Saturday, February 25, 2006

Science and Religion

A very smart friend of mine, who is more widely read on this topic than I, recently posited several questions to me. I'm going to selectively quote her below, followed by my thoughts. Yes, I'm lazy in just quoting some emails, but also I think the questions are important, and well-phrased by Apollonia.

I'm still playing around with the relationship between religion and science and what is the appropriate role of each. For example, science cannot answer "was Jesus the son of G-d?" That is not a question that is testable or falsifiable and so is not within the ability of science to answer. Similarly, religion cannot answer what the mechanisms are that cause AIDS, the Bible doesn't have a chapter on that one.
...
I don't like the idea that the two are separate but equal, that they have independent spheres of investigation and each should stay to its own...At the same time though trying to incorporate the two into some sort of pseudo hybrid that doesnt accurately
reflect either viewpoint like the day-epoch theory to reconcile creation and evolution is equally distasteful because it doesn't recognize the subtle beauty that either understanding brings to the origin of man and his place in the world.


My thoughts:

The realms of science and religion are not separate, you are right in that. They are, in fact, completely overlapping in one sense. If you accept the Christian conception of the world (and all people will eventually, whether they want to or not, but that's another story) you accept the idea that there is one being over all, who created and sustains his creation at his pleasure. Therefore, any investigation of that creation is an investigation into Him, in some sense, however small. As the Psalmist says, "The heavens declare the glory of G-d." (Psalm 19, verse 1)

What does that mean for the scientist? It means that they must undertake those studies, those investigations, in humility before their creator. If you approach the study of cell biology from the understanding that you are a child of the G-d who made and understands far deeper than you ever will the process you investigate, then you are unlikely to use that knowledge for nefarious ends. Dr. Moreau's mistake is not in his science, it is in his replacement of G-d with science. For we are all made to know and love and be loved and known by the creator of the world. That part of our nature begs for fulfillment, and when denied through our sinful stubbornness, our bodies will fill it, with gods our own making, like friends, lovers, sex, possessions, or ideas. Science can become a god like anything else. When it does, there is no consistent way to reign in the drive for knowledge as knowledge, wherever that takes us. And we are warned biblically, what profit is it to man to gain the whole world and lose his soul?

In that sense, science is utterly subordinate to religion, or more properly, to faith, for religion is merely the human trapping that dresses up faith.

In what sense then, are they separate? Faith, or theology, or the church, is, as you stated, ill-equipped to understand the mechanisms of HIV infection, in the protein-cytokine-crazystuffIdon'tunderstand sense. Science as a pursuit can direct our understanding of those processes, but properly understood, science is without an ideology, and is therefore ill-equipped to act on that knowledge in a responsible way. This is where the humility of the scientist before G-d is so important.

It would seem then, that I am saying science is never superior to, or completely separate from, faith. This is true, for though it may be equipped to answer questions, science is only one pursuit within the world, and it is a way of understanding a part of the world, while faith is a way of life, an all-consuming worldview which shapes everything we do, and though when strictly concerned with theology, it cannot answer scientific questions, more broadly, it places science and the answers and questions stemming from it in their proper context.

...

Is the line where I have drawn it, and is the solution as I have outlined? Is it the kind of hybrid my questioner finds distateful?

Friday, February 24, 2006

The Lady With the Sad Eyes

Today I was adopted. A patient of mine, whom I referred to in my last post, had a lot to say this morning between her tears. She said "of all my doctors, you are the one I connected with, because you were there when I first learned ab-about the cancer. And you took the time to listen. And most of all, when I mention prayer and how G-d is going to help me through this, you are the only one who prays too. I can see it in your face. And you remind me of a son-in-law I lost. My family agrees too and you are welcome to speak with them and me as one of us. I'm going to call you 'mijo' because I think you are part of the family now."

That may be a bit odd. I'd probably have a better idea what I think about it if I had a clue what "mijo" means in Spanish.

But this is why I am glad I am here. This is the combination between science and the ministry that drew me to medicine. Here is where my talents lie, I think, in both comforting the dying, pointing the way to the lost, and discerning the way through the mental capacity granted me by the Creator who guides the entire process. I'm both excited and humbled by the opportunity.

And on the topic of pointing the way, it looks like the team may have figured out how to help Elvis. He's still hanging out with us, but he's improving little by little. Scarlett treats me like a son as well, fixing the collar on my white coat whenever I walk in with it a little crooked. Today she told me she "took a shinin'" to me right away, but immediately let me know she'd let me know what she thought of me, "straight out, even if you don't want to hear it, 'cause that's the way the good L-rd intended it."

Excellent.

