REJOICE!

It's Advent! Also, God answered my prayer fervently beseeching Him to send me someone to head up the Catholic Medical Association and Medical Students for Life next year! I am now no longer ridiculously burdened, just semi-ridiculously. :D

ADAPT is over, CMA-SS is in another person's hands (although I'm still first mate), MedSFL is soon to be handed off (although I'm still committed for another year or so), and I declined leadership in the 1flesh university group here as soon we mentioned it. Life is so good. God is so good.

Eugenics, Abortion, and other Insanity in the Hallways

A few snippets of conversations I've had.

#

In lecture on polycystic kidney disease (PKD):

Medullary sponge kidney doesn't account for a large percentage of PKD, but it still adds to the burden on society.

I was jarred to hear the sentence end that way. I was sure it was going to end with a simple, charitable, "but it makes a difference to the patients who have it, and we should be prepared to recognize it for them."

#

Talking with the former Interprofessional Ethics course coordinator, a Catholic OB/GYN, about abortion:

I've done maybe seven [abortions]. One of 'em was an anencephaly case. I talked it over with a priest and he said it was okay, since it never apparently had a soul.

I just saw a MedSFL facebook post featuring a young woman who chose to carry an anencephalic baby (person) to term. The baby boy lived for sixty-one minutes, and he and his mother and father are a beautiful family even now.

#

Talking with other (probable) future OB/GYNs:

It's gross, but I'd go into it just for population control. Some of these people are too stupid to have kids. [And, after lauding Essure and complaining about how dumb teen moms are] I hate people.

 Population control? Birth control for the less intelligent? Hating people? These are the opposite of everything good, just, and loving. I couldn't believe what I was hearing.

The Last Anatomy Lab

Last Wednesday I walked out of the anatomy lab for the last time. To my surprise, I wasn't thinking deeply about it at the time. I remember the last time I was in the anatomy lab as an M1, I felt and thought a lot leading up to it. Even if I didn't feel momentous surges of emotion as I walked out, I stored the moment with resolution I would usually use for hugely important things. I remember what I was wearing, I remember which exit we used, etc.

This time I actually forgot it was my last time walking out until I was already in the hallway walking away. Then, I calmly walked to the lab management office and said to the lady who works there, "I'm not going to use this coat any more. Could you [i.e. the anatomy department] use it?" And I left it with her. (I had noticed recently that our professors use lab coats with unfamiliar names embroidered on them. Fun to think of who will use my lab coat, which has my name in sharpie on it.)

But now I think of the magnitude of things: unless I am invited to participate as a professor or physician (e.g. during our pelvis lab an OB/GYN was invited; during our leg lab a sports medicine doc came in), I will never legally reenter an anatomy lab.

Consecration to Mary and the USMLE and the Immaculate Conception!

Today I renew my total Consecration to Jesus through Mary! Says Pope Pius XII,

Consecration to the Mother of God is a total gift of self, for the whole of life and for all eternity; and a gift which is not a mere formality or sentimentality, but effectual, comprising the full intensity of the Christian life - Marian life. [This consecration] tends essentially to union with Jesus, under the guidance of Mary.

Today is also marked by the formal beginning of my preparation for Step 1 of the United States Medical Licensing Exam (USMLE). We now interrupt this announcement for a brief rant.

Medical testing is expensive. The USMLE has three "Steps." I will take Step 1 this June, I will take Step 2 after third year, and Step 3 in residency. And these are some pretty pricy steps to take. I am about to pay $560.00 to take Step 1, which is seven hours (excluding breaks) of multiple choice questions. Step 2 has a multiple-choice component (eight hours) called "Clinical Knowledge" (CK) and a clinical component (eight hours of seeing standardized patients) called "Clinical Skills" (CS). Step 2 CK costs another $560, and Step 2 CS costs $1200 and can only be taken in five locations nationwide.

I thought the MCAT was a big test, but looking back, the MCAT cost $270 and was only five hours long (excluding breaks). However, there will be no inorganic chemistry, plant biology, or irrelevant physics on the USMLE. So I am happy. End of rant.

Traditionally, Christmas break of the second year is the time to begin studying for Step 1. I am especially fond of doing things traditionally, plus we have a practice Step 1 next Thursday; therefore, today I will begin earnestly reviewing and practicing for the USMLE. Since the formal beginning of the preparation for Step 1 and the feast of the Immaculate Conception coincide, I am going to do something rather special.

---

I here consecrate all my studying for this largest test of my life to my Mother, Mary.

By this consecration I promise to become dependent on Mary in all my studies: to offer all my effort and time to God through Mary, and to seek every gift from God through Mary. 

And I do this with the greatest confidence. Since she is my mother, she knows my needs better than I; and since she is Queen of Heaven, she has immediate access to the infinite treasury of graces in the Kingdom of her Divine Son. 

I beseech her, with St. Joseph, my guardian angel and my patron saints, and all the host of heaven to intercede for me in this endeavor and in my perseverance in the imitation of our Lord Jesus unto my death. Amen.†

---

An exciting period of my life has begun! Happy feast day to everyone!

† I took some of the text from my little consecration of USMLE prep from here.

MedSFL: Pain.

I spoke with a recent acquaintance in the anatomy lab the other day. She is a secular humanist and recently attended a MedSFL event, where she very articulately questioned/opposed everything the speaker was saying. In lab, she told me frankly that she thinks everyone should have to bring in speakers on both sides of any "issue like that," to avoid misinformation and bias and to allow people to make their own decisions. She also spoke about how she was very upset about all the intolerance she saw in her classmates.

I was surprised that she could imply so bluntly that my event (a presentation by a pro-life doctor on abortion) was misinforming, since there was no one who held the contrary position. I was surprised that she could so unabashedly speak about intolerance. Because of my surprise, her words felt like a slap.

This isn't the first time I've been "slapped" in MedSFL. (For the record, I don't count angry emails from strangers as slaps, since they're much less in-your-face and they're to be expected.) A few months ago while I was planning the meeting the secular humanist attended, I contacted two women who I knew to be pro-life. They agreed to meet with me before the next event to talk about it. To my complete and sharp surprise, they sat me down and bluntly told me they both felt the same way: "Let's be clear: I don't do this pro-life action stuff." I am ready to attest that they had good intentions, but the approach left me seared and begging to ask them, "if you agree with me, why put me through such a wringer? Couldn't you just email back and say nicely, 'no, I can't help with the meeting, but I can come,' and leave it at that?"

At this point, I am really the only person in the group. The attitude of these two women, whose discernment I can admire, seems to be the attitude of others as well: "I already do other things. I don't want that label, 'pro-life.' It interferes with the way I live, the way I interact with others, and what I want to do (or think God wants me to do)."

Happily, one of the undergrads at this institution, a former officer in the undergrad pro-life group, is coming here next year and I can pass the torch to her. I'm so ready to be out of office...it's emotionally exhausting.

Penultimate Anatomy Lab and Human Dignity

It's been a long time since I've been in the anatomy lab for the peer teaching program I took up last year. (I was off by my request in September because I knew that Cardio was an intense block and that I had a big MedSFL event then; my October lab was cancelled due to a campus emergency/evacuation.) I went in last week for the dissection of the triangles of the neck (this is the front and sides of the neck). It was a remarkable experience for several reasons.

