Monday, November 10, 2014

Interviewing for Residency: Fascinating Experience

I've now been on four of the twelve interviews I have scheduled. I am amazed at how formative an experience it has been. I had two pools of programs that I looked at: programs that would be good for innovation and research (and future fellowship) and programs that would be open to my choices not to prescribe, sterilize, and abort. I expected that there would be few to zero programs that offered both. In fact, the program that I thought would be closest to "both" was my home program. I collected names of programs in three main groups:
  1. Did a CMA conference attendee, One More Soul, or another Catholic med student friend recommend it? (If yes: on list until eliminated due to financial concerns.)
  2. Do they have an open fetal surgery center? (If yes: on list.)
I add three token applications: my home programs--the one attached to my med school and the one on the campus I did my clinicals on--and that OB/GYN Mecca, Parkland. I felt that a native southerner who really wanted to go into OB/GYN wouldn't not apply to Parkland.  (Dumb reason to apply.)

I assumed that most of the academic centers would refuse an applicant making my choices. I thought that when I informed them of my decisions, they would write me off. I thought I had to decide on a future in the next eight months: will I be a napro doc or an academic researcher with a different fellowship?

To my shock, the answer might be "both!" I have interviewed at three community programs and one academic center, and three of them have been very open to my choices, including the academic center!

I am learning about myself, too: I like good surgery numbers, I like autonomy, I like peace and serenity. So I like the programs that let residents have a life, I like areas without too much traffic, I like single hospitals and few off-service rotations, I like good relationships with faculty, and I like a rich Catholic (sub)culture. I don't really care about simulation centers, and I don't rate being buddy-buddy with all my fellow residents as a high priority, because I'm a private person. To my surprise, I like pretty hospitals and good weather more than I thought.

I still can't decide whether I think it's important that I be able to do research. I'm still trying to figure out what futures I should prepare for. But I'm encouraged: it looks like I might be able to become a researcher and a pro-life physician. I'm most excited about some future interviews!

Saturday, November 8, 2014

CMA Conference Summary

It has been over a month since the CMA conference. As I proceed through the interview season, I am so glad I went. I actually had an open conversation about NFP with a fellow interviewee on the airport shuttle and was unashamed and excited about it. Thanks, Courage in Medicine.

I'm going to review the five or so talks that I found most meaningful. Check out the entire program booklet here, and order copies of these talks here.

Cardinal Burke: Physicians as Standard Bearers in the New Evangelization
This opening talk was a spiritual alarm clock that I desperately needed. I took copious notes during this talk, and I can't squish it into a short blurb, but here are some pearls:
  • Virtue is the primary method of the New Evangelization.
  • If we have the heart of God, our patient care will transform us, our patients, and the culture.
  • We are not saved by a discovery or work, but by a Person who assumes us.
  • The moral norm isn't an abstract--it's Jesus, so get to know and love Him.
Cardinal Burke urged us to form our consciences with moral study to stave off doubt that there is a moral norm. Since I was thinking of my own timidity and upcoming interviews, the message came through loud and clear that I needed to comfortably, boldly live my faith, reason, and religion as the most formative part of my life. My responsibility (since I've been told the truth) is greatly increased, and I wasn't attending to much of the iceberg of my responsibilities to glorify God.

Mike Aquilina: Challenges Before Us in Historical Perspective
The recent changes in healthcare, pointed out this speaker, are a perfect storm to drive out the people who want to serve. He went through ancient history (especially Roman historians like Tacitus and Pliny) recounting some of the same cultural phenomena we see today, such as the increasing tendency to lavish attention on dogs and to go childfree (to be clear to childfree readers: I list those as two separate tendencies). Mr. Aquilina emphasized that the cultural changes we see now are not original: every time a culture forgot to separate what is good from what is desireable, it excluded some persons (females, elderly, unborn, infants, children, various races, prisoners) from personhood and devalue them. However, Mr. Aquilina also showed that there is a history of the aberration of Christianity upsetting dysfunctional cultures. He concluded that there is no better time for us to be alive and serve; God will equip us, as he has historically.

