best educations in the country. I cannot blame my sins, my apathy, my pride, or my lack of prayer on “the system” here at Covenant. My attitude is not the fault of the chapel program, or reformed theology, or contract, or the influence of you my fellow students, or of intellectualism, although I have blamed all of these things. It is my own fault. I have not loved Christ as I should. I have judged myself against my fellow Christians, and used their sins to excuse my own. It is easier to look at myself in the context of other fallen people. But if I see myself as judged against the righteousness of Christ, I am forced to admit my dependence and look only on Him for mercy. This should not only force me to “integrate my faith and learning.” It should pervade my entire being and move me in ways that right now it does not. Thankfully Jesus Christ is faithful even in my faithlessness. He has seen my heart both in the good and the bad.


So, I must come before you and apologize. In a couple weeks I will graduate and leave Covenant. Over these 4 years I have received a substantial scholarship for supposedly being a “leader for Christ” here, but my attitude has often been contrary to the cause of Christ. Yes, I have kept contract for the most part, and I was a leader in the Homeless Ministry, and I have integrated faith and learning, but these things are only filthy rags to carry away with me. In retrospect I wish I had been more open and honest about my sinful tendencies, and I wish I had been more zealous for Christ. I wish I had counted all things loss for the value of knowing Jesus Christ.


In my apathy I have often realized that many confessions from Christians have elements of self-congratulation and false-piety. I fear that this senior testimony is no exception. But I pray that Christ’s grace is what you see. Please do not fear being zealous for Christ, do not fear acknowledging your own sins and asking for forgiveness. It does not make a Christian anti-intellectual or hypocritical to love Christ that deeply. I beg you not to look back at graduation and realize that you have not loved Christ, even though He has loved and sustained you this whole time.


Dear Covenant, I must thank you. I should be grateful for this fine education I have received, and the professors who regularly put up with our apathy and self-righteousness. I must thank my brothers on Catacombs, I have learned more from these last 3 years with you than all my core classes. I am sorry that I have often not been Christ-like to you. I must also thank those of you who have been my dear friends here. You know who you are. You have shown Jesus to me in so many ways that you may not even know. I have admired you and been reminded of this faith to which I have too often been faithless. I have loved you all, or loved you as best I could through my pride and sin. I wish I would have been less interested in impressing you, and more in serving you. As I leave this place it is you who I will carry with me.

The Wages of Nihilism

Today's news is sad but not surprising. It seems that meaningless violence is the hallmark of our generation's nihilism:

"The ideal young revolutionary of our generation is like an uncaged animal that unleashes blind lust or fury at anything that nears it. What other kind of revolutionary could we expect in a world with nothing worth believing in? It is only the insightful revolutionaries who truly identify... the oppressor within themselves, in their own unrestrained passions. What else to do but turn that limitless fury in on itself? So they unleash all fury on their own angry selves, often killing a schoolyard full of random classmates with them, creating a horror so beautiful and rebellious that the rest of us can only watch with awe and envy. The school shooter is not an isolated phenomenon, he is the final product of the Revolution."

Continue reading "Generation X and the Revolution"

The Blind Mechanic

A few weeks back, I saw a very thin man being wheeled into the ER. I nodded toward him and smiled. He nodded back. He was not my patient so I went back to work on my own patients. About an hour later I noticed the monitors and said to a nurse, “You should check him, his pulse is dropping.”


The nurse looked up, “Oh, that's okay. He's dying. Terminal cancer, he just came in for pain control. He's comfortable now, so we're letting him die with his family.”


I noticed several young women around him who I assumed to be his daughters holding the man's hands. “Overall not a bad way to go, painless and being loved,” I thought and returned to my work.


Physicians see death so often that it becomes familiar. We are Mechanics of life and death, tinkering with the machinery of the body everyday. We intervene to keep the machine running, but eventually the mechanism always becomes unstable and breaks down.


Contrary to what you might imagine, doctors have no deepened understanding of death.


