Pushing the President off a Virtual Cliff Isn’t an Answer

This is my Greenville News column from August 1. I forgot to post it to the blog until today.

http://www.greenvilleonline.com/story/opinion/2017/08/01/pushing-president-off-virtual-cliff-isnt-answer/514120001/

Have you seen the charming computer game that allows you to push President Trump off of a cliff, into a volcano or to some other unpleasant location? It allows tolerant, caring individuals to vent their spleens against the man who they typically say is ‘not my president.’ Of course, it’s only the faintest tip of the iceberg, beneath which is a large mass of angry, violent, eliminationist rhetoric.

Not to be outdone (and certainly not new), I recently saw a similar game that allows players to do terrible things to a virtual former President Obama. In fact (in a search that I hope won’t draw the attention of the fine folks at the Secret Service) I found an entire page of terrible ‘kill Obama’ games.

Of course, there are always fringes; I hope it’s the fringes. But I fear this is becoming an increasingly mainstream behavior. I would like to say I’m surprised, but I’m not. Politics is the new religion, and every religion has its heretics. And what do we do with heretics? We kill them! Everyone used to know that was a bad thing, when it actually involved belief in the supernatural. And we’re still shocked when we see horrific tales from groups like ISIS and the Taliban, where you can still be physically (not virtually) tortured and killed for believing or saying the wrong things.

Now, even in the good old US of A, there’s an underlying rage and disdain that leads some people to harm those who disagree with them. (See the shooting of Rep. Scalise or assorted violent protests on campuses). At the least, that anger allows Americans to publicly fantasize about harm against people whom they consider, thanks to their political position or ideology, sub-human.

Of course, the venom often starts with a Tweet, Facebook or blog post, online comment or speaking engagement. Someone demonstrates that they don’t agree with the latest political or cultural trend. They are called out for their thought-crime, and instantly attacked, threatened, and shunned by a community that points righteous fingers and shouts ‘Shame! Shame!’

Discussion is further shut-down by describing the ‘enemy,’ the ‘other,’ in casually launched terms like racist, sexist, homophobic, transphobic, hateful, intolerant or any number of pejorative adjectives that help put the cross-hairs in more stark relief. (In the old days it was Catholic, Protestant or Pagan!)

The righteous can then proceed to acceptably wish harm on the heretic, as several have recently done (for example) towards Sen. McCain in light of his position on ACA repeal. ‘Should have died in Vietnam,’ one said. Others hoped his tumor would kill him more quickly.

In a post-Christian, rationalist, and scientific world, where we are told we needn’t rely on some deity to hold us to ridiculous and uniform standards of behavior we have come round again to acceptable, post-modern fantasies about killing people who make us uncomfortable.

Admittedly (and as I alluded) people of faith have often led the charge of violence towards the heretic. But for a while, we seemed to be rising above it. At least until the church of politics became the equivalent of the Church of America. (Separation clause aside!)
What strikes me, though, is that the Jesus of the Bible (not the Jesus of modern politics) said in Matthew’s Gospel, ‘’But I say to you, love your enemies and pray for those who persecute you.’

He also said all sorts of other pesky, kind things about greed, caring for the sick, the poor and the prisoners. He even said, as he was being crucified, ‘Father forgive them for they don’t know what they’re doing!’

Christianity teaches us that we’re all ‘works in progress.’ That God will, if we desire, remake us bit by bit, sin by sin, into something far better than what we are, both in this life and in the next. That however bad we are, and He means that, He will forgive if we admit we need it; admit we need Him.

We need to try and see everyone as potential saints, not contemptible demons. Wishing, or doing ill to our opponents is not rational, scientific, libertarian, constitutional, progressive or modern. It’s pre-Christian and un-American. And it harms the hater most.
So stop pushing people off of virtual cliffs. And start praying for all the heretics, however you define them. Turns out, we’re all heretics to someone. That realization alone should open our eyes and thaw our hearts.

Graduation, When we Shoot Arrows at The Enemy

http://www.greenvilleonline.com/story/opinion/2017/05/25/its-time-launch-our-arrows/343820001/