Father Roger Landry: Bifurcation of Faith and Reason: Unleashing Radical Secularism and Its Impact on Medicine
This priest is remarkable for his use of the word bifurcation and his Latin three-word summary of how we should live. We should live, he says, etsi Deus daretur, as if God was a given. (Obvious as this may sound, it is difficult to do in the sea of relativism that is mainstream education above the sixth grade in this country.) When we live this way, unafraid that robust faith saves and strengthens reason, our lives are integrated. We also reap the following benefits:
  1. We rediscover wonder.
  2. Technological advances don't outstrip moral development. (More on this in a future post, I hope.)
  3. We don't forget the splendor of being a child of God, and we thus avoid devaluing persons.
We should challenge ourselves and our culture: what stands in the way of your practical atheism being carried into Nietsche's will to power? A hazy self-faith, godless altruism, natural law? Impossibly webby barriers to "might makes right." If you don't buy the CD of any other talk, get this one.

Father Robert McTeigue: Moral Courage in Medicine
Chosen to give the title talk at this conference was a very humorous Jesuit priest. Fr. McTeigue charged his listeners with duties to acquire the virtues (which, by the way, are humanizing and good for people). He pointed out that courage exists for the protection of the good. One of the most surprising things he said quoted St. Teresa (I think?) on the two beautiful daughters of Hope: anger and courage. This is why the evil spirit wants so desperately that we despair: when we hope, we have just wrath, and we pounce on evil! We defy it! We unabashedly judge deeds (our own and others'). Fr. McTeigue's final piece of advice: pray "Jesus, I trust in You," and mean, "I don't trust myself."

Dr. Fernandes: Catholic Medical Professionals: Reclaiming Surrendered Ground in Bioethics 
If I wasn't morally awake after Cardinal Burke and the other speakers, Dr. Fernandes would have gotten me out of any relativistic torpor left. This Wright State attending (gently, with humor) lit a fire underneath me. Like Cardinal Burke's talk, I'll just have to give you some soundbites:
  • Make yourself reasonable. Confuse them [relativists and practical atheists].
  • If people are worm food, why should we suffer, delay death, or respect religion as an add-on?
  • Cultural relativism is wrong. What if a culture is intolerant?
  • "Loving" "People" is easier than truly loving persons in front you in the present.
  • Between good and evil, there is no safe place.

Dr. Patrick Yeung: Fertility and Infertility Within a Catholic Moral Vision
Dr. Yeung, who is a professor at St. Louis University and directs the Center for Endometriosis there. He, being a napro-trained OB/GYN, had lots of relevant advice for me. "Do not look at it as a bunch of things you cannot do. Make it green and holistic and positive." "For best results," he also quipped, "follow God's design." One more neat quote: "Optimal medicine is holistic and doesn't solve one problem at the expense of [creating] others."

Wednesday, October 22, 2014

Did a Doctor of the Church Prescribe Abortifacients?

A medical student asks:
I am trying to choose/discern who is my Confirmation saint. A friend mentioned St. Hildegard of Bingen, and I thought she sounded really interesting. In doing more research, I found ... some "sources" [saying] that she was against abortion and contraception and some [saying] that she was in favor of these through certain herbs that are "menstrual regulators." Here are some of the articles I found.
I love St. Hildegard and jumped at the excuse to delve into her Physica and letters. Let's 1) examine her work, 2) review how Church doctrine develops, and 3) mention a fundamental issue at stake. Busy people read bold.

St. Hildegard and Abortifacient Herbs
Does St. Hildegard prescribe abortifacients? In the most relevant part of her Physica, she uses a large group of herbs in a concoction for "obstructed menses."
Let a woman who suffers from obstructed menses take tansy, an equal weight of feverfew, and a little more mullein than either of the others. ... And when she enters [the] bath, let her place these warm herbs on the bench and sit on them. ... Let her do this as long as she sits in the sauna so that her skin and flesh are softened on the outside and in her womb by the humors of these herbs and so that her closed veins are opened. Then let her take bearberries, a third as much yarrow, rue a third as much as the yarrow, birthwort as much as the bearberries and yarrow, and a little more dittany. ... Boil this in the best wine and mix this into the sack with the previously mentioned herbs and thus prepare claret. Let her drink this daily...until she is well.
First of all, the goal of therapy is to make someone well. I expect our medieval mothers were familiar with the subtle signs of pregnancy, and they did not share the modern mindset that it is an illness. But let's not guess at authors' intentions; let's look at the facts. Are these plants abortifacient?

