"So, what brings you in to the doctor today?"

I recently had to write a paper on the theories and models of the doctor-patient relationship. There is the paternalistic model, in which the doctor knows best and tells with patient what is wrong and dictates the care plan. There is the engineering model, in which the doctor gives the patient the facts and allows the patient to decide their own health plan. Then their is the collegial model, which emphasizes the need for relationship between the doctor and patient. It states that the doctors role is to listen, ask questions, advice the patient based on medical fact but the ultimate care plan is to be shaped by both the patient and the doctor, so that it takes into consideration the patient as a whole person, not just an isolated illness.

These all have different pros and cons, and (in my very limited experience) it really depends on the patient. In general, you (are supposed to) start with the collegial model, and adjust if you have to. The paper led me to think about the general role or job definition that physicians have. Although the obvious answer might seem to be, "heal people/improve their health," I'm learning how debated that answer is in the medical community, both in what it means and in its legitimacy as an answer to the question. A lot of the debate ends up centered around the doctor-patient relationship, and how the doctor is supposed to view the patient.

If the doctor views the patient primarily as a disease or illness, rather then a person, then the goal is simple: fix it. It might sound kind of harsh to say that these kinds of doctors don't see patients as real people, but as something to be cured, but they also get a lot more done. They see more patients a day (ie. they technically have more chances to heal), and the patient generally always receives the best care in the medical/scientific sense. Some patients seem to want this in their doctor, others don't.

If the doctor views the patient as a friend, or younger sibling, they might be really great at hearing the whole story behind the illness or injury, getting all the social/psych/family background, sympathizing or empathizing well, and maybe even sharing a personal fact about themselves. But after all of that, a lot of time has been spent and nothing has been done about the acutely medical need. Yet, a great relationship has been built, trust built, and whatever advice the doctor does give might be carried out more effectively by the patient because of that relationship. Again, pros and cons. Some patients think this is just a waste of time, others need it before they can trust the doctor.

I'm going through the gospels as my Advent reading, and its making me wonder: how would I classify Jesus' doctor-patient relationship. Sure, it gets more complicated because, well, He's the Son of God and knows people lots more intimately then I will ever know my patients. So maybe the question is more: what kind of doctor-patient relationship does Jesus teach others to have (noting the difference between following/imitating Jesus, and actually being Jesus)?

I'll let ya know what I think after I read a little more. After all, its only the second day of Advent :)

Built to Last

I am in the midst of studying for my anatomy exams, so this is just a quick thought.

When I buy something, say, a piece of furniture, or electric appliance, or article of clothing, I always hear my mom's voice in the back of my head, "you get what you pay for." And behind that little saying is the implication that things don't last forever. Applicances break, furniture gets shabby, and clothing wears thin. Sure, we can take good care of our belongings and they last longer, but very rarely do we buy something with the intention of keeping it in tact and working for the rest of our life.

As I've studied anatomy, one thing I have found so amazing about the body is that it is really built to last. Of course, we age, things go wrong, and we die, so still the physical body has its limits. (and yes, it really matters that the physical body as we know it on earth has limits, but that is a whole different topic) But in comparison to the vast majority of possessions we have, the body really is built to last a long time. What else do we use every day with so much stress that lasts for so long? It is amazing to take apart the body and see all of the tiny ligaments, tendons, joints, and muscles that hold us together. Every movement our body makes, from a long run to the slightest twitch in our sleep, relies on the fact that all these body parts are put together properly, and are doing what they are supposed to do. Individually, each of these parts are so delicate and vulnerable. I can squeeze two vertebrae in my hand with enough force to cause life-long pain in a person, but when they are inserted into the vertebral column, with all of its protections and connections, they are one of the sturdiest parts of our skeletal system. And aside from surgery, we don't really revamp our body the way we would refurbish a computer or load batteries into a flashlight. It comes with the machinery to do that itself.

Pretty cool :)

Leaf Blowers: a lot of hot air

Leaf blowers. There are probably a very select few situations in which they are appropriately used. Mostly I think they serve no real purpose and just contribute to pollution, but I suppose if you had a really really large quantity of leaves in some area, they could blow the leaves together into a pile for you to rake up more easily.

Needless to say, this is not the way leaf blowers are used typically. Every morning on the walk to school there are several men blowing leaves off of the sidewalk and into the street. Over the course of the day, the cars on the street push them back onto the sidewalk, or the staff of other businesses in the area have to deal with them (often just by blowing them back).