Doctors talk a lot about their own deaths, but not like you might talk about it. They don't discuss the meaning of death, or how it makes them appreciate the beauty of life. Seeing so much death, doctors mentally amass large collections of different ways people die. Doctors discuss the pros and cons of different ends to life, like other people might debate which car or computer is best: “Not a bad way to go.” “I hope I don't go like that.” “I want to go quickly.” “No, I want to go slow so I can set things in order.” “I want to feel nothing, just load me up with pain meds.” “No I don't mind hurting some so I can be aware of my family visiting me.” “I won't let them run a code on me if I'm old.” “I would prefer a sudden heart attack, dead before I hit the ground.” “No, I want to fade into dementia and never know what's happening.” “Renal failure isn't so bad a way, you just fall asleep and don't wake up.” We actually have such conversations, pulling various deaths from our collections and comparing them. Since we tinker with the mechanism of death we think we understand it.


Doctors mistake familiarity for understanding. We mistake the end of our job for the end of the matter.


Even we physicians of faith often think like nihilists. I struggle to remember that I know more than what I see. Every time I recite the Apostle's Creed I affirm that “I believe in the resurrection of the dead, and the life everlasting.” Still I must tear these blinders from my eyes to see with the eyes of faith. My perspective is limited, and my blinders that help me in my work sometimes make me blind. There is so much more to life and beyond life than this these faulty machines and ways the are repaired or broken.


*Note: information about the patient mentioned above is intentionally inaccurate to protect identity and privacy.

Places forget people

Places have a way of forgetting people.

As of today the place we have called “our home” now belongs to someone else. Place we inhabit become a subconscious part of our identity.

Places, however, have no memory. This house will not remember Joy and me or the happy years we spent here. To the people who bought 310 Union St it is just an empty space for them to use, just as it was for us when we moved in. As I was cleaning the basement I came across old writing in cement:

“DEC. 5, 1977 LAURA

I had seen the scrawled letters before, but as I am packed to leave I became curious about this person who had lived in my home, writing her name in the drying cement almost 30 years ago –just a few weeks before I was born. I wonder where Laura is now, or even if she is still living. Had she been a girl she would still likely be in her 40's now. If she was an adult at the time she could be quite elderly now. I wonder how her life turned out. I wonder if she remembers scrawling her name in wet concrete of this basement three decades ago?

The impersonal nature of the world always feels cruel to relational creatures such as ourselves. We want the physical world to remember us, to hold some evidence of our lives. Perhaps this relational nature even more than superstition makes us imagine ghosts of people who lived in our spaces long ago still inhabit them. This is the reason we leave monuments bearing our names throughout the world? Of course, none of this matters. People in the future will look back on our names as dull and empty symbols.

No object or place can maintain a relationship. We all eventually move on. A few hundred years from now and no one will know that any of us ever existed. Those who are remembered only can only hope to become lifeless notes in historical records –a historical figure: the exact opposite of a person, who lives, and loves, and hopes. Even still we hold on tightly...

I marked on the pavement beside Laura's inscription:

“JOHN & JOY: 2004-2007”

My Politics

Almost a year ago I mentioned the Consistent Life Movement as a idea that intrigued me. I've thought about it a good bit and I am fairly certain now I have converted to Consistent Life Politics:

My ideas about politics and policy have been changing. While this shift in my thinking began long before I discovered the Consistent Life website, it has been comforting to realize that others are arriving at the same place. At this point the main focus of my voting and civic involvement is changing ours to a society that does not kill.

Unfortunately most social/political dialog in our nation appears to be mostly on economics (Capitalism vs. Socialism) or citizen rights and responsibilities (Conservativism vs. Liberalism). While economics and rights are important, I believe we lose sight of more central values. All these popular ideologies seem to assume that intentionally destroying other human beings (in one form or another) is necessary for achieving social good. Looking at a history of civilization there are a few bloodthirsty madmen, but many more have been killed by people with good motives believing a better world would be created by removing certain others.

“We would be safer if we kill those who might attack us in the future... Our lives would be better if we have the right to kill a fetus... We would be upholding justice by killing a murderer... We can be kind to a suffering or disabled patient by killing them... Think of all the cures we might get from killing unwanted embryos... The world would be a good place if we could just get rid of the Jews, Blacks, Whites, Hispanics, Capitalists, Communists, Homosexuals, Muslims, Christians, Atheists, etc.”