Reading the Catechism is awesome.

I signed up for flocknote's "Read the Catechism in a Year." We're now on day thirty-something and I am SO glad I signed up. At first, I expected that I would get behind and let the daily emails pile up in my inbox like all those 40 Days for Life messages and other action group mass-mails.

But happily, that hasn't happened. I've missed a day here or there, but it's simple to catch up and (honestly) it's really interesting reading. And it's going to get even better: I looked at the Table of Contents in the CCC I have on my phone, and this book has it all: the Trinity, angels, hell, morals, Mary, saints, apologetics.... I can't wait.

I had a few vague expectations when I signed up for this. Mostly, I thought, "I've always wanted to do this and it seems like something I should do." I had no idea how important a thing I was doing! Since I started reading the Catechism, I've realized at least two very important problems in my spiritual life.

Problem One: I think of the Holy Spirit more as a creature than as Creator. Somehow, in my imagination or thoughts, He is not as much God as the Father and the Son. Probably, this is a combination of several things, like:

1. His name is less concrete. In our materialist culture (which I can't escape), what is "spiritual" or not a human being isn't real.
2. He is always described last and often negatively or by exclusion.
3. He is pictured more often as not human. A dove is more like a symbol than a person.
4. My spirit-of-Vatican-II catechesis invoked Him so strangely that I've kept my distance since.

As a result, I think of the Holy Spirit as I do of grace (a creature), when in fact he is fully Divine.

Thank goodness I am reading the Catechism, which brought this mistake to light. I'm now working to erase this mistaken way of thinking by praying the Litany to the Holy Ghost (because I'm renewing my Total Consecration) and calling to mind his Divine power and personhood.

Problem Two: my faith is not very robust. I know it's not a sin to have difficulties, but about once a month I have a spasm of secular humanism that makes me think, "wait, Jesus is truly present in the Eucharist?" I wrangle with the thought, trying to bring out proofs and helps to bring my intellect back in line.

We had to take some online courses through the Institute of Healthcare Improvement open school (which, parenthetically, I highly recommend) and one of them was on workplace safety. A hospital/clinic that has a strong culture of safety, the module said, permits a janitor to say to the chief of surgery: "did you wash your hands?" Certainly, often the chief of surgery does the right thing and, in fact, does great things. But in a workplace that is really interested in the good of the patients allows the lowest, simplest person can say to the most senior and qualified, "don't forget the right thing."

Similarly, the highest powers in me (my intellect and will) often do right and great things, like studying theology, obeying my conscience, and loving others. But if I have a strong faith, then the "lowest" part of me (the little Catholic woman with her simple faith) can say to the highest (my intellect or will), "don't forget, God's existence is incontrovertible and He cannot lie."

I realized that my approach to the secular spasm is off: a woman of strong faith will simply say to those doubts, "Yes. Jesus is truly present in the Eucharist. There is no room for doubt." The Catechism helped me realize this by quoting Bl. John Newman's Apologia:

Ten thousand difficulties do not make one doubt.

So, if you haven't signed up for flocknote's "Read the Catechism in a Year" it is time. You can catch up with the past month or so here and sign up here.

Living with the Poor

At a recent Christian Medical Association meeting, the speaker spoke about how to help the poor who are close to us, which is a very very very important topic to me.

Speaking as a "mainstream" Christian (i.e. non-Catholic or Protestant), he noticed that most Christian doctors don't live in poor neighborhoods. He related results of informal poll he'd done: he'd asked his Christian colleagues why they lived like typical doctors, when Christ lived among the poor and preached poverty. His colleagues told him that they'd been encouraged by pastors to use their gifts and acquire wealth to glorify God.

I almost fell out of my chair when he said that. I cannot imagine a devout Catholic priest saying that to a Catholic physician. To be charitable, I know that many non-Catholic Christians are also shocked at this sentiment (why else could the CMA speaker make us aghast during that meeting?), but the Catholic Church seems particularly immune to it, especially in her saints.

Even the saints who are wealthy, and our contemporaries who are in typically wealthy orders like the Order of Malta or the Order of the Holy Sepulchre, place explicit emphasis on dispensing wealth for the sake of the Church and the poor. (On an unrelated note: I just discovered that there are five knights/dames of the Holy Sepulchre at the parish where I attend daily Mass. They came in all their regalia to a special Mass recently and I was so excited.)

The happy news is, I'm Catholic and there are many non-Catholic Christians who are like me at least in this: they want to imitate the Catholic saints (whether they know it or not) and serve the poor without concern for themselves.

Practical suggestions from that speaker included living among the poor (to find out where to move, visit the Oval Project). Since my third and fourth years will be located in a different and larger city (in fact, my home town), I mapped it out and am looking for places where there are short ovals.

Can't I just stay in here?

Marc Barnes has said that his general feeling of fighting the culture wars is a vague bleaugh....

Yesterday I went from bleaugh to WAAAHAAHAHAAA! and I guess I just talked with one too many firmly convinced, articulate, faith-and-reason-are-opposed and I-can't-force-my-beliefs-on-my-patients secular humanists.

I don't want to fight any more. Can't I just stay inside my safe place and pray and grow in holiness away from the war zone? Do I have to be a force for quiet conversion, a challenge to the dominant worldview, etc, etc?

Yeah, I know the answer seems obvious, but it sure seemed like a difficult question to answer yesterday. Pray for professional students.

First OSCE

Yesterday I had my first objective simulated clinical encounter (OSCE). This means I went to the simulation center (pretend clinic/hospital) that is built into our medical school and saw a simulated patient (a normal person who's trained to act in a certain way to make it seem like they're sick). It was really awesome, for lots of reasons.

First, a silly reason: I got to introduce myself as "student doctor so-and-so," and it was thrilling to hear myself say the word "doctor" before my name while introducing myself.

Second, I knocked on the door, interviewed someone, and then stepped out and charted on the encounter. In preceptorships, there's not much documentation that medical students to (at least, not in my experience). But here, I got to pretend that I alone was responsible for the medicolegal documentation of what that patient had and needed. Cool, eh?

Third, I got to use my (still embryonic) clinical acumen to decide which questions to ask the patient, and what parts of the physical exam I should do. Even though during my feedback session I discovered that I'd missed some things that were important, I still listed a good differential diagnosis.

The War of World-Views

Source

Last week I arrived early for Case-Based Learning so that I could sit in the empty seminar room and quietly study. I found a Muslim classmate already in the room, seated on the other side of the small table. I greeted her and we chatted briefly before we both resumed the never-ending task of studying. Before long, another classmate joined us. She is a "none," but very politically conservative. She is the prototypical virtuous pagan, so we agree on many things and I like her a lot. She sat down next to me amiably.

Shortly thereafter, a third classmate came in. He identifies himself as a Christian, but does not do anything that would give him that title. He is the prototypical post-Christian apathete. He sat on my other side, because we've been in a few classes together.