Perhaps you know where I’m going with this…

Why should the leaf blowers care where the leaves go, as long as they aren’t on the property that pays them to get rid of the leaves? They did they job they are paid to do. Should anything else be required? A question that at some point that all individuals and groups have to ask: Why should I/we care about anyone or anything that is not directly related to me/us? (if there is such a thing...)

The leaf blower example is over simplified, but I think it goes a long way. Not caring about what happens to the leaves, as long as it isn’t your problem, is inefficient. It gives you more work (ie. you’re not really getting rid of the problem), it diminishes the value of your work, and it creates unnecessary work for other people. I wonder how often we function like this in day to day work: simply through the routine of the work, not stopping to think about its effects. There’s more to be said about why it is important for a society to feel that the work they do has value, but for now I’ll just say that even if there is no emotional or justice-related concern for what happens to those leaves or if they actually get taken care of, it is still advantageous on a personally economic (and psychological) level to care about it.

It’s one thing to spend extra time raking up leaves, but as soon as the analogy gets extended to apply to national, international (and actually even familial) policy and practice, the situation becomes more complicated. I think this is partially due to the fact that it is harder to see and feel the personal gain that comes out of caring more deeply about the welfare of others or the quality of a particular job and how it is connected to the welfare of others.

I think that scripture affirms the notion that “your welfare is found in the welfare of others,” both in Jeremiah 29, but also more widely as a general theme. (I’m going to pull a Laura and choose not to exegete that right now). I will say though that it is a pretty dramatic command to find find one's welfare in the welfare of others while you are in exile, which was the case in Jeremiah. My own opinions on how much that philosophy of welfare, in addition to the general idea of grace, should shape and influence government and policy are in constant transition. Even if I come up with an opinion, it’s hard for me to know where to begin in terms of application. In many ways, I think addressing the topic on the level of leaf blowers is more practical, and just as biblical. At least that is how my brain is wired. Where are some practical places that small adjustments in policy and practice can be rethought to improve the value of work and move towards an economy that recognizes our interrelated welfare?

*not trying to attack the guys who blow leaves, just using them as an example.

Genomics and Immortality

Jonathan asked me the other day if I thought we could get to a point in medicine when we could make people immortal, or cure them of all disease, or at least extend life by another hundred years or so. At first I quickly dismissed those as possibilities, at least for the general population. Well, I have been in my genetics and genomics unit for the last week and now I am not so sure.

A lot of people in medicine right now are really pushing the idea of personalized care, meaning that we can sequence everyone’s DNA genome and therefore know exactly what disease they have, what kind of medication would work best, in what amount, and what kind of effect it will have. There are some great benefits to this! It means that we could know if a child has the genes for a disease that will develop later in life that could be prevented or at least lessened. It means that medication could be given effectively (a surprisingly large number of people die or are made worse due to medication complications) because doctors would know exactly how much they need, of what, and how their body will react. Treatment like this would significantly decrease a lot of health care costs, number of unneeded tests and medications, and would decrease time spent figuring out what is wrong and how to fix it.

There are also some potential drawbacks, or at least strong ethical concerns. Parents could know the exact genetics of their child while it is still in the womb, and could choose to abort if they don’t like what the genome shows. With gene therapy, parents could “fix” the genes of their in-womb child. Individuals could do that for themselves as well, though to a slightly less degree given our current technology. People could request to see the genomes of their girlfriend or boyfriend before deciding to marry and have kids. Sites like match.com could start to include a section for “genetic profile.” Ok, so that is a light-hearted example, but the point is that people who have some hidden genetic mutations, or just not “ideal genes” could be intentionally selected out of the mating pool. Here are some questions this raises for me:

-who would have access to the genomic info of another person?

-what effect would this have on insurance, if a genome showed that a person was predicted to get, or at high risk for a particular disease?

-what would the psychological impact be on society if people were able to know all of their different genetic mutations?

-what effects would this have on procreation, choosing spouses, and abortion?

-would we turn into a standardized society with a definition of “ideal” or “perfect” genes that people will preferentially select for? (ironically, diversity in the gene pool is actually considered a sign of a “healthy” population that is of low risk to severe mutation, but even that would change if you could control or fix mutations)

Right now these techniques are too expensive for the average person, but that is predicted to change over the next 10-20 years, so getting your genome sequenced could be as routine as getting your basic childhood vaccines. So this isn’t as far-fetched and distant as I initially thought.

