Sunday, October 15, 2017

Quick Takes as Fellowship Comes Closer


Professionals of all stripes use LinkedIn. Basic science researchers use ResearchGate. Private physicians use Doximity. And, of course, everyone still needs a paper CV or resume. This sets up an obvious problem for the (hopeful) academic physician with a strong community presence. Aware that tl;dr has its own meaning, I affectionately call this resume problem "TLDR." Whenever I have something to put on my CV, it has to go in four places: Text, LinkedIn, Doximity, and ResearchGate. (And I haven't even mentioned the fact that NRMP, the "common app" for residency and fellowship, makes you build yet another CV in its system.)


This month I went to wedding, two conferences, and a strategic planning meeting. One of the conferences overlapped with call, so I flew back through recently-flooded Houston the night before I showed up for a 24-hour shift. I feel like I'm always leaving friends and family behind, never present to them. All in all, I am traveling 4 out of the 5 weekends of this month. (I spent the other weekend TLDRing.)


Hello Internet is a podcast by CGP Grey and Brady Haran. I used to watch a lot of YouTube science, so I knew the creators and listened to a bunch of the podcast while collecting data for a research project. One interesting episode talked about time management across four categories: work, family, health, and friends. Grey made these categories analogous to four lightbulbs, and posed the question of time management in terms of how bright (or dim) each bulb is or should be, given limited wattage for all four. He related personally that his "health" bulb hadn't been on in the early years of starting a successful YouTube channel. As I listened to the podcast, madly collecting data, I felt similar. I, too, am self-employed in a way. I'm in that phase in my career that involves aggressive self-improvement. I'm looking for excellent skills, rare opportunities, good connections, advantageous relationships, and strategic projects. And that "health" bulb is really dim! I'm trying to turn it up a little, but the wattage limit and my chronic ambitious habits are making it really hard.


I'm homesick. When I applied to residency, I had few incentives to stay in my hometown because the public hospital rejected my ethical choices, the good private hospital had residents I didn't want to work with, and I thought the other private hospital was a dead-end career choice. Now I might be able to wedge my way back in, and I'd really like to. I don't like being the stranger at Christmas, that "older sister" who is never present to my siblings' lives. I want to be near my parents and be in the city I know and love. I can't tell how important these feelings are, though. Should I prioritize training in this important stage in my career? Should I go somewhere for the sake of a key mentor or a key set of experiences? And the all-important question: will they take me?


You know the fable of the man who started with a piece of straw and ends up a millionaire? I feel that way sometimes. I started in homeschool and traded up to a good private elementary school. This allowed me to trade up to an academically decent but philosophically terrible private high school. From there, I could have jumped academically higher (and philosophically lower) into college, but instead traded overall "up" to TAC. But TAC is a "straw" in terms of the rest of the world. (All the Thomists may now laugh at TAC being straw.) But I was still able to trade up to get into medical school. From a community program, I traded up again to an academic residency. I wonder whether fellowship will be another trade "up," or whether I've maxed out my potential. 


Can I admit something? It relates to "maxing out potential." There is a barely perceptible but real glass ceiling over me because of my moral choices. I can't go to top places because they don't want someone with my "limits." I am not comfortable putting a list of places I'm blocked from online, because I still have steps left in my training and don't want to close doors. But I have this long-lasting frustration with being inferior. I guess it started at TAC: I felt like I took the moral high road, and my high school classmates who had gone to better colleges were getting into better med schools. Then from my state med school, I felt that again I was getting fewer competitive interviews. In any given city, there's a glass wall between me and the big hospital and the big research projects. It makes me irrationally hungry to go to those places and do that research. There is a lot more funding and networking in those places, and I could do more. Wouldn't it be good if I could do some animals studies to further the possibility of ectopic rescue? Wouldn't it be good if I could study methotrexate more?


I look at the last quick take and part of me thinks: "Networking and funding are fancy words for power and money. Don't look to those things. The Lord doesn't want you to do things independently. He wants you to be His Bride and He will make all the rest possible for you, even if it requires more work and you do not meet with success." There is more purity of heart in this response, I think. Less slavishness to ambition and outward things. More peace. Please pray for me, that I can have this peace and trust in the Lord, rather than anxiety over worldly things that I miss because of adherence to the truth. Please join me in that trust, in whatever opportunity you have in your life.