Wednesday, February 22, 2006

On Call, the sad part

I sat with a patient who has just been diagnosed with cancer for well over an hour late last night, as she struggled to come to grips with her diagnosis. The news had been given to her quite suddenly, and probably less than delicately. And I felt more like a doctor than I ever have, and also more helpless. I've felt competent when I know what to do, and I've felt accomplished when my staff or residents realize I know what to do, but there, at 1am, when no one knows what to do, and the best thing you can do is hold a patient's hand while she cries and pours out her concerns for herself, for her family, and for her soul, is where I felt again, powerfully, that G-d has indeed guided my choice of profession.

I was reminded of Whittier, "the Good physician liveth yet, thy friend and guide to be" and also of Pare "I treated him, G-d healed him." But most of all, I was reminded of G-d Himself, who speaking through the writer of Deuteronomy said

Now see that I, even I, am He, And there is no G-d besides Me; I kill and I make alive; I wound and I heal; Nor is there any who can deliver from My hand.

I can't deliver my patient. I can't heal her, and given what she most likely has, neither can modern medicine. And despite her hope that G-d will heal her, which He may, He also probably won't. She was enheartening though. I struggle with how to share faith with patients, and so I let her guide the discussion for the most part, but when I made the comment that Jesus was the greatest physician, she corrected me. She said "no, He is our Saviour." I was pretty close to crying there myself.

On the way out, she said "I think you are the best doctor in the world, and you all are the best doctors and nurses in the world, and I bless you all."

On Call, the funny part

Scarlett came up with another priceless idiom: "I was madder than 20 horses."

She is both kind, understanding, and extremely flattering. She calls me "doctor" though I've corrected her several times. She insists "you know enough to be a doctor as far as I'm concerned." I only wish I knew enough to be able to help Elvis more.

Also, Mr. Indestructible shared with me his secret for living forever. The key it seems, is in the diet. He insists that for breakfast, one should always have 4-6 eggs, one half pound of bacon, grits, a glass of milk and coffee with cream. For lunch, fried chicken with rice and a cornmeal sauce, and for dinner, steak or something similar. He even showed me his grocery list and offered to shop for me "since you ain't got no wife or girlfriend." He's not entirely there mentally, but his ingratiating manner and ebullient persona make him quite popular among the house staff.

Saturday, February 18, 2006

Hold your taters, darling

I'm taking care of Elvis. Seriously. Well, not seriously. But I'm going to call him that anyway. He and his wife are quintessential Deep South. My patient's wife, whom I'm going to call Scarlett, helped me in a marathon phonetag session in which I contacted no less than three separate VA hospitals, and between my earnest, serious requests for information and her down-home cajoling (involving exclamations like "well kiss my grits, honey, you're just gonna have to do that for me" and "hold your taters there darling, I'm his wife, of course I have a right to this information") we managed to get almost all of the records we needed to treat Elvis. I have no idea what those phrases mean, but they seem to work. Usually better than my more restrained requests. I somehow doubt I could pull off her style though.

It is touching to see how deeply in love Elvis and Scarlett are. She's there all the time, and she told me that, when he's asleep, she sees wings and a halo on him. Patients like this are a joy to treat.

Friday, February 17, 2006

He's quite spry

The husband of one of my patients is who I want to be when I get older. He's 90 years old, and doesn't look much older than the weather-beaten 60 year-olds I'm used to treating. And he's not sick. He carries a cane, but he doesn't actually use it, he just carries under his arm like an umbrella. He stopped me in the hallway today and said "I forgot to tell you. A few years back, in let's see...1984 it was, when I had my fourth heart attack, the doctor told me to get more exercise and be careful. And you know what? Nine months later, I was at that doctor's funeral. He died of a heart attack. I never been to a doctor since."

There really is no correct response to that, I don't think.

But he'll be the reason his wife gets better. He's always dragging her out of bed to go on walks, and the constant exercise is great for her. I feel a little bad for her though, being married to someone twenty years older than yourself who looks like he hasn't been sick a day in his life and who is still walking up and down the stairs in the hospital for exercise while you're asleep. Amazing. I almost think that her complaints are just to get him away from her for a while.

Monday, February 13, 2006

Flashback: Surgery

Sissa posted something which reminded me of the first patient I saw who was not going to survive his illness. He was mid 30s, married, with one daughter and another on the way. His doctor told him he'd be lucky to see her born, much less grow up. And being reminded of that, I wrote the following on her blog:

The first time I saw a patient who had a death sentence diagnosis, I didn't think about him as him at first, I thought about him as the subject of a diagnostic biopsy in neurosurgery. It was only later, walking past his room and seeing him, alone in his bed, with no sign of the wife or daughter mentioned in his chart that the sadness, and alone-ness of death hit me. I wanted to go in and sit with him, say something, do something, anything which might...I don't know. Do something for him. But I didn't. He was asleep, and every time I had seen him awake there were tears in his eyes, though he never audibly cried. I wasn't sure I could take it.