So to return back to Jonathan’s initial questions, having your genetic sequence and using gene therapy wouldn’t definitively cure a person of all disease, but it has potential to cure a lot of the deadly illnesses.

Suddenly, an important question arrises: Is mortality an illness? If the role of scientists and doctors is to heal and cure the sick, and if we generally say that saving someone’s life is the goal of a medical procedure, then it seems to follow that trying to extend peoples’ life would be a good goal (I don’t mean just keeping old people alive forever in a state of sickness). That has certainly been the trajectory of medicine so far. One of the key methods of analyzing health of a country is to look at the average life span, and almost all countries have increased their avg. length of life over the last 100 years. But what if we have the technology to make people double their life span? No, that isn’t immortality, but it would have HUGE consequences on daily life and the core philosophy of life as we know it.

For me, this brings up the core question of what the goal of medicine and scientific research is. I think that technology has many great benefits, and I think that healing people is a good and valid life profession (or it would be hard to be in med school). I think that giving people the physical experience of going from sickness to wellness is a way of helping people experience the gospel, and a God who is all about giving health to the sick in the most holistic and eternal way possible. But I internally squirm when I think of us being immortal, or even living two or three times as long, here on Earth because of our advanced technology. I do think we are meant for eternal life. But isn't there a difference between the eternal life with God that scripture talks about and eternal life that we could give ourselves? How much does God inform and move forward our technological advances? How can we tell? The goal of life and health is similar to God and scientists/doctors, but do they move towards them in the same ways? Does God use doctors and scientists to do this? Are we even able to comprehend what God means when he talks about eternal life and health, or are our thoughts and definitions too feeble and small to really have any idea what He intends for us?

Questions that I do not have answers to, but that I think will persist thoughout med school.

"So, what brings you to the doctor today?"

I recently had to write a paper on the theories and models of the doctor-patient relationship. There is the paternalistic model, in which the doctor knows best and tells with patient what is wrong and dictates the care plan. There is the engineering model, in which the doctor gives the patient the facts and allows the patient to decide their own health plan. Then their is the collegial model, which emphasizes the need for relationship between the doctor and patient. It states that the doctors role is to listen, ask questions, advice the patient based on medical fact but all the ultimate care plan to be shaped by both the patient and the doctor, so that it takes into consideration the patient as a whole person, not just an isolated illness.

These all have different pros and cons, and (in my very limited experience) it really depends on the patient. In general, you (are supposed to) start with the collegial model, and adjust if you have to. The paper led me to think the general role or job definition that physicians have. Although the obvious answer might seem to be, "heal people/improve their health," I'm learning how debated that answer is in the medical community, both in what it means in its legitimacy as an answer to the question. A lot of the debate ends up centered around the doctor-patient relationship, and how the doctor is supposed to view the patient.

If the doctor views the patient primarily as a disease or illness, rather then a person, then the goal is simple: fix it. It might sound kind of harsh to say that these kinds of doctors don't see patients as real people, but as something to be cured, but they also get a lot more done. They see more patients a day (ie. they technically have more chances to heal), and the patient generally always receives the best care in the medical/scientific sense. Some patients seem to want this in their doctor, others don't.

If the doctor views the patient as a friend, or younger sibling, they might be really great at hearing the whole story behind the illness or injury, getting all the social/psych/family background, sympathizing or empathizing well, and maybe even sharing a personal fact about themselves. But after all of that, a lot of time has been spent and nothing has been done about the acutely medical need. Yet, a great relationship has been built, trust built, and whatever advice the doctor does give might be carried out more effectively by the patient because of that relationship. Again, pros and cons. Some patients think this is just a waste of time, others need it before they can trust the doctor.

I'm going through the gospels as my Advent reading, and its making me wonder: how would I classify Jesus' doctor-patient relationship. Sure, it gets more complicated because, well, He's the Son of God and knows people lots more intimately then I will ever know my patients. So maybe the question is more: what kind of doctor-patient relationship does Jesus teach others to have (noting the difference between following/imitating Jesus, and actually being Jesus)?