We have a quiver full of arrows in the house. Over and over again, the kids and I have used the target arrows it holds. Many of the arrows are worn and dinged, and some fletchings have come loose. (I have no idea how many rest beneath the grass or are stuck into trees in the woods.) The remaining arrows are sentimental to me, but still see use now and then as the mood strikes us.
Since yet another of my children prepares to graduate high school, I found myself thinking of Psalm 123: that says ‘like arrows in the had of a warrior are children of one’s youth. Blessed is the man who fills his quiver with them.’ Jan and I are about to launch another ‘arrow.’ But not at a target. Our son Elijah is being launched into the great battle of life. And as I heard a preacher once say regarding that passage, ‘what do you do with an arrow? You shoot it at your enemy.’
I am unapologetic about the martial metaphor. We live in a time of conflict, contention and danger. And no matter what one’s political, cultural or spiritual alignments, the fact remains that our children go forth into difficult times.
There are physical dangers, of course. The cowardly murders in Manchester, England remind us that violence lurks in the world and no amount of lovely colored buildings or candlelit, hug-filled marches will impede those who find its use expedient.
Cruelty is timeless and knows no borders. Slavery is still widespread, in the world at large and even in the US in the form of sexual and financial exploitation. Women of every race and creed are treated horribly in many lands. Globally, children die of starvation, dehydration and assorted diseases that we can easily manage in even the lowliest American hospital.
War continues to raise its endless Hydra-head. Gang violence robs necessary, beloved young people of their potential and their lives. Domestic violence and child abuse are rampant; especially in SC, sadly enough. Addiction is an entire war in itself, demanding aggressive action to save lives and families.
There are also political dangers. On both sides of the political aisle, there is fear that the glorious traditions and safeguards of the Republic may be imperiled. Each thinks the other is wrong. But each is concerned about something; each side has a sense of unease.
There are many battles to fight. Some compassionately advocate for equality of groups marginalized by race, gender or sexual orientation. Others battle for preservation of freedom of conscience, for the precious right to believe and act based on faith and tradition rather than cultural trend.

There are battles for abortion and against abortion, for open borders and for more regulated immigration. Climate change pits economic interests against environmental, both making important arguments for the future. Behind each lies the war of objective truth versus the cheap manipulation of spin and emotion.
Hardly a pep-talk for graduation, is it? But that’s the lay of the land. Graduation is beautiful and thrilling and all of us try to stifle our tears and cracking voices as we applaud our young people and give them hope.
But I want to give all of them, my own incredible son included, more than pretty images and vapid platitudes about ‘following your dreams.’ I want to say this: ‘It’s tough out here; we’re ready for reinforcements so get with it. Welcome to the team. Keep your heads down.’
I find that a more useful and thrilling thing than what graduates are all too often told. I want to see them launched at the problems of the world, in the full knowledge that it isn’t safe, that it isn’t easy, that they have a purpose in all the struggles and that they are needed. We need their courage, their insight, their creativity. We need their brilliance, their success, their strong backs, their loving hearts.
We live in a culture of increasing self-interest. Young and old spend too much time reflecting on their own wounds, victimization and identity politics. These things pull us apart rather than uniting us in the fray.
Dear graduates, look up and look around! Show us how to rise above ourselves and live well, how to glory in the struggle, how to win (or lose) with compassion and love, and also with ferocity and risk when necessary.
We loose you, dear arrows at the various enemies we face.
Strike true.
And congratulations, Elijah and all.

 

A Wedding is the Portal to the Mystery of Marriage

Congratulations Meg and Tyler!

This past weekend we celebrated the wedding of our dear friends Tyler Jordan and Meg McCall.  It was an event filled with the the grace of  God, expressed in a truly perfect Spring evening, in the love of parents, friends and the blessed couple.  It was conducted in all the glorious, meticulous yet casual elegance of the South Carolina coast.  All of our children were in the wedding party (along with many other wonderful folks). I was privileged to be able to deliver this short reflection at the wedding.  Thanks to Meg and Tyler for including me!

A wedding is a beautiful thing. It is a celebration, and in life’s troubles we celebrate too little. At a wedding we smile, and cry. We laugh and dance, we eat and drink and send a new couple on their way into life. A wedding is an event where others witness and affirm our vows, in order that others may help hold us to our promises. Wedding ceremonies are much valued in our time, and we spend great amounts of time and treasure to make weddings beautiful and memorable, to make wedding dreams come true.

However, despite its beauty and wonder, the wedding is not an end in itself. It is a gateway which serves to fuse two into one. When a man and woman walk through that gateway, through that portal, they enter into a beautiful mystery.

Beyond the vows, the veil, the ring and the kiss lies previously unseen, unknown garden of their common life together. That life is a new creation waiting to be unveiled and explored, shaped and molded hour by hour, day by day, year by year over a lifetime. In so doing they are living in the spirit and tradition of Adam and Eve all over again.

St. Paul says that this is a great mystery. In Ephesians 5:31-32 he says, after a profound explanation of the relationship of husband and wife, ‘For this reason a man shall leave his father and mother and hold fast to his wife, and the two shall become one flesh. This is a profound mystery, but I am talking about Christ and the church.’ We’ll circle back to that last bit in a moment.

Here Paul uses the Greek word Musterion, which means ‘a mystery that can be revealed or discovered through God’s revelation.’

The mystery of marriage is not ineffable, because God who created it is constantly teaching us through it. It is not beyond comprehension. It does, however, require that we be committed in order that we understand its riches and metaphor. It cannot be approached tentatively, with one foot in to test the water, but all in, with all our hearts.