Somehow, the virtuous pagan and the apathetic post-Christian got into a discussion of what makes good movies good. She said that it was virtue in the characters; he said it was the CGI, the action, and the entertainment. It was an incredible conversation because it reflected two different world-views. I felt like I was watching Apathy and Virtue in a Greek play.

"300 was about truth, goodness, and beauty. It's even reflected in the lines...." Virtue insisted. She'd already made the point about Pride and Prejudice.

"Are you kidding? It was about a bunch of ripped guys goring each other with awesome CGI," Apathy said. While he didn't say exactly the same thing about Austen, it was close. Because Virtue is a very choleric person, the conversation escalated.

Apathy. Src

Virtue. Src

"Psh, there's no need to get upset," Apathy said with a superior tone and without raising his eyes from his computer screen (one of the large ones meant for gaming).

"I'm not upset," Virtue countered evenly but strongly. "I'm passionate. This is what passion looks like."

"Whatever." Then, after a pause:

"We can't be friends," Virtue said shortly to Apathy. "We're classmates, I'll be nice to you, but we can never be friends."

This knocked the wind out of me! A Catholic could never say that; although I might not like people, I can never move away from them, especially if they're in great need of the truth. Forgetting that she was not a Catholic, acting on the one-of-seven-children instinct, and victim of the I-am-trying-to-study-guys-please reflex, I said to Apathy:

"She's kidding."

"No," Virtue said to me firmly. "I'm not."

I became decidedly uncomfortable. Luckily, more classmates began to trickle in at this point, and the play was ended deus ex machina. 

The conversation has given me a lot of food for thought. Three of them:

1. Probably, I should hold my tongue next time two world-views clash. I'm less likely to be singed and I'll be more polite.
   
2. More seriously now: my classmates captured two world-views, both of them pagan. The post-Christian apathy is far from Christ's burning desire for the Baptism of the Cross. And the virtue of the pagan who desires excellence for her soul and the political sphere but cuts off those with wrong-headed ideas is far from Christ's love for us "while we are yet sinners."
   
3. How other-wordly and amazing true Charity is! By it, we love other souls like our own, so that our desire that they be saved is just like our own hunger for heaven. This is beyond Aristotle's highest form of friendship, and we are to have this for every human person, by the grace of God. I'd forgotten how unknown this is to the natural order. Wow!
   
4. It's interesting that the Catholic got involved in the pagan discussion and the Muslim did not. I don't want to read too much into this, because my Muslim classmate may not have known the other two well, or may have just been trying to study. But I have noticed that the desire to battle errors and fine-tune the truth is had to a unique degree in the Catholic Church. Glad I'm in it.

Quick notes

Blogging time has been restricted by time crunches, so I'm resorting a seven-quick-takes style today. I can't call it seven quick takes because I'm not sure there will be seven, and I cannot assign it a day of the week, either, since I've been meaning to type this post up for two and half weeks.

1

I am growing celery. It's fun to have a little greenery in the room.

2

After a certain event in September, I whined that I would never host another event again. This was ridiculous, as I was already planning to host a family practice doc to come and talk for MedSFL and two more CMA-SS meetings were on the books. The MedSFL event and one of the CMA-SS meetings are happening next week, on successive days. Oops!

3

I am shocked and slightly embarrassed at the hatred that radiates from people who disagree with me. Things I wish people knew:

1. Disagreement isn't the same as hatred.
2. Religious people can have intellects.
3. People who have not had the same life experience as you can have valid things to say.
4. Dialogue can focus on one issue at a time (restated: just because I hold one position that you disagree with, does not mean that I also hold another, or that want to talk about another).

4

Turning the other cheek and being polite is so hard. I want to be all things to all people, simultaneously never lying or withholding the truth out of fear. Someone liberal on Facebook can sling mud on Romney and say "I hate him," but I must only politely point out that Obama's policies aren't working, or draw attention to little-known facts like his support of inaction if a botched abortion results in a live fetus. 

Or, in comboxes: someone can lay a thick layer of Red Herrings, Ad Hominem, and Internet-Disinhibited Judgment on me, and I must truthfully and meekly answer for their good and the good of future readers. Humility in the face of misunderstanding; gentleness in the face of accusation; short replies in the face of diatribes. Basically: the second greatest commandment? Not cake.

5

I am in a group at the Catholic student center here called "Samuel Group," and it is put on by some religious sisters here and meant to teach youth, over day-long meetings throughought the academic year, how to discern. The requirements include monthly (or more frequent) spiritual direction, regular reception of the Sacraments, daily prayer, and restricted use of recreational television and internet.

We began with working to increase our trust of God, then looked over our life to find his providence in it (even those terrible, hard times that you never want to think about and think something must've gone horribly wrong with God's plan) and discover how we can magnify Him. Tomorrow is the third meeting and we will work on detachment.

6

The Respiratory block is over and we are now in the final block of the semester: Renal. This block is notoriously laborious because of all the physiology involved. Bring it.

Yesterday I learned how to intubate, put on casts (I casted someone in a short-arm cast for practice, and it looked like the one at right, although it had a final layer of deep blue, and I thought it looked amazing), take off casts (terrifying because you're sawing into someone's arm with the same kind of saw we used to cut bones in anatomy lab), do vascular and thyroid ultrasounds, and...

deliver a baby!!!

Although the "mother" and the "baby" were both mannequins, I thoroughly enjoyed it. In my small group of medical students learning together, I was the only one who had ever seen a vaginal birth, and the teaching resident had me explain what I thought of it for the other students. I told them that it was a surprise (there's a head coming out of where??) and a delight (this is a new person that no one's ever seen with their eyes!).

This is sort of what our L&D model ("Sim man") looks like. She breaths and pushes out the baby, who can present in any way. She also has a placenta, cotyledons of which can be "retained" so that you have to manually scrape them out. Our workshop only focused on normal deliveries, though. Source.

The Picture of Our Country

Our patroness is watchful even as we're razed nearly to the ground. 

Pray to maintain your hope, then pray for the nation.

Jesus, we trust in You!

Where I Belong (Praying for the Holy Souls, the Culture, and the Election!)

I've noticed a strong happiness and fulfillment, as if I'm in my proper place, whenever I'm...

...praying for the souls in Purgatory.

Yesterday I went to gain a plenary indulgence for the souls in purgatory, since we are in the Octave of All Saint's Day. As I walked among the headstones, I had the strong sense that each stood for one or two people and that I was really but imperceptibly walking among a crowd of my fellow men. (This sense gripped me especially as I passed the infant graves, where headstones were closely packed and one stood for a pair of twins. The dead are like the living: some are young, some are old.)

In truth, the souls do not ordinarily linger on earth and so cemeteries are not crowds of souls, but the mental image or perception swelled to tremendous strength for my benefit. I realized that the only difference between me and the dead is that my soul and body are together and the souls of the dead are gone either to their eternal place, or to Purgatory. Except for this accident, we are alike. 

Those souls still exist, and those in Purgatory were doubtlessly aware of me as I walked on earth in prayer for them. Praying for the souls is a great (some say the greatest) act of charity, since they are very (or most) helpless. I became acutely aware of this yesterday, as I realized that the crowd I was surrounded by was hungrier than any starving person, more captive than any earthly prisoner, and more desperate and naked than any poor person. They are so holy and close to God, yet cannot slake their thirst for Him yet!