I'll let ya know what I think after I read a little more. After all, its only the second day of Advent :)

Stolen Bikes and Starbucks Seats

For the last three months, every morning on the way to school I would pass Jeffrey, who would sit outside Starbucks asking for money. After the first week, he stopped asking me for money and would just say hello, ask how I was doing, and we would chat for a few minutes. It was a small thing, but I enjoyed the regularity of seeing him every morning (although ideally he wouldn't have to beg outside starbucks). In the afternoon when I passed by, he would ask, "so what did ya learn today?" and I gave him some medical fact before going on.

As of last week, I don't see Jeffrey anymore. Starbucks put up a rail about 7 feet off the side of the building and put inside of it some more permanent tables and chairs. It looks nice. It keeps the street litter from coming in and allows people to sit and drink coffee without beeing bumped into by folks on the side walk. But it also means that Jeffrey can't sit there anymore, at least not without buying something first. Earlier today I saw him a few blocks away by CVS and said hello. He said he doesn't like sitting outside CVS as much. "The people aren't as friendly," he said. "I think coffee makes people happier, they give a little more money."

The scenario is a small picture of a much larger issue. Starbucks does something to make their store a little nicer, not in itself a bad thing at all, but it displaces Jeffrey. The same thing happens on a bigger scale when new stores and houses are built in lower class renting neighborhoods where rent prices fluxuate. What makes me frustrated is that there shouldn't be anything wrong with making a nicer store front, fixing up houses, and improving the neighborhood. These are beneficial things that don't end up benifiting the people in the neighborhood. How did the system come to be like this?!

On a related but different note, last friday a bunch of bikes were stolen from outside my apartment building. Mine had already been stolen earlier in summer. A women saw the guys doing it, yelled and said she was going to call the cops. The cops came later and asked some questions, but let's be honest...DC police have better things to do with their time then chase down bike theives. Since I live in a newly renevated building, all of the people have just recently moved into the area. As I read the responses to the bike theft (and attempted break in earlier last week) on our building listserve, I was so frustrated. These events confirm their prejudices and stereotypes and I wanted people to love the neighborhood.

It is absolutely true that stealing and breaking in are wrong. It is legitimate to feel anger and hurt in response. And if we were to look at it on the flip side, there are negative effects for our neighbors due to the fact that our building was redone, new people moved in, and it has made the block "nicer." Their feelings of powerlessness and "being moved in on" are just as legitimate (though harder to quantify).

When I think about what God's goodness looks like, I see something that doesn't discriminate. It isn't good for one person and not another. It is good, all the time and to everyone (though maybe not always felt as such). But we don't see that played out in life on earth very often. What is good for my apartment building and for starbucks was not good for the neighborhood and for Jeffrey. And what Jeffrey and the neighborhood might define as good may not feel that way to others. But God's creation was a creation of goodness. Tov! It's tov, very tov! And it's our hope that it will once again be (and is on its way to becoming) even more good. That isn't a goodness that is easy for us to see, or understand, or even to have the faith to hope for. But I think I'm learning that solid faith in God's goodness actually changes the present reality (not just my perception of it in some spiritual sense) into something that is in fact closer to the goodness of God, because it changes what I do, see, say, think, and understand. And our faith and hope in promised goodness is legitmate because "he who promised is faithful." (Heb 10:23)

Ambulence Sirens

I live a little under a mile away from Howard University Hospital. One of the things this particular hospital is known for is its excellent trauma department. I hear ambulances with blaring sirens going down the main street near my apartment all the time. At least one per hour, I would estimate, and sometimes more depending on the day and time.

I had an exam this morning, which meant that the last few days were consumed with studying. Since I have been studying mostly in my apartment, I hear these ambulances quite frequently. Hearing them while studying to become a doctor is an excellent characterization of some of my current frustration with being a student again. There I am, slaving away memorizing which enzymes cleave which parts of DNA, when, how, and what the significance is, and out there is all the action: real doctors with real patients.

Of course I am glad that those real doctors went to med school and learned their stuff, and that this is simply the stage of life I am in right now. I am generally someone who really enjoys school. I enjoy learning, and sometimes studying, and I am able to make the connection between working responsibly as a student in a subject area I love and worshipping God. God's given me a mind that can think and learn in a paticular way, and a desire to learn a particular set of material. Ignoring or not using that gift is not glorifying to Him, and I believe that God delights when we live and move and have our being in accordance with the way He made us, rather than trying to invent false selves.