To comprehend the mystery of marriage we can only cross the portal, and in faith and hope and love leap headfirst into the unknown. And it is an unknown.

Dating and courting and all the time we spend together before the vows are exchanged are critical. They help us to learn who it is that we can indeed spend a lifetime loving. But something different and mystical happens when we take the plunge of matrimony. Suddenly, the world takes on a different light in the power and energy of the fusion of two into one.

Through the mystery of marriage, through the great unknown garden of life together, we learn small things. That our beloved is beautiful to us first thing in the morning and last thing at night. That our beloved is a human with frailties, failings and annoying habits, but that they are no worse than our own. We wonder, at times, why they stay with us; at others why we stay with them. And then we all laugh at the fact that we both ask the same questions.

We learn that the one we committed ourselves to is cherished and precious like nothing we ever grasped or imagined.

We learn to be humble and thankful in times of joy and gracious and hopeful in times of suffering. We learn the mystery that those words, so often spoken about richer or poor, sickness and health, take on very real meaning in the hot forging fires of life.

We learn that whatever else may fall apart, whatever else may evaporate before our eyes, whatever trials life visits upon us, if we are together we can endure.

Marriage is the first place where we perhaps truly understand what it means to love someone so much we would rather see ourselves suffer or die than have it happen to our partner.

It is hard to impress upon the young, but in a marriage properly tended, in our own small Garden of Eden, love only grows deeper and wider with every passing year, every financial struggle, every wrinkle, every illness, every success and every day, or night, spent together.

Ultimately we find that looks and wealth come and go, but as we are made more and more into one, the greatest gift is their hand in ours, their warm body sleeping next to our own. This is an ageless, timeless blessing.

This is part of the mystery. The discovery that love is not contingent. That it is not contingent on youth or beauty, success or power. That it simply grows; possibly deepest in trouble, despite how we all hate to pass through it.

Over the years and decades, we become mysteriously intertwined. We are made one by our vows, but we are transformed into one by time, by shared stories, by shared goals and struggles, by neurochemistry… for all we know by genetics as each physiology impacts the other.

If you doubt me, ask those people you know who have loved long and well. It is hard to put into words, but in marriage, in time, the things we thought valuable and desirable fade away, and we desire our beloved above nearly all.

So much so that we cannot fathom, especially in youth, the phrase ‘tell death do we part.’

But that’s where the mystery delves deeper and more wonderful. What we are learning in the mystery of marriage, as wonder after wonder reveal themselves, is that our marriage is a microcosm of the love of Christ for the church.

It teaches us to love unconditionally as he does. It teaches us to love without fail, with no term limits or expiration date. It teaches us to love when we are wounded and when we are hopeful. It teaches us to forgive and love more and more. And it teaches us that all of this is an end, THE end, in itself. We do not love for meals or laundry, for support or company. We love because in love we reach God.

And there is one more thing. This love of Christ for the church will carry us beyond. The painful mystery of separation in this life is not in our power to overcome. But it is in his power. And that is the promise.

Our love for our spouse will be interrupted one day. But it will go on for all eternity in the Kingdom of God as every tear is dried and every sorrow comforted. And in that place we will see the kind of love for all that we in our mortality took a lifetime to learn for only one.

A mystery indeed.

And today, we are witnesses as the story of wonder and mystery begins once again in these two young lives about to become one..

So let there be joy and laughter in all our hearts as we witness things far beyond our comprehension and realize that mystery is all around us today.

Mothers are People First

Mothers are People First

This was my Mother’s Day column in the Greenville News.

http://www.greenvilleonline.com/story/opinion/2017/05/12/mothers-day/101521348/

I have been graced by a long line of mothers. I had two grandmothers who loved me dearly, and who (though they have passed from this life) remain dear to my memory. My own mother Sharon was, and remains, a wonderful woman who raised me gently and with endless help and encouragement. My mother-in-law Carma has ever been kind to me, and treats me like a son.