This isn't to say that we should ignore the hungry, poor, imprisoned, and naked on earth. It is only to say: do not forget the Holy Souls, if for no other reasons than (1) that you are not so far from being dead, and (2) because their need is so desperate.

Today I went again. Please visit a cemetery today to pray for the dead.

...hacking at the root of the Culture of Death.

Coming back down to earth: the excitement of fighting the good fight is an enormous high. I'm up to my eyeballs in it, with CMA-SS, MedSFL, 40 Days for Life, NFP apologetics, and (most recently) starting a 1flesh chapter at the university associated with my med school.

I'm fighting a war on half a dozen fronts (you might say I'm completely surrounded). Because I have the Truth, who is on the Cross, it can be very motivating and also extremely discouraging. Sometimes I want to fight, and other times I can't bear the thought of it.

...praying for our nation.

It doesn't look good, the morning of election day.

Eight years ago, too young to vote, I watched an election map progress through the evening on my laptop, bargaining with God that if He let the incumbent win I would spend the rest of my life fighting the pro-life cause (sheepishly admitting that I would also do that if the other candidate won). Bush won.

Four years ago, I voted pro-life, but I watched in a hazy apathy as Obama was elected. I didn't think he would be able to do much damage. To be honest, I don't know the severity of the damage he has done, since I cannot find a source that simultaneously avoids demonizing him and avoids worshipping him. I do not doubt, however, that he is the most liberal president we have had and that he has done damage to the country, especially in areas of fiscal responsibility, international catastrophes, and social/sexual issues.

This year, I avoid both of those attitudes by trusting in Jesus, in whose goodness I am firmly confident. My prayer is that Mr. Romney will be elected because I perceive fewer souls will be placed in danger under his leadership. But I am aware that my King is Mercy and whatever we will undergo is not only "okay," but wonderful.

New Look because I'm Feverishly Procrastinating

I am desperately avoiding the impending doom of studying for my comprehensive Respiratory Block Exam. I have a take-home quiz to complete, plenty of First Aid practice questions to go through, and HOURS of lecture to review but I am choosing instead to twiddle the knobs on Blogger's template editor.

I like the new background image of vigil lamps hanging in the Church of the Holy Sepulchre in Old Jerusalem, taken by Guillaume Paumier. I found it while searching for the below image (a painting entitled The Vigil by John Pettie, better resolution here) which I love because it reminds me of Crusades and St. Joan of Arc and Adoration and surrender.

Look at the knight's expression, and how formally he holds and presents his sword! It's clear to me that he is vowing allegiance, or perhaps even exclusive love, to his Lord. And look how the artist hints at the monstrance, yet piously declines to depict the Host. Perhaps Pettie prefers to depict the majesty of the Eucharist by the grave, yet loving expression in the eyes of the knight...after all, this is often the way we experience the majesty of God: through the devotion and virtue of others.

Escaping the Culture: You Can't

That's funny; it's spelled just like "escape."

One talk at the CMA conference touched on something really important that I don't hear often enough in talk about the New Evangelization.

Mother Ann Marie Karlovic, O.P., of the Dominican Sisters of St. Cecilia in Nashville, TN, stood up to speak about "The New Commandment and the New Evangelization: Culture of Love - Culture of Life."

But she came to the podium and explained very simply that she felt prompted to scrap her prepared talk because it wasn't what was necessary. She said she hoped this was the Holy Spirit's idea.

At first excited by this development, I began to question her decision when she faltered a little in beginning anew. Was this the right choice? I stupidly thought to myself, forgetting all the advice to mind my business, trust in God, look for good in others, overlook apparent mistakes, and humbly look for benefit in all circumstances. I doodled in my notes, doubting the next hour would contain substance enough to fill all the lines.

My doubts came to a screeching halt shortly into the talk, because Mother Karlovic said something very important to the New Evangelization. "We need to ask," she said, "how has this culture affected me?"

Pause, and read that again.

We may think we are far away from this culture's influence; we may think we have a strong guard against its suggestions; we may think we have rooted it out of us with our dismissing bad habits and acquiring good ones. We are wrong. The culture is a complex animal and is not limited to new sins, new apathy, and old philosophical errors, from which we can be reasonably free.

We can't easily shed the way we think; however, this is part of our culture. I remember reading the early moderns at TAC and being embarrassed. Their works were easier to read than Arisotle's, even after correcting for language and temporal circumstances, simply because they and I tend to think alike about nature, man, and God, in an erroneous fashion hard to shed. Example: Descartes thought all science should be used for good. I immediately said, "yes!" before remembering that everyone from Aristotle to Pope Benedict XVI says "no" (knowledge is a good in its own right; this is a key truth important in  I hadn't realized how deeply I carried elements of our culture.

We can't easily shed the way we hope; however, this is also part of our culture. I tend to measure success in quantified productivity and progress, and my hopes are for success (e.g. more Planned Parenthood closures, fewer states capitulating on the definition of marriage, more young people becoming faithful, increased acceptance of NFP). Living a Catholic life and disassociating holiness from success has been a huge struggle. I hadn't realized how deeply I carried elements of our culture.

Have you realized how deeply you carry elements of our culture?

I still cook

...just not as often. In fact, my diet has really declined due to a combination of unplanned spending (various extracurriculars not delivering compensation as expected) and food prep time depletion.

However, during the weekend between the cardiovascular block and the respiratory block, I cooked up a storm. My roommates and I bought two pumpkins: one for carving, and one for cooking.

Carving a pumpkin is halfway between a workout and an arts and crafts session.
Notice the artistic use of the sharpie (upper right) and the athletic use of the knife (lower panel). 

The finished jack o'lantern. We put an apple cinnamon candle inside it and it smells amazing.

We roasted the smaller pumpking and pureed it to make pumpkin bread....

...and pumpkin yogurt...

... and pumpkin soup (sooooo tasty).

And, of course, there were pumpkin seeds aplenty.

Cool Stuff

Over my first preceptorship, I saw, heard, and felt a lot! This post has nothing to do with Catholicism, faith, holiness, dignity, or anything supernatural. It's just a list of amazing things the human body exhibits when something's wrong. If you're bored you should google some of these.

1. patient frustrated with the wait time (this is actually a not-so-amazing thing the human mind does when something's wrong...)
2. skin grafts
3. screws bulging under the skin of old internal fixations
4. inverted T wave on ECG (cardiac ischemia)
5. arcus
6. excessive bony transverse processes in cervical spine compressing nerve roots (shooting arm pain)
7. omega-3 FA deficiency
8. polycystic kidney disease
9. glossitis
10. puncture wound to foot
11. fibromyalgia
12. cherry angiomas
13. polypharmacy causing fatigue
14. sarcoidosis
15. Bell's palsy
16. possible new Ehlers-Danlos diagnosis?
17. diabetes mellitus (type II)
18. recurrent UTI
19. diabetic neuropathy: hyperesthesia in hands and feet, anesthesia in feet
20. pitting edema
21. enlarged tonsil (making the uvula deviate)
22. femoral bruits
23. hemiplegic migraine
24. mild clubbing

I also wrote my first two prescriptions! (I didn't sign them; that would be illegal...so maybe we should say they weren't my first two prescriptions. But the drug, dose, number, and sig were all in my handwriting!) Wow, what an experience.