But sitting there studying, even though I can feel connected to God in doing so, still leaves me longing to be out in the "real action." It isn't because the studying is boring, or because I don't understand its importance. Even Israel had to go through massive training in the "wilderness school" before being ready to live in the promised land. Yet, it is easy to disconnect time spent studying or "in training" from God's greater purpose. But the second they are disconnected, the preparation looses its purpose and despair ensues. Israel had to continually be reminded about who God is and what He promised not only because they were forgetful and it is important to not forget about God, but because their life situation wouldn't have made any sense outside of that context. They had to intepert the present through God's work in the past (creator and liberator), and through His promise for the future. Without the past there would have been no trust or sense of identity, and without the future there would have been no hope. And yet trust, identity, and hope are to be used in the present.

So in some ways, the amublance sirens are helpful in reminding me about the future (not that I want to be a trauma surgeon...). They also have the temptation of allowing me to think that for now my job is to study and that one day my job will be to heal people, when in fact we are created to preserve life, or "be salt," at all times, not just after going through the proper training.

Bright Lights

In an effort to focus on the blessings I have/am being given, and to remember how God defines himself for us as being always enough, here are some "bright lights" from daily life in DC. (this is in opposition to the moping around that I've been doing recently)

Sunrise at 6:08 am. True, it is early. But I enjoy my morning time of drinking coffee, reading some Words, and getting ready to face the day. Leaving the apartment at 7:20am. The morning air is a little cooler and people are starting to get up and move about. And, His mercies are new EVERY morning!

Georgia Ave. The street I walk down to Howard. Even though I dislike the frequent cat-calls, I do like that I am starting to recognize the different people I see every morning. I'm friends with the guys who sit outside Starbucks in the morning asking for money. Every morning Jeffrey asks, "how's it going Stefanie?" Every afternoon, "so, what did you learn today?" And I tell him a fact I learned during the day.

One of the schools I pass on the way to the grocery store. The little kids are always out in the afternoon playing soccer or football and they are sooo cute!
This is probably my favorite part of the neighborhood. It is a mural that lasts almost the length of the block and is entitled: wholistic peace. It was sponsered by the DC community economic development group. A group of youth worked on it all summer and it was awesome to see them put so much effort into it and see people stop by and ask about it and encourage them.

Some other bright spots that I don't have picture of...

Even though I've only been here 2 months, I have gotten to spend time with a lot of friends!

-Laura (my peton!) drove through and we had an excellent time at IHOP and driving.

-Margaret came for a few hours and we had some great chat time at the Potter's House.

-Lindsey came by on her way to a conference and we also had great chat time.

-Rachel Han came over for dinner while she was here with her family on vacation. Catching up was so gooood!

-Sarah Stew is now living nearby and working nearby and we had dinner and decided we should be friends :)

-And tomorrow I'm having dinner with Janice and a friend of hers.

All in all, I'm really not as alone as I have allowed myself to feel.

"Have I not commanded you? Be strong and courageous. Do not be frightened, and do not be dismayed, for the LORD your God is with you wherever you go." Joshua 1:9

Nutrition through the lens of the Gospel

A wise person once told me that all things can be done and seen through the lens of the Gospel, but it is the things that you, in particular, are able to see do through that lens that show you what God has built you to work and care for in a unique way. One day our eyes wil be fully opened, but for now, we have to pay attention to where we are given the most sight.

Learning and thinking more about nutrition while in med school has been a process that was much more clearly linked to the Gospel (creation, fall, and recreation) then other subjects I’ve studied, though really they could all be linked in such a way.

Here are some threads of one train of thought…

There are many decisions that people think pretty intentionally about. For many, choosing a doctor or dentist or babysitter or school for their children recieves many hours of research, consulting among friends and co-workers about the best options, and even going to try it out before committing. For some, this process is just as involved when choosing a gym, or neighborhood to live in, or place to worship. (on a side note, one way that I would assert the existence of oppression would be the situation when one group of people has many good options when faced with these choices verses a group that has perhaps the same number of options total, but has significanly fewer good ones, hindering the ease and probability of making a choice that will be of greatest benefit).

All of these choices have significant daily consequences on a person’s well-being. To take it to a slightly more detailed level, people make intentional choices about what kind of company they keep, who they date, what media they engage with, what they read, and what kinds of medications they take.