I will start applying for fellowships in July of 2018. I will start preparing my application around December, when interview season for the entering intern class of 2018 is over. Please pray for me! If there are priests reading, please consider saying a Mass for me.

Saturday, September 30, 2017

Why is IVF wrong? (Minor premise and Conclusion)

This post is a defense of the minor premise of a syllogism begun in "Why is IVF wrong? (Question and Minor Premise)." The premise is: All conception must be through sex, and this post takes the syllogism to its conclusion.

I just think blastocysts are lovely.
Img credit: Nina Sesina, Wikimedia Commons
In a way, this is the only premise necessary and the syllogism melts into an enthymeme. The original question was "can we use IVF?" and I reply, "no, sex is the only way we should conceive." The major premise was necessary to establish the fundamental difference between sex and ARTs, but this premise is the key. This is also the trickier premise because it relies on natural law and revelation, two things that our culture (and therefore I) are/am not that great at.

For a foundation, we don't prove that revelation is true, we receive it. We hold it with the same faculty that holds a Euclidean proof, but not because we have a demonstration of it. Rather, we hold revealed truths as gifts because the authority they carry is stronger than demonstration (Summa I.1.8). Our only job when it comes to studying and arguing about revealed truths is to defend parts of revelation based on other parts and show that the conclusions are cohesive and holy (for instance, defeat Arianianism by citing John 1:1,14, 1:30, and 8:58, or to point out that the Incarnation is a suitable medicine for our fallen condition for the reasons Athanasius cites). So I cannot demonstrate that sex is the only way which we can conceive, but I can show it in revelation and show that it is cohesive and holy.

To begin formally: reproduction involves creation and thus is a divine act. New embryos' souls are the only instance we still see of ex nihilo creation of a new substance. Like all creation, it is properly a divine act. It is God's to decide how His act proceeds, and He chooses to share it with us in a certain way. The way he shares it involves sex, so sex is like Him (it's life-giving, exclusive, and faithful as intended) and it's like us (surprisingly animal, but sublime). "Say," you might object, "how do we know that sex is the 'way' He chose? Maybe He just chose sperm egg fusion, in which case IUI and GIFT would be okay. Or maybe He just chose pronuclear fusion, in which case ICSI would be okay. How do you know He didn't choose something less inclusive?"

Img credit: Rugby 471, Wikimedia Commons
Actually, He chose something more inclusive: He chose marriage, including preparatory chastity and intramarital fidelity. We know this from revelation, especially Genesis, the Song of Songs, Mathew, and the letters of St. Paul. The revelation cited above is best expounded in Dignitas PersonaeDonum Vitae, section 8 of Persona Humana, and Man and Woman He Created Them (in decreasing order of high- to low-yield as far as time spent reading the entire thing). Persona HumanaMan and Woman He Created Them, and Donum Vitae in particular cite scripture and magisterial authority. So revelation supports the premise.

Moreover, it is also cohesive with the rest of theology. This whole plan is like God: fiercely, uncompromisingly faithful, especially in its faithfulness to children. For this reason, neither marriage nor sex can be intentionally interrupted or replaced by a third party or nonsexual act. Sex looks so ordinary to us but it's on the level of angelic war--it's God's other way of making saints. Cloaked in normalcy, sex is actually a mechanisms of salvation history that is almost beyond our human capacity. This is why the Church seems so preoccupied with sex--it's hard to see what is right and wrong!--and why it seems to say "no" to so much. But this is why divorce, contraception, IVF, and surrogacy are wrong.

The final syllogism is a second-figure Cesare with a slightly complicated predicate in the minor premise.
No ART is a sexual act.
All conception must be through a sexual act.
Therefore, no conception can be through a sexual act.
In addition, remember that there are other big concerns with IVF (embryo construction predisposes to seeing people as products/things rather than persons, embryo destruction, and embryo freezing), but you asked about the act itself, as if it were used in the best possible circumstances: a sacramentally married couple with good intent and who only desire embryos to be made who will be implanted and refuse to destroy embryos (success rates probably less than 40% with those caveats).