Before you know it creating a better world ends up making the world much worse. More than any Right vs. Left political allegiance, I have begun wish we could change into a society that agreed to kill no other human being no matter how insignificant or bad that person might be.

In the post about Hussein's execution Chris McCartney asked “But was it Just?” Yes, as a Christian I have to acknowledge the justice of “the wages of sin is death.” My entire hope for redemption is based on an execution/sacrifice. (Although, the fact that Scripture teaches that all who ever sin deserve death makes me wonder how such just killing could every be accomplished by any society) Morality is different from policy, although they should be related. Recognition that greed, gluttony, smoking, or adultery are wrong does not necessitate that it is good for our society to make them crimes. Similarly believing that a despicable person or group of people deserves do die is quite different from claiming we should kill them. Similarly, it may be true that it would be “better” for many people if we killed an inconvenient minority. Any benefit (real or imagined) or removal of threat no matter how great does not justify the crimes we commit against those few. If we could cure poverty by eliminating the poor, could we really imagine we had done any real good for our society?

At this point the only justification I could imagine for killing another human would be self-defense (in the face immediately attack: not preemptively or retroactively) and even then, as Chris pointed out, we should be "saddened by death even if it is justified," rather than celebrating such violence.

As a convert to Consistent Life politics, I am no Utopian who imagines that somehow making these changes in our policy would suddenly create a society of perfect harmony and happiness. The human condition will always be deeply flawed, and humans will still suffer and someday die. I also recognize that spiritual redemption is far more valuable physical life. These policy changes, however, could be attainable if the political will existed. If it is the duty of a citizen to improve his government, then spreading and supporting Consistent Life is what I will do for my country.

I don't know if I yet have a great argument that would convince others that it is good policy for our government and society to abstain from all killing. (I realize that a majority of my argument above is “slippery slope”) I still ask myself how much of my shift towards supporting total non-violence is based on personal emotion. Over the recent years I have seen a lot of people die, which has no doubt affected me. I also wonder how my feelings on lethal force might be now if the war in Iraq had gone as smoothly and Iraq were now stable? I wonder if my own fear of losing the person I love the most (my wife) and the prospect of having children of my own have lessened my ability to accept the sacrifice of any life? Emotion does play a role in my change of mind, but in whose mind is emotion not a part of understanding truth?

While I still have a lot of contemplation on this subject to do, I feel certain enough to declare that these are my politics. As far as I know I am in a very small minority, and I must give up on finding any home in Democratic or Republican Parties. But several hundred years ago those who opposed slavery were a similarly small minority, and now the almost the whole world has accepted their policies.

Weariness

I've been in the hospital a lot lately (hence the lack of recent posts). It is interesting to reflect that my formal medical training ends in 4 months. Nearing the end of almost a decade dedicated to becoming a physician I feel more weary than anything. I came in an idealistic young man, certain there could be no better way to "help people" than being a doctor.


I still love the actual experience of caring for my patients, but in the real world paperwork is the majority of my job. About 60-70% my day is filling out forms and notes documenting medical care. All this paperwork is governed by so many laws and regulations that mistakes in paperwork could end up hurting my patients or having me lose my medical license or get sued. I still hold to the ideals that drove me into this field, but as I look for a job I find that there are very few places that I can practice the kind of medicine that I had hoped. Even volunteer opportunities to serve seem out of reach. (I recently got turned down by two places I where offered to work a month for free.)


The disconcerting reality is that this is more a job than a calling, an often exhausting and frustrating job. In this job most of my time and energy will end up being put into insuring the practice I join stays financially stable and doesn't get sued. Do well at this and you might get 10% of your time to do that "making a difference in people's lives" stuff I dreamed about as an 19 year-old when I suffered through Organic Chemistry in order to graduate pre-med.


A decade ago I had seemingly endless energy and idealism. Now I'm tired, in debt, and skeptical about how much good a doctor can actually do. I can't help but wonder, if I might have invested the last 10 years of my life better doing something else.


Hopefully, this is just a phase I'm going through --the uncertainty of starting out to practice on my own after so many years of training. The idealist and optimistic 19 year-old inside of me says that once I start practicing I'll find out again that I love this job and wouldn't want to do anything else. I hope he's right.