My wife Jan is an incredible mother, who has dedicated her life to our children, going so far as to homeschool them for many years. She is indulgent and patient with them and they are always in her thoughts and fervent prayers. She is a Godly mother like all of the mothers in my life.
Having praised these women, let me say something shocking that we forget all too often on Mother’s Day. Although we seem to have a ‘cult of mama’ here in the South, mothers are just people like all the rest of us. They are capable of love and hatred, they can be supportive and destructive. They may lift their children up or tear them down. (Both the stuff of various books and movies.) They have good and bad days, and decades. Mothers were once mere girls, then they were lovers or wives. Along the way they accumulated hopes, dreams, stories, successes, failures and wounds of their own.
Because they were not born mothers, but become mothers, they bring all of these things with them when they bear, or adopt, children. So into the wonder and chaos of motherhood they bring their humanity. And humans, mother or other, are imperfect.
These imperfect people we call mothers are often subject to some nasty treatment. Sometimes, we confine them to their maternal roles. As if all they are capable of is producing and raising kids for the future. Jobs? Degrees? Achievements? Passions? Irrelevant, as some women are subordinated to motherhood by their families, and are not encouraged to attain the full glory of the various reasons for which God put them on the earth.
On the other hand, modern society often says to moms, ‘sure, you can choose to be a full-time mother, but what a disappointment you’ll be to all of the women of the world! Career and education are so much more useful and interesting than caring for mere children! What a waste of your potential!’ As if raising human beings, loving and caring for them, were no more exciting or important than having fish in an aquarium. While ‘choice’ is a powerful mantra, the choice some women make to focus on motherhood is sometimes unfairly viewed as failure.
The third option is perhaps cruelest of all. It tells mothers to be everything. Raise perfect children, and feed them lovely, healthy meals, engage them in all activities and make them super students. Simultaneously, rise meteoric through the corporate world! Never say no to a new project, a new goal, a better job! Stay thin and beautiful and do all things as they appear in glossy magazines. ‘Bring home the bacon, fry it up in a pan,’ or else be a pathetic loser.
Mothers, meanwhile, struggle with just being people. Like everyone else they have fears and anxieties, sorrows and addictions, illnesses mental and physical. Some mothers are close to ideal, others will wound the ones they bore. Some, overwhelmed by their own troubles, simply cannot raise children, while others make it look effortless. There are those mothers who are stars in business, government, professions, athletics or other fields. And yet, all too many never have good jobs or educations. Some mothers land in jail.
The thing is, mothers are are neither gods nor angels. And it is cruel of us to expect them to be either. They will not always accomplish everything they dream of and sometimes their children will be less than they had hoped despite their best efforts. Sometimes children will be disappointed with their mothers, fairly or not. This is reality. This is life in a fallen world.
In the end, we should celebrate the many gifts and sacrifices of all mothers. Simultaneously we must remember that mothers deserve, as do their children, to be loved for who they are. And given grace despite who they are.
So love your mom this Mother’s Day! But along with dinner, flowers or the assorted gift offerings you bring, give her the freedom to be perfectly imperfect. Just like you and just like me.
Happy Mother’s Day moms!

Emergency Medicine: a Model for Unity

This is my April EM News column.  I hope you enjoy it!

http://journals.lww.com/em-news/Fulltext/2017/04000/Life_in_Emergistan__A_Model_for_Unity_and.12.aspx

How do you define yourself? How do you describe yourself? In the past, I have tried to avoid immediately categorizing myself by my profession. I always agreed with The Little Prince:

“Grown-ups love figures…When you tell them you’ve made a new friend they never ask you any questions about essential matters. They never say to you ‘What does his voice sound like? What games does he love best? Does he collect butterflies?’ Instead they demand ‘How old is he? How much does he weigh? How much money does his father make?’ Only from these figures do they think they have learned anything about him.”
-Antoine de Saint-Exupery, The Little Prince.
Taken from https://www.goodreads.com/work/quotes/2180358-le-petit-prince

And yet, we do this constantly. Physicians especially love to divide ourselves into groups. Each group has its own characteristics. Most of those reading this (but not all) are EM docs (ER docs if you’re older), also known sometimes as ‘pit docs.’ There are internists, or fleas. Surgeons, or cutters. Anesthesiologists, or gas passers. Pediatricians, or pediatrons. Radiologists, or shadow doctors. Orthopedists, or carpenters. (I kid!) This is a natural division as our specialties are our big, nerdy fraternities and sororities. They are the places we learn to make our living, establish habits of thought and behavior, create world-views and life-long friendships.
Unfortunately, it goes much further than specialty. We are divided between rural and urban, and there are significant problems in that chasm, as physicians in urban teaching centers sometimes have little knowledge of the stark limitations of the rural setting when we call for help or transfers. ‘You don’t have a surgeon? You don’t have an ICU?’ Likewise, rural physicians often forget that even ‘the big house,’ eventually reaches capacity and can’t take transfers; and the presence of the large center (or a helicopter) is no excuse for sloppy care on the outside.
We are also demarcated by into ‘community vs academic.’ In my medical wanderings over the past few years, I have found that this is a point of contention with many community physicians. Research, treatment pathways, algorithms, check-lists and new imperatives seem to constantly emanate from academic centers and flow to the community hospital and its citizens. Community physicians, many of whom have lived through countless swings of the medical pendulum and associated policy changes, are often reasonably skeptical of the latest study, the latest rule about pain medications or sepsis protocols. They feel cut-off from what they perceive is a connection between academics and policy-makers, and they feel particularly excluded if, later in life, they have an interest in entering academia, which seems like a closed club.
Physicians are also increasingly divided by gender and sexuality, as we see various physician advocacy groups pop-up. That’s fine, I suppose, so long as it doesn’t split us further apart but serves as a source of encouragement and connection for the members of those groups. (It becomes toxic when it is used as an exclusionary tool. I was told once that my opinion in a debate was less relevant because I was a ‘straight white male.’)
However, our divisions seem to be at their worst when it comes to politics. And it’s a pity, really, because we have such potential to be models for the rest of the world. I have seen physicians argue politics in person and online. I have been part of some of those debates, and it can be very, very ugly. I have recently withdrawn from most political dialog because it wastes time, causes anger and accomplishes nothing.
But I will give this ‘opinion’ and stand by it. I’ve worked with physicians who were Christian like me, Muslim, Hindu and atheist. I have worked beside ardent progressives and hard-core conservatives who make me look like a socialist (and that’s tough to do). I have worked with physicians who were gay and straight, rural and urban, academic and purely clinical. I’ve laughed and cried with them, eaten with them, encouraged and been encouraged by them. And I’d do it all over again. Because when it comes to our job, our real job of treating the sick, easing suffering and saving the dying, all of our differences evaporate into vapor.
So identify yourself by whatever category you wish. But never forget that we can serve as a model for unity, a model for the greatness of all free people, when we do our jobs well, and do them together for the good of others.
Now, what’s your favorite food? What’s your hobby? Tell me about your wife, husband and children. Because those categories interest me more than all the rest.