Vibrant Catholic Culture in Exam Rooms is Awesome

Right now, my country is trying to shove my faith out of my work. How dare I bring my vibrant Catholic culture into the exam room? Recently, I was glad I dared to bring my vibrant Catholic culture in to see a patient.

I was working in the office of a Hindu physician, many of whose patients were from south/east Asia. I felt out of place until I saw a patient who was much like me: white, Christian, and Southern. She was applying for federal disability income and had a long story culminating in her current deep poverty. She cried as she said "I'm indigent," but dried her tears as she repeatedly professed faith in God's will for her.

If my preceptor had seen this patient, the patient would not have gotten so far as to mention God's will. Because my preceptor is adept at getting clinical information quickly, she probably would have listened to a few sentences of the patient's spiritual situation, would have nodded and produced a true but not supernatural platitude in a tone of voice implying closure, and asked another question about the patient's disability. Because I I know the truth of God's providence and the ultimate purpose of this life, I could nod with real understanding and begin to pray earnestly for this poor woman.

I love it when cultural competence, a humanities buzzword, actually refers to cultures to which I belong. In other words, I love it when cultural competence is something I already have, instead of something I woefully lack because I am not brown and, alas, something I will probably never acquire because I am not a liberal.

But this experience goes beyond, "I'm so glad I am a Christian and was there for a Christian patient."

Advice from a CMA NFP doc, or "Forward!"

As the CMA conference ended and I, with my rolled-up poster, went up the elevator to my hotel room I met an NFP-only family practice doctor who seemed interested in my work. (Yay!) He gave me his email; then, we spoke by phone. I forgot how awesome it is to get encouragement from mentors who really share one's ideals! The march toward being a doctor gets a little mindless at times.

His advice:

1. You're in a culture that doesn't appreciate the dignity of the person, the excellence of NFP, etc., and medicine is at the height of this lack of appreciation.
2. Keep the faith.
3. Stay confident; you know you're over the target when you're fired on. NFP is good medicine, especially long-term. It is medicine that conforms to the body's physiology and pathology.
4. Let the comments slide and pray for those who disagree or make life difficult.
5. Don't wear yourself out trying to convince people; just witness.
6. Meet people (patients and colleagues) where they're at. Listen (only when you listen, can you speak effectively) and they'll come back.
7. DON'T participate in things that your conscience is uneasy with.
1. If a patient comes in for birth control, you can still do the H&P. 
1. If she has a boyfriend, sit down and talk with her about her boyfriend. "What happens if you get pregnant?" you might ask. "Are you sure you want to have sex with a guy who won't stick around?" If nothing else, this is informed consent. It doesn't take much time, but it may help her begin deliberating early about these major choices.
2. If she is there because of a parent's wishes, ask her what she would like to do.
3. If she does decide she wants birth control, complete the H&P and in the oral presentation, simply state, "...and she is here for OCPs, but because of my faith I cannot provide that."
4. Or, in residency: "Okay, that's your choice; I am not able to help you with that, so I'll call in one of the other residents and she'll take care of you. I will always be here if you'd like to see me again."
2. During a C-section with BTL, assist with the section and state, "I'm happy to assist at surgery, but during the tubal ligation I'll back away from the table, staying sterile, until you're finished." If the attending makes it clear that they will therefore close alone, simply say, "Okay, thanks for letting me assist. I'll let you know how the baby's doing."
3. Go to the supervisor if an attending grades you badly because of this, stating, "I am willing to take a bad grade for something I did badly or didn't understand, but..." If the supervisor doesn't help, ADF will.

He also connected me with some awesome resources, including One More Soul, AAFCP, IIRRM, the Gianna Centers that St. Peter's in New Brunswick is hoping to place everywhere, and (of course) PPVI and FCCA. There are some names I should apparently know: Erik Odeblad, Kyle Beiter, Anne Notle (I've actually met her!), and Joseph Stanford. Joseph Stanford and IIRRM are doing a lot of research, notably on men's interest in NFP (93% was the number this doctor gave me, but I can't find the study), couple's month-by-month intentions (CEIBA), and effectiveness of miscarriage prevention and infertility treatment (iNEST).

If we start a crusade, we could wear
long, white, matching outfits and carry
pointy things. Oh wait, doctors do
that anyway.

He also said that obstetrics/gynecology has, more than any other specialty, fallen behind. Cardiology is talking about calcium channel blockers in heart disease, but no one in gynecology cares what kind of channels the cervix has (apparently, the cervix also has important calcium channels?). He urged me to think about family practice (which I have, and don't want to again), but then urged that if I was going to practice OB/GYN, that I not get rusty--that I keep up with endocrinology, general health, etc--and not be a referral machine. (This is exactly my hope! People don't want six doctors.) He explained that the reason OB/GYN is behind is that it's imbued with a culture of death, which is wringing out any faithfulness and religion, even when it is detrimental to patients. A stat he threw out: in the 1950s physicians had an 80% pregnancy rate in women with PCOS; now we're at 23% with IVF. Doesn't that just make you want to preach a Crusade?

The march toward being a doctor just got  invigorating again. Forward!

The Priest and the New Evangelization

Rev. John Bartunek's presentation entitled Making All Things New: The Priest in the New Evangelization was arguably the best talk at the conference. (So if you haven't bought any recordings yet, now is the time.)

The priesthood, Fr. Bartunek stated immediately, is for the Church and for others. Rather than give a theological exposition of the priesthood, he instead listed three demands being made on priests now, and ways laypeople can help meet those demands.

1. Priests will need to be ready for martyrdom.
   There were no analogies about "a kind of martyrdom." This is real death he's talking about. The springtime of the Church comes only after the planting of seeds, and the seed of the Church is the blood of the martyrs.
   
   Things laypeople should do: pray for priests.
   
   
2. Priests will need to work harder than ever. There are more souls in grave need than ever before due to increased population, decreased prevalence of Christiantiy, increased prevalence of ex-Christianity and new atheism, and new sorrows (abortion, drugs, porn). There are fewer priests in many places.
   
   Things laypeople should do: connect the spiritually and physically needy to the priests (keep the priests busy). Things like the Legion of Mary, Regnum Christi, and dozens of other lay movements are terrific at this. New media initiatives are also excellent.
   
   
3. Priests will need to renew their commitment to becoming experts in things of God. Priests should be examples of great holiness and they must be specialists in promoting the interior life or the encounter with God. They must pray, be men of God, and nourished by grace.
   
   Things laypeople should do: ask priests to do priestly things! It reminds them of their calling. Have a priest give a benediction to your group or bless your house/office/car/dog/wine (I'm serious)! Just like patients remind doctors of their vocation, laypeople remind priests. It's a brilliant setup.

The last one is my favorite, but I love it all. Bl. John Paul II said that the world looks to the priest in this time of turmoil. Let us look to the priest, strengthen him, and help others to find him, too!