To go with the medication example…when the doctor prescribes a medication, the process is actually pretty involved. First of all, you went to the doctor, so you are getting a professional opinion. Second, the doctor has other people she/he consults with (pharmasist, collegues, and you) to determine a good course of treatment. Then he/she is supposed to teach the patient about the medication- how to take it; when; how much; with what kinds of food; possible side effects…etc. Even for just over the counter tylenol, people read the back labels to know how much to take depending on age/weight, and how often, and what exactlythe effects might be.

Choosing a diet (I don’t mean a weight-loss plan; I mean choosing how we interact with food) should not be any different. On a biochemical level, the food we eat is like medication. It effects every single one of our body functions down to the very ability for us to be alive, and places us on a gradient between life and death. It effects our emotions, physical state, mental state, and spiritual state. (not sure about that? Try fasting. Or try eating a bag of jelly beans all at once). Never would we go the pharmacy shelf in CVS and grab any old medication and take it without considering if it was actually relevent for our illness and what its side effects and dosages are. But we do exactly this with food. I’m not suggesting we become obsessive about every thing we eat. I find it sad, however, that proper nutrition is the easiest and cheapest way to care for our bodies (which leads to care for the rest of ourselves), and yet we often disregard it.

(Granted, not everyone has equal options to eating in a way that cares for their body. Not even everyone has the equal option to eat period. But that isn’t what I’m addessing here. )

The God of our creation cares about our physical being! I’m convinced! If he didn’t, it wouldn’t have been effected by the Fall; He wouldn’t have come to earth as a healer, showing people the nature God in part through physical healing; He wouldn’t promise a bodily resurrection and a day when there is no more sickness. These things wouldn’t matter to a God who didn’t care about our physical being. But instead, we are commanded to love God with mind, heart, soul, and STRENGTH! We aren’t allowed to rank those. What we do with our bodies matters a lot to this God of creation. Just as Christians talk about the need to be spiritually fed and built up, we also need to be nutritionally fed and built up to glorify God in our bodies, which are living temples. Jesus was distessed and even angry to find the temple being turned into a marketplace, filled with things that weren’t meant to be there. Do we care as much when we fill ourselves with things that don’t help us to function as we were meant to and be most alive?

More to come on this topic…

Sorry if it was rambly. In my defense, writing it was my study break between two six hour chunks of study time.

transition, transition

Clearly my lack of posting indicates that med school is A LOT OF WORK. Not to mention I still don't have internet at my appartment (which makes me very productive at home!)

On Jonathan and I's first Sunday in DC, the church we went to used this quote in the sermon:

"My Lord God, I have no idea where I am going. I do not see the road ahead of me. I cannot know for certain where it will end. Nor do I really know myself, and the fact that I think I am following your will does not mean that I am actually doing so. But I believe that the desire to please you does in fact please you. And I hope that I have that desire in all that I am doing. I hope that I will never do anything apart from that desire. And I know that if I do this you will lead me by the right road, though I may know nothing about it. Therefore I will trust you always though I may seem to be lost and in the shadow of death. I will not fear, for you are ever with me, and you will never leave me to face my perils alone."
-Thomas Merton. "Thoughts in Solitude

That pretty well describes the transition process to DC.

I'm getting to know people and places more by now, and feel some connection to life here. I've been reading through the story of the Israelites leaving Egypt and journeying through the desert for many, many years. I'm struck by how often they needed to be reminded of who God is (LORD), that God IS (I AM), and who they are (God's people). Transtions expose all kinds of fears and doubts, but this is the comfort we're given. God is. God is God. We are God's.

"Is the LORD's hand shortened? Now you shall see whether my word will come true for you or not." -Numbers 11:23

Lateral Lines and Panda Bears

Have you ever seen a big school of fish swim? They all swim together, making the slightest turns in perfect unison. They can do this because they have a sense organ called the lateral line that detects vibration and movement in the water. This way, fish avoid collisions and orient themselves with the flow of the current.

I've been in Turkey for the last 2 weeks, and have lots of interesting blog-post worthy thoughts and questions from time there. This post relates to something my sister said while walking down a hot and crowded street in Istanbul.