What Jesus would do, and say, today…

My most recent Greenville News column.

http://www.greenvilleonline.com/story/opinion/contributors/2017/02/10/commentary-some-thoughts-what-jesus-would-do/97743538/

Some thoughts on what Jesus would do today 

(As we all grow more and more divided and arrogant in our views.)
Given the current political climate, a lot of our citizens are reasonably sure they know exactly what Jesus would do if he were here now. I happen to have a few thoughts on that topic myself.
It seems to me that first and foremost he’d disappoint us all by not debating the way we do. He’d actually love the people he was talking with, and want the best for everyone. Screaming matches and endless point-counterpoint were never his thing, or so it appears in the scriptures.
I think that while everyone was trying to convince everyone else about their opinion (and not changing anybody’s mind), he’d be on some street-corner healing sick people. And he’d be doing it in a way that was so dramatic people would think he was a charlatan. ‘There’s no way that paralyzed kid can walk now! It’s just a trick to convince simple-minded, unscientific people!’ That’s what some would say. And Jesus would keep right on healing cancer, HIV, gunshot wounds, schizophrenia and other awful problems.
And those people who were so full of inner pain that they wanted to die, and kept thinking that they had no worth? He’d heal their pain, and cast out demons from them. That’s what the Bible says he did, anyway. He said he was God and he taught about things like demons. People probably wouldn’t like that much; neither atheist skeptics or solid, staid, educated Christians. But the people he healed would love it.
Of course, he’d talk to people at the marches, the rallies, in the halls of legislatures and in the churches. Unlike our milquetoast, pale-faced images of gentle Jesus from Bible story-books, he would sometimes look (and be) angry. Angry about injustice and cruelty, angry about the neglect of the needy. He would also be angry about false teachers and others who robbed men and women of faith in God and left them nothing to comfort them. As before he would be angry at anyone who led others to sin. Occasionally, he would be sarcastic and insulting. He’d have harsh words for lots of pastors and sanctimonious believers. Read the Bible; it’s how he was.
Our many-flavored hatreds would give him plenty of fuel for parables, in order to guide us to the truth. But he would also be unhappy about the division and ideas heaped on people that leave them feeling worthless. Like the idea that humans are a scourge, a virus on earth. Or the obsession with hungry, sick animals while children face the same. And the way men and women are weighed down with one of two burdens, endless victimhood and its chiral image, the belief that some people’s ‘privilege’ causes all the world’s problems. He came to liberate everyone from beliefs that imprisoned them. He condemned religious leaders in his day for giving people burdens but not helping carry them; he would do the same for modern politicians and educators, ministers and mullahs who create anger, tension and violence in order to control and manipulate others.
Obviously, would talk about ‘sin,’ from greed to sexual immorality to idolatry and all the rest. He talked about those things a lot. He’d preach about the coming Kingdom of God and eternal life and redemption and judgment. He was serious about sin, but kind to all sinners, right, left and moderate. Conquering sin and death was his main mission, after all.
That would be just about enough for lots of folks. Because they didn’t come to be pressured about morals or lectured about their personal lives or told stupid fairy tales; they came for justice! For revolution! And they’d ask him to leave. Or maybe scream at him, because it’s what we do when we’re angry and sure we are right.
Ever the gentleman he would leave if asked. But before Jesus left, he might remind all of the passionate, angry people of what he said before:
“You have heard that it was said, ‘love your neighbor and hate your enemy.’ But I tell you, love your enemies and pray for those who persecute you, that you may be children of your Father in heaven. He causes the sun to rise on the evil and the good, and sends rain on the righteous and the unrighteous.’
It seems to me that in his absence he remains present, and his teachings still condemn our hatred 2000 years down the road. If only we’ll listen.