The Call to Holiness = The Foundation for Catholic Health Care

St. Basil, one of the founders of the
Catholic hospital (a.k.a. one of the
founders of modern hospitals)

This was the title of the talk given by Fr. Joseph Johnson at the CMA conference last week (except he used a real predicate instead of an equals sign).

I completely agreed with his thesis before Fr. Johnson ever stepped behind the podium. Ever since reading How the Catholic Church Built Western Civilization and being floored repeatedly by the chapter on the Church and healthcare, I've agreed with this thesis.

Thomas E. Woods, author of the above, chronicles saints' work to build hospitals and fill them with the sick, especially the poor, the family-less, and the homeless. Importantly, Woods emphasizes that this work stemmed directly from the saints' understanding that their faith demanded it. Becoming holy required God-like deeds which (for a religion proclaiming a God who was Mercy itself and had exhibited that Mercy in countless healings and acts of supreme self-sacrifice) meant works of mercy.

(This makes me want to spiral off into a discussion of love, and how true Love is only had by mirroring Christ and anyone who agrees should readily understand the doctrine that there is not salvation outside the Church...but we'll stay on-topic.)

Medicine, Fr. Johnson said, is elevated from a career to a vocation because healthcare workers earn their daily bread by touching Christ in their patients and being Christ to their patients. Asked what the solution was to the healthcare crisis, Fr. Johnson simply said, "we need saints." We need people who will restore compassion to healthcare and repair the patient-doctor relationship to the Love with which it was inflamed in the first hospitals.

A Catholic doctor wishing to become such a saint seeks more than good bedside manner; he seeks a sincerity that stretches him and makes him more Christ-like.

Isn't it naive, an objector might ask, to approach the culture of death (so many problems!) with only these scant recommendations?

Hardly, Fr. Johnson retorts. The above is a full-bodied prescription for sainthood. Here are its ingredients:

1. Formation. Nemo dat qui non habet, and action follows contemplation just as it did for the saints Woods discussed. Prayer and study of Scripture and theology fill us and motivate us to love others and teach others. Without prayer and study, all our frenetic activity lacks meaning!
2. The Sacraments, especially the Eucharist and Confession.
3. Sacrifice, which allows us to learn to love as He loves.
4. Adherence. Never excuse yourself from this! This represents a change in the spiritual diet, but be a compliant patient of the Divine Physician. Remember that your patients need a doctor who is Christ-like.

A crucifix in Vilnius. (The triumph of love.)

Simple, but not easy. We need to learn to love better, or we need to learn to allow Christ to love for us. Luckily, medicine presents constant opportunities for the physician to increase in love, Fr. Johnson said. The need of others becomes an opportunity to serve Christ. In fact, some of those early hospitaller saints would call patients "my Lords, the sick and the poor." This reminds me of the additional Divine Praise that Missionaries of Charity say at Benediction: "Blessed be God in his most distressing disguise," meaning that each poor person they serve is God.

To become a saintly doctor, Fr. Johnson concludes, is exciting. It is to realize St. Teresa's poem; it is to become a lover, not a fixer (because Jesus is a lover, not a fixer); and it is to triumph, because we already know that Love has triumphed.

The Crisis of Modernity: The Past two Popes and the Church of the 21st Century

The first speaker of the CMA conference last week was George Weigel; this was probably vital since the conference had stolen its title right from Weigel's 1999 book A Witness to Hope: The Biography of Pope John Paul II.

Still being in student-mode, I took copious notes. Mr. Weigel, alluding to Alisdair MacIntyre, began by saying that our culture possesses the language of morality without theoretical or practical comprehension of what the language expresses. I vehemently agree! Post-Christian healthcare as it insists on human dignity and simultaneously affirms unbridled human autonomy doesn't realize what it's talking about.

To discover how we got into this situation, Weigel next reviews Marx, Bentham, and Hume: Marx, who thought that the good was some glorious society of men, the pinnacle of evolution; Bentham, that the good was the benefit to the greatest number; Hume, that morality could not be derived from reality. Granted, each of these develops into a different dystopia (for Marx, see 1984 or your history book; for Bentham, see Brave New World or the newspapers; for Hume, see both).

But all three had direct political and practical effects: morality, unrelated to reality, became arbitrarily or socially derived. Politics, unrelated to reason, became a business or utility. The purpose of life collapses into social or hedonist utility and the long-asked, bigger questions about beauty, goodness, and being become irrelevant.

Utility (not dignity) became the measure of a man's worth, because to dismiss these questions (as part of a dismissal of higher purpose, need for salvation, etc.) is to dismiss man's nature, designed to appreciate created and uncreated truth, goodness, beauty, and being. A dismissal of such a particular rational nature includes all that comes with it, including dignity, since man's nature alone (among material creatures) was made in the image of God.

This leads to "a pulverization of the fundamental uniqueness of each human person" (Henri de Lubac). Fortunately, the cure is well-known and easy, if long: we must daily confirm the richness of each person, founded on the Incarnation* and defended by true philosophy. Practically speaking:

1. By applying Christ, our Remedy, we can heal. Therefore, promote the Sacraments and Scripture and transform our lives to be Christ to others.
2. The culture is not neutral or permissive to passing on the faith. But don't just sit there pouting about it and feeling all righteous. Convert the culture, with a return to virtue ethics!

Long story short: great talk.

CMA Conference Debriefing

Cathedral of St. Paul, St. Paul, MN.

Last week I attended this year's annual CMA conference, held in St. Paul, Minnesota! It was a very good conference. At first, I was captivated by the excellent lectures by speakers such as George Weigel and Rev. Michael Keating. (Recordings available in the CMA online store.)

But soon, I was very surprised to realize that there was very little medical content in the talks. There were a dozen talks about philosophy, history, law, diabolical forces, vocations, the Vatican, politics, new media, the priesthood, personal holiness, and beauty. There were only three or four talks directly related to medicine: Rev. Robert Sirico of the Acton Institute lectured on allocating scarce resources; Dr. Lester Ruppersberger shared how he went from prescribing contraception to using NFP only; Dr. Wes Ely discussed end-of-life ethics; and Jere Palazzolo shared his work toward a stateside Casa Sollievo della Sufferenza.

I was also amazed by the number of people attending the conference (six hundred), which was much larger than the 2008 attendance. The medical student number had doubled or tripled.

Is this the same CMA?? I wondered. I liked that many of the talks in 2008 were medically-driven and given by physicians, and I'd been amazed and pleased that ethics was consistently dicussed about every medical question, not just the hot-button issues. (For instance, there was a talk on when plastic surgery is morally appropriate; the surgeon giving the presentation described how the body is an important part of us and can affect our esteem, health, and peace. Any surgery advancing could be defensible. He especially focused on rhinoplasties and breast reduction.) In addition, physicians were very thoughtful of their patients and of the human person. (Another example: there was a talk about sexuality in the older patient, and questions to ask to ensure that he or she was undergoing the aging changes well or needed help in this weighty area.) I spoke to several of this year's attendees who remarked that even last year's conference was more medical.