Feverfew has been studied in patients with migraines and is thought to be a vasodilator. A review does not list miscarriage or menstrual effects among observed adverse effects over 245 patients. It caused as many menstrual disorders as a placebo did in a low-powered randomized controlled trial.

Mullein, besides its current uses as a fish poison, has been used for ulcers and pulmonary complaints. Natural Standard gives the evidence supporting its ability to relieve earache a "C."

Dittany has been used for hysteria and uterine hemorrhages in the past; Natural Standard has no evidence on these uses.

Bearberry (of kinnikinnick fame), has "C"-grade evidence for use in urinary tract infections and hyperpigmentation. Natural Standard warns that the berries "in large amounts may induce labor," but gives no evidence to support this.

In a single animal study, yarrow was associated with decreased fetal weight and increased placental weight, but no studies have investigated further. An ethanolic extract of yarrow (200 mg/kg/day, intraperitoneally, for 20 days) and a hydroalcoholic extract (300 mg/kg/day, orally, for 30 days) had severe effects on murine spermatogenesis (a male contraceptive effect).

The only study that mentions tansy as an abortifacient is a 1979 sociological narrative. Although it goes into great depth on some herbs, its short paragraph on tansy explains that it was not used much among the population studied, and the authors didn't know why.

Rue contains pilocarpine, an abortifacient used in horses. (An FDA-approved medication for dry eyes and dry mouth.) Natural Standard cites deaths in women who use rue as an abortifacient. Rue's inclusion in the potion may explain the addition of yarrow and mullein: rue causes a contact phytophotodermatitis, and perhaps the anti-inflammatory or wound-healing effects of the other herbs was thought to be prophylactic.
Contact dermatitis from rue.

Birthwort contains p-coumaric acid and aristolic acid. These are abortifacient in mice with a single oral doses of 50 mg/kg and 60 mg/kg (of the methyl ester), respectively. A sesquiterpene isolated from the roots is abortifacient in 91.7% of pregnant mice at a single oral dose of 100 mg/kg.

I have no information on how much of these chemicals is contained in the raw or dried plant, so I have no idea how much of the plant parts a human being would need to consume to cause an abortion. Fortunately, it doesn't matter that I don't have this information, because St. Hildegard doesn't give absolute quantities, either. It is possible that the doses intended by St. Hildegard are lower than the doses required to produce an abortion.

Are some of the herbs that St. Hildegard uses abortifacient in certain quantities? YES.
Is she intentionally ending a pregnancy? DOUBTFUL.

Would her remedy end a pregnancy? DEPENDS ON DOSAGE.

A Doctor of the Church from the turn of the twelfth century composed an herbal remedy to bring on a late period; we now know this may be an early abortion. Should our adherence to the Humana Vitae come crashing down? Should we picket our chanceries for support of the HHS mandate?

The Church on Medical Ethics in General

No. This shouldn't ruffle any faithful Catholic feathers: it doesn't give us any reason to doubt the Church's teaching on abortion and contraception.

SNARE proteins at work in exocytosis.
(The same proteins underlie sperm-egg membrane fusion.)
St. Hildegard, like St. Thomas Aquinas, knew to protect human life as soon as she could detect it (more on this below the jump). Without microscopes, she could not observe that ovum and spermatid join, and the resulting zygote acts as an independent organism immediately after sperm-egg membrane fusion. If she was wrong about when human life begins and so thought that a remedy to "bring on the period" might be beneficial to a patient, she was invincibly ignorant.

Church teaching always develops as our knowledge develops. As embryology improved (with a French paper in 1879 describing "immediate animation") our mores responded (with protestant-based cultures like the U.S. outlawing abortions beginning in the 1800s), and so did Church teaching.