Sanitized Human Experience in a Reality Challenged Culture

 

My column in today’s Greenville News.

http://www.greenvilleonline.com/story/opinion/contributors/2017/01/27/commentary-hollywood-sanitizing-human-experience-reality-challenged-culture/97136066/

I love a good action movie. I tend to prefer the Marvel franchise over DC. I think Superman is too perfect and Batman just too moody. I mean, which rich guy would you rather party with? Bruce Wayne or Tony Stark? Exactly.
But I have always been amazed at the amount of destruction wrought by my beloved X-men and Avengers when battling monsters, aliens, gods and other ne’er do wells. Buildings and freeways and bridges destroyed, untold cars exploding, earthquakes and giant holes in the ground. It’s apocalyptic! In fact, if that were really happening, the toll of human dead would be staggering. Tony Stark could probably make a fortune selling coffins, and ER docs like me would be overwhelmed.
Movies like that are obviously meant to be outlandish; and to take your hard-earned vacation money. But I fear that television and movies sanitize too much of our bitter human experience, making misery somehow palatable.
Take regular action films for instance. Whatever the underlying story, it seems that gun-fights are everywhere! Bullets fly in all directions. Then, at the end of it all, bystanders aren’t injured. Nobody lies moaning or screaming for help. We don’t see the pools of blood spreading across the ground, the skin becoming more clammy, more pale as police call for an ambulance, as the paramedics or surgeons try frantically to stop the flow. We don’t see, or hear, the family member of the dead when they’re told what happened. I’ve done that a bunch and it’s something you never, ever forget. Scenes like that don’t make for fun entertainment.
In our movies nobody sees survivors, good and bad, condemned to paralysis, or with colostomies or amputations from those exciting gun-fights. What about characters punched and kicked to a pulp, their faces bloodied until they can’t breathe? They get chronic headaches, brain damage, vision problems, inability to chew or smell. I have seen them die too.
But we’re oblivious to more than real violence. When we watch trials and cheer for justice, when we want this or that person to go to prison for their crime, we sometimes forget that the imprisoned don’t see their families much, and their families miss them for years, or for life. And let’s not forget that prison, real prison, is a place where violence, rape and drug addiction are far too common.
I hate it when someone says, ‘guess he’ll get it good in prison; I hope he enjoys his cell-mate,’ or some other bit of cruelty. It’s never OK to wish for someone to be raped, male or female. Ever. Although prison has a necessary role, maybe we need to revisit the boundary between punishment and torture. We should want better for even the worst; especially if we call ourselves Christian.
There are others disconnects, of course. When characters in movies have multiple sexual partners, it looks like nothing but fun to modern, sexually liberated viewers. But we seldom see the misery of loneliness that comes from all of those connections, made and broken. Films and television do a poor job of showing us the pain and terror of HIV or hepatitis, the anxiety of unplanned pregnancy and the reality of abortion. They fail to reveal the suffering brought by cervical cancer associated with HPV. The don’t show the tears shed over infertility caused by chlamydia or gonorrhea infections; the danger to newborns caused by herpes. It’s also hard to fathom the fact that many who work in pornography are miserable in heart, mind and body, and some around the world are compelled to do it against their will, working as sex slaves.
On screen, getting drunk is just what you do. We have all laughed at intoxicated characters, for as long as actors have played them. But we seldom consider the mortality and disability from car crashes. We rarely think about the way men and women die from head injuries or asphyxiation due to alcohol or drug abuse. We don’t get to witness the abuse and neglect of children, the cruelty to spouses, the lost hope, lost productivity and broken families from both.
We have to remember that what we see in movies and television is seldom the whole story. Sometimes, the truth is better. And sometimes, unfortunately, the reality is a lot worse, and far darker than the screenwriter, producer or director can ever, or would ever, convey to our entertainment soaked, reality challenged culture.

My column in the Winter 2017 Gray Matters, Newsletter of the Osher Lifelong Learning Institute at Furman University.

 

THE NEWSLETTER OF THE OSHER LIFELONG LEARNING INSTITUTE @ FURMAN

http://www.furman.edu/sites/OLLI/member-resources/Documents/GMJan2017-PDF_reduced.pdf

PAIN MANAGEMENT AND THE TIE TO ADDICTION – PART 2

Sometimes medicine offers us wonderful, almost unimaginable gifts. Heart attacks that were devastating, life-altering events a few short decades ago are now treated with an expediency and skill that our grandparents couldn’t imagine. A couple days pass, and the victim is home with stents in occluded arteries and directions to modify activity and diet. Pneumonia, once the ‘old person’s
friend’ (so called because it took the aged to eternity), is far less terrifying, thanks to both antibiotics and the pneumonia vaccine.