But after a little thought, I realized that this year's conference was very necessary, and very good. The explicit political-commercial healthcare crisis the Church in the U.S. is facing exposes the need to confront the culture more than ever and dramatizes our call to holiness. This might explain the high attendance and the shift in topics.

Imitation of the Pieta, Cathedral of St. Paul.

Like 2008, this year's conference didn't skimp on the perks: the Rosary was prayed each morning, Holy Mass (with bishops, ten priests, chanted introits, and an organ!!) followed, the Blessed Sacrament was continually available for veneration, confession was offered almost constantly, and the conference culminated in the White Mass held at St. Paul's beautiful Cathedral.

Like 2008, there were many religious there, including the Religious Sisters of Mercy and some Little Sisters of the Poor, both of whom I love.

Unlike in 2008, this conference was made an indulgenced act (there was an indulgence granted to all who attended and who met the qualifications to receive it)! The Church and her Master are so, so good! Imagine: I can gain a plenary indulgence for a soul by spending a day at a professional conference, receiving Our Lord, praying for his Vicar, and being free from sin. Talk about making ordinary acts holy....

I'd like to spend a few posts reflecting on the talks I think were the most content-rich, necessary, and effective. Until then: this has been your shameless plug for the CMA.

Songs for the Lost

We acts as we sing. Song is a sign of our internal loves, because song is a form of intimate communication. (Fascinating implications for our country, the Reformation, the Church, and pretty much anything else.) Song is imbued with emotion, and emotion can be fuel to whip up zeal, contain grace, and remember God.

Some time last week, I was facing a dark development in the life of a friend (which has disappeared and all is as it was). The friend seemed lost, off the path so far I could not reach him. Despair is easy to slip into in such times, although a Catholic has hope. I was so hope-emic, though, that I needed some IV hope. Enter, song.

Song of the Church who has reason for her hope in the Cross. Song, especially, of the Medieval Church.

Adam lay ybounden,
Bounden in a bond;
Four thousand winter,
Thought he not too long.

And all was for an apple,
An apple that he took.
As clerkes finden,
Written in their book.

Ne had the apple taken been,
The apple taken been,
Ne had never our ladie,
Abeen heav'ne queen.

Blessed be the time
That apple taken was,
Therefore we moun singen.
Deo gracias!

Hope trumps sin; Christ saves Adam. This song captures the true happiness amid suffering and courage amid darkness.

First afternoon in first preceptorship

My first afternoon in Dr. F's preceptorship gets mixed reviews. You may recall that it had a rocky start.

So, confession time: I really want to be a doctor. I want to put my stethoscope on people and ask them questions and think up some things that might be causing their problems! I want to get messy and make mistakes! My preceptor, Dr. F, has a different approach. She wants me to see a lot and transition slowly. So, I spent the bulk of my day shadowing, took one history, and performed zero physicals. That made me angry.

I admit, her approach may have been a result of the way I presented that one history. I know presentations are supposed to be brief recaps of longer interviews that a med student makes to a physician. This allows the physician to check the student's mental work: what did she think was important? What step did he take next? What is he thinking of for a differential diagnosis?

I boiled down the history too much, I'm afraid, and I left my preceptor with the idea that I hadn't taken a complete history. To my frustration, she did not ask me for more; instead, she went in and interviewed the patient again, obtaining the same set of details that I did and all the while interjecting meaningful injunctions to me about collecting details.

Ah, misunderstandings! How you art rife when there is a power disparity!

I hope next week is better.

Conflict Resolution: I...can't do it.

You might think that the oldest of seven children, a "talker" in TAC sections, and a leader in lots of student groups would have some conflict resolution skills. But in the past few weeks the need arose for conflict mediation with a superior (Dr. F) and I was completely ineffective.

Although Dr. F asked for my goals during the preceptorship and was no doubt trained by my course coordinators in what I could and should be doing, my afternoons with her did not resemble a preceptorship at all. 

We spent large chunks of time closeted in her office talking about spiritual things and her philosophy of medicine (very alternative). While spiritual things and alternative medicine are terrific, it grated on me to see time slip away when I knew that I should be seeing patients (or studying). Worse, the patient volume while I was there was very small--I only saw two patients this week, and that was representative of the past three sessions. Finally, I was not able to practice forming assessments and plans, since the patients I was seeing were being evaluated for federal disability and no treatment is ever given. Granted, she calls me in to show me pathology, like femoral bruits or xanthelasmas. But the primary purpose of the preceptorship is to hone H&P skills.

I tried several times to ask her whether I could see more patients. "I could go in and see this one while you see that one," I'd say, but she would gently coerce me to do what she wanted in an annoyingly nice way that she probably meant well. All of this made me really angry.

Upshot: I called the course coordinator and I'm being moved; I won't even talk to Dr. F again.

Ironically, we have a Professionalism class about "Communicating in Challenging Situations" on Monday. I was reading through the presentation just now, which articulated all the things that I experienced:

The Typical Physician [and, by extension, the med student] is...

• Compulsive [check]
• Perfectionist [check]
• Guilt prone [CHECK]
• Exaggerated sense of responsibility [check]
• Limited emotional expressiveness [check]
• Significant communication deficits [ouch]

Conflict arises when...

• Perception that another person is blocking our goals [exactly what happened]
• Another person is not acknowledging or understanding our beliefs or values [definitely contributed]
• Different expectations about roles, resources or outcomes [the root of the problem]

I wonder how a two-hour class hopes to teach us how to resolve such complicated problems. These are moments when I'm glad I went to TAC, where criticism of ideas happened daily and formal behavioral  feedback (don rags) happened twice a year.

I guess I'm no perfect communicator, but I trust that the rest of medical school and residency will shape me a lot.

YAY!

So, the meeting today with CMA-SS's advisors about whether we're going to become an actual chapter of the national CMA-SS was...a complete success!

The advisor who expressed doubt about the cost/benefit ratio of chapterhood spent 90% of his time talking about how we could raise funds to pay the dues. The other advisor did the same. It was great to sit down and talk about what the group can realistically be. (And what we can be is exciting!)

Aaand, that's all I have to say. Sorry for the measly blog post.

Fortnight of Frenzy?

If I survive the next two weeks, it will be a feat of incomparable scheduling gymnastics. Watch what's happening:

1. Sept 17: CMA meeting to decide if our local CMA-SS will be a chapter of the big CMA-SS (involves finances and money, etc yuck)
2. Sept 17-20: Lectures covered by Exam 2
3. Sept 20: MedSFL reception in Houston (I'm going for fundraising and networking) [too crazy]
4. Sept 21: Exam 2
5. Sept 24-27: Lectures covered by Exam 3
6. Sept 23: first (mandatory) meeting of bible study I signed up for
7. Sept 23: monthly Mass with CMA-SS members
8. Sept 25: MedSFL meeting at my school (big event I've been working on for about a year, or maybe since June 2011)
9. Sept 26-30: CMA Conference, at which I am presenting a poster. If it seems odd that I be in Minnesota at a conference and at home taking an exam, don't be confused, because...
10. Sept 25: I take Exam 3 early (four days after Exam 2)

In order to do this, I am studying Exam 3 material now. (It's awesome, it's all about cardiac conductivity; I just wish things were a little more spread out.) I'm grateful that I'm not in the anatomy lab, that I've been taught cardiac physiology at every level of my education since age 14, and that Our Lord is present in the Eucharist all the time, waiting for me to lay the head of my soul on his Heart when everything gets too hectic. 