Female and male pronuclei in a zygote ready to divide
for the first time. Polar body at one o'clock. Src
We are freed by a more complete knowledge to better do what St. Hildegard was already doing: protecting unborn life.

Some still do not recognize that "bringing on a period" (and its more current equivalents) can result in loss of a human life. A Catholic who cannot see this can fall back on the Church's teaching, so that she can at least hold the truth. Unfortunately, those who are interested in potentially-deviant teachings by historical Catholics are often not open to falling back on the authority of the Church.

The Fundamental Issue: Catholic Docility
Something very fundamental is at stake in the discussion of whether St. Hildegard supports this or that. Faithful Catholic discussions about individual theologians must stand on docility. By "docility," I mean a an attitude of ready submission to the truth. This mentality is often missing from discussions of reproductive rights; however, without it, discussion and rights are meaningless.

Discussions are about truth, and rights are about happiness (or achievement of "the good," if you will). No human being can add or subtract to truth, and no human being can fabricate happiness. These are outside us, already determined by Someone else, and therefore "limited," in a way. The "limits" to truth and goodness are like bowling alley rails, helping our intellects and consciences reach perfection. If we bowl within the rails, we stand a chance of knocking down a pin. Without regard for the "limits" (docility) we bowl all over the building, pursuing apparent goods that aren't fulfilling according to opinions that aren't true.

Purely secular docility means regard for our inborn and universal human nature by forming our souls to achieve that nature's greatest good. It means informing our intellect with truths we or others can prove (e.g. that there is a God) or which need no proof.

Revelation adds to nature like General Relativity adds to Newtonian physics. There seem to be more limits, they are more complex, but this means greater freedom. Catholics are docile to the Truth as a God who loves us and left us an institution to help us apply the truth to our lives, so we expand our docility to include the Magisterium. A docile Catholic forms his conscience and intellect with the help of the Church, without which he cannot have faith. This formation and docility 1) helps us avoid sin in the advancement and application natural science; 2) makes conscience and the sensus fidelium accurate barometers of what will bring us happiness, rather than opinions and democratic whim; and 3) helps ground us when human persons say and write confusing things.

St. Hildegard was a great defender of docility to the Church and her headship. In an early letter to Pope Eugenius, she describes the Church as:
...a useful institution, tending toward God (and therefore assisting mankind), providing a light for man’s benefit. ...[M]any teachings and the fragrance of orthodox writing flow from the vigor of truth to it, but some people frequently reject them without justification.
She elaborates on those "people" in another letter to the same pope, complaining that they "disparage everything that prelates do, because they scorn the notion that they are inferior to their prelates...because they are full of the poison of envy." St. Hildegard herself had imperfect superiors; nevertheless, she encourages us to love the Church and be submissive to our superiors.

This attitude of submission grounds us, so that we're not easily ruffled by the behavior, speech or writings of individuals. "Keep calm and carry on," is the docile Catholic's mantra, and St. Teresa of Avila summarizes it well:
Let us look at our own faults and leave aside those of others, for it is very characteristic of persons with...well-ordered lives to be shocked by everything. Perhaps we could truly learn from the one who shocks us what is most important even though we may surpass him in...our way of dealing with others. ...[T]he Lord will take care of these souls.
Maybe St. Hildegard prescribed abortifacient herbs. With St. Teresa, I say "So what?" We can surpass St. Hildegard in our protection of human life. We shouldn't be so scandalized that we fail to learn the more important lessons St. Hildegard has to teach: that human life should be protected, and that we must be docile to the Church.

In conclusion, I am uncertain that St. Hildegard knowingly recommended certain herbs to end an early human life. One of her herbal remedies included chemicals that are certainly abortifacient, though I can't comment on what quantities would be required to cause an abortion and whether St. Hildegard used these quantities. Even if she did, she 1) protected the intrauterine life she recognized and 2) vehemently demanded docility to the teaching Church. If we value St. Hildegard, we would do well to imitate these two choices.

Replies to objections (including more on St. Hildegard's protection of the unborn) and recommended reading below the jump.