However, some of the things we do give benefits that are less clear. Although it could be an entire column in itself, the ‘stroke center’ movement, with the promise of miracles from ‘clot-busting drugs’, is a thing full of as many questions as answers. And what about depression and anti-depressants? When I looked up the side-effect profile of an anti-depressant a friend was taking, I was reminded that all of them have the potential side effect of increasing suicidal behavior.

But what about pain management? Thanks to improved understanding of the physiology of pain, the persistence of medical providers, and the investment and research of pharmaceutical companies, we have a wide array of pharmaceuticals available for the treatment of pain. Some are over-the-counter, like acetaminophen and ibuprofen. And others, those we refer to as narcotics or opioids (because in previous times they were derived from opium), are useful, potent, and (as is increasingly evident) fraught with danger unless used very cautiously.

Of course, for a very long time, physicians were taught to be judicious in prescribing narcotics. Our venerable teachers warned young doctors in training to be frightened of the side effects. We were especially aware of the very immediate danger that patients would stop breathing and die due to excess sedation. We were also aware that over time, patients on narcotics might develop problems with addiction.

About 20 to 25 years ago, that whole paradigm shifted and physicians were suddenly accused of callous disregard of suffering for prescribing too few narcotics. I remember this because I was in my emergency medicine residency at that time. We were constantly reminded to give more narcotics and be sensitive to pain. We were taught to use the ‘pain scale,’ in which a patient-reported score of zero meant no pain and a score of ten meant ‘the worst pain of your life.’ Never mind that it was entirely subjective and that there was no objective standard, no ‘painometer’ against which to measure it. We were instructed to see pain as the ‘fifth vital sign’ after blood pressure, pulse, respiratory rate and temperature. Of concern to many, these initiatives coincided with the development and aggressive marketing of ever more powerful, addictive medications like Oxycontin tablets and Fentanyl patches and lozenges.

Patient satisfaction surveys included the question ‘was your pain adequately treated?’ Physicians were castigated when those satisfaction survey scores fell. Physicians were instructed, by non-clinician

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administrators, to give more pain medication to make patients more satisfied. (A satisfied customer/ patient is one that may come back!) Physicians who resisted, in the name of science or safety, were too often met with threats of reduced income or job loss if patient satisfaction scores fell. In some instances, physicians were (and still are) reported to state medical boards for alleged inadequate treatment of pain.

I sincerely believe that most of those encouraging us to write more narcotics prescriptions did so out of genuine concern and compassion. People are in pain, so why not treat the pain? In medicine, where science meets suffering humanity, it’s so easy for us to say, ‘Well, it just makes sense, doesn’t it?’ We assume that our compassion will be supported by our science. It happens with infections; sure it’s probably a head cold, but what’s the harm in an antibiotic to keep the patient happy? The child bumped her head pretty hard, so what’s the problem with a CT scan, even though she looks good? The parents are customers, after all, and want a scan!

With tragic consequences, our compassion sometimes causes harm as the Law of Unintended Consequences rears its ugly head. For instance, those antibiotics for colds? They can cause dangerous allergic reactions and life-changing intestinal infections requiring hospitalization or surgery, and resulting in death. Those CT scans everyone wants? Physicians are trying to reduce the number of scans, as many of us are concerned that they may induce malignant tumors later. And those pain medications? The evidence looks pretty damning.

Addiction to prescription narcotics is growing at a terrifying rate in the U.S. Likewise, death rates from narcotic overdoses have soared. The U.S. has seen 165,000 deaths from opioid overdose between 1999 and 2014. http://www.cdc.gov/drugoverdose/data/overdose.html. In fact, opioid-related deaths have now surpassed deaths from firearms in the United States. http://www.cbsnews.com/news/drug- overdose-deaths-heroin-opioid-prescription-painkillers-more-than-guns/ Admittedly, some of those deaths are not due to prescription opioids but rather to injected heroin. However, many heroin addicts began their addiction issues when taking legitimately prescribed pain medication.

Sadly, seniors are not immune. Physicians don’t want to see seniors suffer, so they often give narcotics even for pain that in decades past would not have been treated with those drugs. We give them for back pain, headache, arthritis, or other less serious conditions. And we use them extensively in treatment of chronic, intractable pain. In fact, in 2015, one-third of Medicare recipients received a prescription for an opioid analgesic; some 40 million prescriptions. https://www.statnews.com/ 2016/06/22/many-opioid-prescriptions-seniors/

Furthermore, seniors not only develop addiction, not only die from accidental overdoses, their narcotic analgesics have a host of side-effects, including (but not limited to) the following: excessive sleep, impaired thinking, increased pain sensitivity, nausea, constipation, and cardiac arrhythmia. In addition, opioid drugs contribute to weakness and loss of balance and thus to falls, resulting in head and spine injury, various fractures, and other trauma. Their already impaired reflexes are dampened by their medication so that for those who still drive, it becomes an even more dangerous activity than before.