It's the sort of thing I'll regret for years, probably forever. Because I don't know if he was a Christian, if his wife or daughter ever visited, or if he is still alive. Given his diagnosis (glioblastoma mulitforme) he probably isn't. Even the fact that he wasn't my patient, and that I only met him because I walked into the wrong operating room my first day on surgery doesn't make it better.

I'm still learning how to deal with my life and my opportunity to "fight suffering" as you phrased it, and I'm not sure, even being here, if it isn't possible to ignore that suffering still.

Inpatient

First day on the inpatient ward. My resident seems like a pretty good guy, headed for GI or Hem/Onc, so smart, with a sense of humor. Like most internists actually, which is probably why I like them and this environment so much. But most of today was simply inprocessing, getting badges and computer access, meeting the teams, etc. My resident said the magic words (you can go home) at about 3, because today was a clinic day and I have no patients to catch up on right now.

This new hospital (friends, Romans, and countrymen who actually know where I am, please, no comments) is far different than my last one. This is much less well designed in an architectural sense, though system-wise, it may be better. Patients are scattered to the four winds: there are ICUs on three different floors in two different wings, rooms on four different floors, clinics on three, the ER buried in the basement, and the all-important cafeteria at the other end of the basement. And those four diffferent floors are 2,3,7, and 9, so non-continuous. There are no windows in any of the hallways, and no way to navigate except by knowing where you are going. It is apparently a badge of honor once you know your way around. We'll see how long that takes me.

Thursday, February 09, 2006

Great news

When I fall, I will arise;
When I sit in darkness,
The L-RD will be a light to me....

It certainly looks like I'll be writing that chapter for my attending. It might actually end up as a review article though, and we'll be trying to get it published. As I said before, it will take about a year of work, probably mostly on weekends, and will take 150-200 references, which means I have a huge task in front of me. Budgeting an average of 10 pages per reference (not unusual, and perhaps an underestimate, since books will be involved too) that means I've got to read enough pages to fill Harrison's Principles of Internal Medcine, only solely on this topic, and then write a 20-40 page paper on it. However, I'm up for the challenge, and if G-d grants this opportunity, I'm going to make the most of it.

I'm no longer tempted to jump up and down (because I realize the size of this task), but my heart certainly is.

Wednesday, February 08, 2006

Exasperating?

I saw a patient of the kind that exasperates physicians. She has diabetes, but is has been in denial of it, doesn't take her insulin, doesn't exercise, eats all the wrong things, and then is surprised when her doctors express frustration.

It looks like she got a wake-up call this time though. As part of the interview, she was asked how she'd been doing recently, and she casually mentioned that she had been brought to the hospital last weekend. "Oh really?" was pretty much the most disinterested reply managable at that point. "Yeah," she replied, "I passed out and in the ER they said my blood sugar was 800."

As a bit of a side note, your blood sugar should be between 70 and 100 (in milligrams per deciliter) all the time, with only minor variations. Diabetics get a bit of leeway, and they usually try to keep it under 120, though lower is better. 800, though, is like having Karo syrup in your veins. I was honestly floored that such a level was even possible. The Zen Master, almost imperturbable, said that this was a new record in his practice.

Back to the story though, this might actually be the wake-up call the patient needs. She's a grandmother, and with some stern exhortations that if she wanted to see her grandchildren get too many years older, and remember their grandmother as someone who could see and had all of her fingers, toes, feet, and/or legs, she would have to get her sugar levels under control. It may sound a bit heartless, and perhaps it will be when I'm an older, more prone to be jaded physician. But for now, I was just excited that she seemed to want to change, and her motivation seemed so good. It was said with genuine conern for her quality of life. I don't want to lose that concern.

Tankard of Tea: I'm class Q4 rebel

Or rebellion, conformity, Fight Club and the lens of Christ.

With no patients showing up to my clinic this morning, I'm entertaining myself by reading and research. However, even that can get old after a while, so I thought I'd link to a post by eLr which led to a discussion which was pretty good.

Tankard Of Tea: I'm a class Q4 rebel.

Monday, February 06, 2006

No patients

An uneventful day in clinic this morning. No patients, so no work. I was reminded, however, by an attending that "medical school is horrible. It is denigrating and disillusioning at the same time. It destroys your perception of life and beats you down." I had pretty much figured that out, but it is nice to know that it wasn't just my pessimism acting up there.

Thursday, February 02, 2006

And I thought today would be a bad day

But this morning I got a fantastic news item. I may get the opportunity to author a chapter for a textbook an attending of mine is compiling. It would take about a year, and I'd have to work through and around my duties next year, but if this works out...wow.

I'm trying desperately not to jump up and down as I walk the halls seeing patients this morning.