"Why can't people walk more orderly?! I hate it when everyone is bumping into one another. Can't people be more like fish, you know, have lateral lines or something. This is so annoying!" (imagine that said in a mixed tone of sarcasm and whine)

People definitely do not have lateral lines. Life as a human being is messy. We're not like pandas, who live most of their lives in isolation, spending time together only to mate and raise cubs. We are not like fish, who are always together, and even work together to hunt, but never bump into one another.

We are made for community, but functioning together as a community is not smooth or even natural. You don't need to walk down a crowded street in Turkey to realize that; it is usually apparent at the family dinner table.

While in Turkey, I thought about what it is exactly about wealth that makes me uncomfortable. I have spent different parts of the last 22 years embracing wealth and living into it, as well as truly hating it, and trying to escape it. Neither felt right. A lot of my discomfort has to do with the fact that in my experience, wealth turns people (myself included) in to pandas or fish. (disclaimer: these are not by any means the only effects of wealth, and other things can lead to these states of being as well).

Pandas are self-sufficient. They use their panda community only when they absolutely need to (mating, and extreme food shortage). They don't need other pandas; they have the ability to get everything they need all on their own. Wealth can allow for this kind of lifestyle as well, and the luxuries that wealth gives often promote a more isolated life-style (quiet day at the spa, big house outside the city, car rather than public trans, ipods, private school with small classes...etc). But it isn't just about isolation; it is about isolation born out of self-sufficiency.

Fish, on the other hand, are not self-sufficient, but they also don't actually communicate with one another. They communicate with the vibrations in the water created by what is around them. They are also almost completely identical. As soon as there is any kind of significant difference, those different fish break away and form a new school and ultimately become an entirely different species. You see, each species of fish has a unique lateral line, and any variation in that will mess up the perfect swimming formation. When people are all the same- have the same goals, doing the same things- society tends to be more streamline. Wealth, in my experience, allows for a certain degree of "streamline-ness." It allows people to remove themselves from the chaos of society and steamline into another social group which does things together but doesn't actually require interaction. (if God had wanted a streamline society, He certainly wouldn't have created two genders which differ so greatly)

We aren't pandas and we aren't fish. We are made for community, rather then self-sufficient isolation, but we are not programmed to form streamline community that looks and acts the same. We are made to bump into one another- to both smooth and sharpen one another.

Perhaps that was a harsh view on wealth. To be fair, poverty has its own set of characteristics that lead to broken communities and should definitely not be glorified. I think what makes me so uncomfortable about the panda/fish scenarios, is that the more time I spend developing close relationships and communities, the more I firmly believe that it is that process that teaches me about God . The forming of community is a redeeming and sanctifying process because it makes us more like God and the community of Father, Son and Spirit.

tennis ball fuzz and surf wax

Playing tennis and being at the beach for the last week reminded me of the reasons why I love tennis and surfing...so here's a random fun post about that...

Things I love about tennis
-the sound and smell of opening a fresh can of balls
-ball fuzz, and how it gets everywhere (in the soles of my shoes, between racket strings...etc)
-the squeaking sound of tennis shoes as they scurry to hit the ball
-drills and targets
-the personal and intense nature of the game. Just you against another person.
-that I feel like I can still be girly and be taken seriously
-that it is a sport equally valued among men and women
-the satisfying sound of smacking the ball right in the sweet spot
-spinning the racket in your hands as you wait for your opponent to serve
-the naturally polite and sportsmanship-focused nature of the game
-the perfect combination of strategy/skill and athletic ability. Both are absolutely necessary.
-while tennis can very much be a team sport, I like it for its individual quality. Probably because I like being in control (sigh). When something goes well, it is because of your skill. When you lose a point, it is also because of you. There is no blame shifting and full transparency in what kind of a player you are.

Things I like about surfing
-the smell, touch (and taste? no...just kidding) of surf wax
-the way water washes over the board for the first time in the day
-the science of waves (balls of energy that push water up as they crash into the sand. SO COOL)
-seeing the fish swimming below as you stand up on the board
-long rides and long boards (9 ft or longer only)
-getting as close to flying as humanly possible
-always knowing that it is never you controlling the waves. They are always more powerful, and surfing is like being allowed to enjoy their power. You're being moved by something much stronger then yourself, and you'll get to shore one way or another. If you let the wave do the work, you get there with speed and style. If you fight the natural motions of it, you end up in a tangled seaweed mess.
-feeling ridiculously small while sitting on the board in the vast ocean
-the feel of salt, sunscreen, and sand on your skin after a great surf session

Interesting. Tennis is all about perfecting your control over the ball, and surfing is all about realizing the lack of control you have over the ocean. Love them both.