No one is immune from this devastating epidemic, not rich nor poor, not young nor old. The medical profession, the mental health community, law-enforcement, social services, churches, families, and friends all have to come together and find ways to roll back the rising tide of death and addiction, which came as an unforeseen outcome of attempting to ease suffering with compassion and science.

This problem will be highlighted this spring at an OLLI bonus event, March 31, 2017: Seniors and Opioids: Unexpected Origins of a Greenville Epidemic. I will be speaking in conjunction with James Campell of the Phoenix Center addiction and rehabilitation facility. We really hope you join us to learn more about this pressing public health crisis.

Christmas Poem, G.K. Chesterton

Christmas Poem

G.K.Chesterton

There fared a mother driven forth
Out of an inn to roam;
In the place where she was homeless
All men are at home.
The crazy stable close at hand,
With shaking timber and shifting sand,
Grew a stronger thing to abide and stand
Than the square stones of Rome.

For men are homesick in their homes,
And strangers under the sun,
And they lay their heads in a foreign land
Whenever the day is done.

Here we have battle and blazing eyes,
And chance and honour and high surprise,
But our homes are under miraculous skies
Where the yule tale was begun.

A child in a foul stable,
Where the beasts feed and foam;
Only where He was homeless
Are you and I at home;
We have hands that fashion and heads that know,
But our hearts we lost—how long ago!
In a place no chart nor ship can show
Under the sky’s dome.

This world is wild as an old wife’s tale,
And strange the plain things are,
The earth is enough and the air is enough
For our wonder and our war;
But our rest is as far as the fire-drake swings
And our peace is put in impossible things
Where clashed and thundered unthinkable wings
Round an incredible star.

To an open house in the evening
Home shall all men come,
To an older place than Eden
And a taller town than Rome.
To the end of the way of the wandering star,
To the things that cannot be and that are,
To the place where God was homeless
And all men are at home.

(Gilbert Keith Chesterton)

With thanks to:

http://www.gkc.org.uk/gkc/books/christmas-poem.html

Not only do GKC and I share a name (my first name is Keith, as is my father’s), he is truly one of my great literary heroes.  If you aren’t familiar with his work, please look it up.  His biographies of St. Francis and St. Thomas are very good, and his fiction is always fun; even his serious Christian work is a pleasure.  He was a great influence on C.S. Lewis.  Oh, and he carried a sword cane and pocket pistol with which to defend his treasured wife.  Thanks, GKC, for your gifts to us!

 

Election Related Illness…

Now that the presidential election is past, national emergency departments are seeing an increase in election-related health problems. While anxiety, depression and homicidal rage are what one might expect, it turns out, according to emergency physician Dr. Chuck McShortridge, the bigger issues seem to stem from people sitting at computers all day long and linking to political posts on Facebook, Twitter, Reddit and assorted other online outlets.
“Just last week we had three patients with massive pulmonary emboli. I asked their spouses about surgery, cancer, fractures, trips overseas, and the common thread was this: ‘No, but he (or she) spent the last six months linking to articles about how Hillary is a crook or Donald is a liar, or something like that.’”
Other physicians have noticed the same. Dr. Maggie McFarris reported another issue: “I keep seeing patients who complain of a constellation of symptoms: blurred vision, sleeplessness, carpal tunnel syndrome and in some cases, acute renal failure. I call it Donald-Clinton Syndrome. They never get off the (expletive deleted) couch. All day long it’s ‘that Hillary is a crook who can’t be trusted’ or ‘he hates women’ and links to dozens of articles a day. They don’t eat, they don’t drink, they don’t exercise, they don’t even have sex.”
One spouse we interviewed in the waiting room of a large ER said, “My wife has lost a lot of weight because she won’t eat! Just the other day I made this great vegetarian dish she loves and all she said was ‘I don’t have time, I just found this incredible piece on Trump at Politico and I have to share it!’ I ate dinner alone. Thank God the election is over say she can finally get the Xanax and IV fluids she needs.”
On a related note, some politically active physicians we met in the course of this article are lobbying to have advocacy counted as CME. Dr. Joseph Mooring, known for his bumper-sticker-laden Subaru, political buttons and frequent presence at online forums, stated: “CME? Who has time for that? I’m trying to save America, and in the process American healthcare! I should totally get credit for the hours I’ve logged trying to save the nation!” American Board of Emergency Medicine representatives said the board might be able to work political advocacy into the new Lifelong education modules.
Practitioners are urged to continue to be diligent in looking for election related illness and injury.