Hopefully, this won't be a frenzied time, just a very, very busy one where I hang on to Christ's peace until the whirlwind is over.

Law, Tests, and Posters

After taking Spirituality in Medicine and Literature in Medicine, I jumped at the newly-opened chance to take something a little more hard-core: Law and Medicine. We're learning all about the role of the expert witness, which is how doctors (who aren't being sued) see the inside of courts most often.

Also, today I took the first Cardio exam! It went well.

Afterwards, I picked up the printed poster I created for the upcoming CMA conference! I am very excited. Here's the abstract that goes with the poster:

Repair of Fallopian tubes (tuboplasty) was the standard of care for tubal disease before the advent of artificial reproductive techniques like in vitro fertilization (IVF). Tuboplasty is a morally acceptable treatment for women with tubal factor infertility. 

The recession and the upcoming compensation changes in the Patient Protection and Affordable Care Act provide stimuli for mainstream medicine to prioritize what Catholic gynecologists know to be the ethically superior treatment. This year, the Practice Committee of the American Society for Reproductive Medicine (ASRM) edited their Opinion on tubal surgery: where they had recommended IVF as the preferred treatment option for any woman with tubal disease, they now recommend tubal recanalization techniques for treatment of several tubal disorders in young women with no other significant infertility factors. 

This presentation aims to review the research prompting the ASRM’s shift and the potential corresponding shift in medical practice. Surgical techniques reviewed include falloposcopy with a linear everting catheter, guidewire cannulation, coaxial cannulation, falloposcopic catheterization, selective salpingography, fluoroscopy, and hydrotubation. The best of these techniques have success rates similar to those of IVF and should be preferred for medical and economical reasons, if not moral ones. 

In conclusion, there are manifold opportunities to increase availability of IVF alternatives in mainstream gynecology, especially to young women who suffer from tubal factor infertility. At the same time, gynecologists have a chance to popularize ethically superior alternative treatments and raise discussions among their colleagues about other morally excellent practices.

(Like NFP.)

Struck by Dignity

Another opportunity to think on my feet: I was told to see a returning patient who was following up on pain problem.

The patient told me about her pain and that she figured out what started it all: holding the phone with her head for hours while working around the house. At that time, a new relationship was beginning for her, and she would spend a lot of time on the phone. After a few more minutes of history, I asked her conversationally about that relationship.

She told me it was great! They were finding so much in common and it was a great source of enrichment and joy for her. I could see that it lit up her face. Then, between sentences about how the relationship was flourishing she said, "now, I won't lie to you, it's not a man--it's another woman, and..."

I stopped hearing her for a few words, feeling as though I had been struck. Everything was so normal until that sentence. Now what do I do? Instantly I began to determine how I should receive this news: it is clear that this relationship is more than friendship and I know that homosexual acts are naturally disordered and spiritually harmful. But I am not this woman's doctor and am, in fact, a stranger and a medical student visiting the office for education. But will I give scandal if I calmly smile and nod? I am wearing a crucifix and am therefore a representative of Christ for this woman, who is surely observant enough to notice my necklace.

The patient was concluding, saying that she felt valued in her relationship. I decide to say true things but withhold the truth that is inappropriate to provide. "I am so glad that someone can make you feel the dignity you have as a person, can appreciate your worth," I said.

Her response was almost as shocking to me as the original admission. She was delighted! She said, "that's exactly it," and that I completely understood. She went on about her partner while I went off into thought. Untangling my thoughts later, I wondered:

1. This woman only found appreciation of her transcendental value in this relationship. This is terribly sad: everyone can appreciate everyone's human dignity...we don't need intimate relationships for this (although I'm sure this love is crowned with greater intimacy).
2. Is hunger for this appreciation fueling homosexual intimate relationships and the gay marriage drive? 
3. If there someone else made this woman appreciate her human dignity, her , would she ever want a homosexual relationship?
4. This woman is missing out on a unique element of marriage: self gift as a woman, to a man. There is so much more to marriage than simple (though profound) appreciation of human dignity.

The patient later told my preceptor that I was "an excellent human being" (I guess, the highest praise of the secular world?). I think I was at least excellent in one thing: I saw what she loved about being loved.

The Preceptorship Diaries

During second year, medical students at my school are placed one afternoon each week in a physician's office to learn to take histories, perform physical exams, create assessments and plans, and document their work at a tempo that resembles real life. (This replaces the lovely take-your-time atmosphere of the simulation center.) I became really excited: finally, a chance to play doctor at a real pace!

I knew that my preceptor, Dr. F, was an internal medicine physician. Further, I'd heard that she gave an informal talk on superfoods and was going to come talk to the Holistic Medical Society (which is actually a cool group, when it avoids the hippie commune end of the spectrum and adheres to good practice using all available wholesome methods). Her name was Indian.

Her office was adjacent to an acupuncturist's (later she told me that she was also certified in acupuncture). I entered and was asked to wait in the waiting room while she got off the phone. This was unusual for a medical student (usually, I'm told to come right back), but I sat among the patients and quietly waited the short time until I was called back. I noticed that this office, like Dr. D's, attracted people like the doctor: Dr. F's staff and clientele were more brown than, say, Dr. C's or Dr. A's.

When I was called back, Dr. F greeted me warmly and sat me down in her little office. She asked me what my goals were for this preceptorship, for which I was grateful. Next, she discovered that I studied philosophy and theology, and asked me for a favorite scripture. I mentioned the Song of Songs, and recited the verse that appears when my alarm goes off in the morning ("Arise, my beloved, my beautiful one, and come!"). She was charmed, and hinted that she might look up the book on Google.

While I was describing TAC, she learned that I was Catholic. She asked me, "what do you think of diversity?"

I answered honestly, if in an abbreviated fashion. "It's beautiful," I said. "I haven't always spent time in the most diverse environments" (TAC had one black student?) "but I realize that people's different experiences and cultures are enriching." This was true, and largely the product of my summer with Dr. D. I left other thoughts about diversity unstated: its ascent to a replacement for true exchange of ideas in this culture is strange at best, and relativist at worst.

Dr. F smiled slightly, but then looked at me squarely. "I meant difference in religion," she said.

For an instant, I was at a loss. I gathered that Dr. F was something of a pancretist: she had a large carving of a Native American medicine man on driftwood in her office, she wore a tiny rhinestone angel pin, she had a calendar displaying a Hindu god, she promised to look up the Song of Songs, and she was asking me this question.

I could not lie. "While I believe that my faith is the truth, I cannot and will not treat others without the dignity they have as human persons."

Boy, that was hard to say! A little wall went up in her eyes after the first clause, and her next sentence started in a tone most professors reserve for the correction of a wrong thought. ("Well, hypertension is associated with atherosclerosis, but this question is actually asking something else....") I'm not sure whether this preceptorship will go as swimmingly as I'd hoped. Time will tell.