Lessons Learned

There are many, but here are a few things I've learned, or at least thought more about, over the last year:

1) What I'm good at (and feel particularly equipped to do) and what I enjoy doing are not always the same. I've learned to be (more) ok with enjoying things I'm not good at and still feeling their value. But I've also learned how to let some of those things go and embrace more of what I am actually made to do. Sometimes the two coincide, and that feels great!

2) God's plan is always good, but that doesn't mean it isn't sometimes terrifying. I spent a solid two weeks feeling almost convinced that God was calling me into full time ministry rather then med school.

3) God is not just redemptive (ie. redeeming, or perfecting/purifying the ways that the world is broken by our alienation from Him), but He is also creative. God is and does good because it is in His creative nature to create more good, not because of a need to react against our lack of good. He doesn't need us to be good, we need Him to be Go(o)d. This means that we're made to be creative too!

4) Observation. Interpretation. Application. They aren't just good Bible study steps, they are great steps to go through in almost any situation/text/conversation.

5) Fear of God, the kind we are commanded to have, is very different then fear of people/world/situations. The second kind makes us afraid to walk on water, the first makes us fear the God that made us actually able to do it. Sometimes they overlap, but not as often as I usually think they do. Fear of anything but God, I've learned, is almost never a good motivation or decision maker; but what exactly fear of God means/looks like, I'm still learning.

6) Interpretation and point of view is everything. Ok, maybe not everything, but a whole lot. Two people, presented with exactly the same set of facts, or involved in the same conversation or situation, can come away with entirely different interpretations. Different people/groups approach the same situations with different "toolboxes," different ways they are equipped to respond. Communication, I've learned, begins in understanding the other person's toolbox, and therefore the process by which they arrived at their interpretation of some set of facts. Learning this has required me to have a lot more grace for people.

7) There are multiple situations I've looked back on, or stepped back from, and have said, "wow, it really matters that I believe in an all powerful, loving, and strong God." I mean, I know it matters, but after encountering new life situations in the past year, I feel like I have new perspective on why it actually matters so much.

8) Voicing expectations of others, and needs for myself is necessary to healthy relationships.

9) My own comfort, in the general definition of the word, is pretty much never the most important thing in any situation. Not that being uncomfortable is a goal, but that it is never really supposed to be about me. Situations/conversations/relationships that are more about God then about me often lead me away from self-focused comfort, into discomfort, but also into a deeper idea of Comfort as a spiritual state rather then just a self-centered emotion.

10) People pleasing is dangerous ground to tread. In return for our faith in Him, God promises and gives us His pleasure. The pleasure of a person, in exchange for the pleasure of God, is like Esau's exchange of a bowl of MSG soup for his entire inheritance. Peace and pleasure-filled communion with God is our great reward, and it isn't only meant for the future.

Well, 10 seems like a good number to stop at. I didn't write in here much this year because I was always around people processing out loud. I'm planning on using it much more as a process palate next year when I interact less with people and more with text books.

Freedom

The culmination of the inauguration has left me thinking a lot about freedom. We live in a country that boasts about its access to freedom for all. But we talk about freedom typically as a means to an end, rather than the end itself. We say "you are free to speak, to defend yourself, to have a speedy trial, to pursue prosperity" and more. We never say, you are free to be free.

It is certainly true that the people of America are more free, in many ways, than the people of other nations. Even with the presence of inequality, racism, and prejudices of all kinds, a certain degree of freedom does exist. But the funny thing about freedom is that no one really has it unless everyone has it. If I am rich and my friend is poor, what is my freedom? Should it be said that I am free to help my friend, or free to ignore him. I guess both are technically options, but I want to suggest that feeling "free to ignore" is not actually freedom at all, it is bondage to my status, wealth, and position, rather than freedom to love and serve without worry or anxiety about what I am losing and what someone else is gaining. Is it freedom that allows some to give sub-prime mortgage loans, and is it freedom that allows for landlords and health insurance companies to refuse service to people with AIDS? These are choices freely made, that is true, but they are not made out of a spirit of freedom but rather out of a spirit of bondage. And is it freedom to say to the over-worked inner city single mom with four kids, whose father is in jail, and who continue to pass each grade level despite learning almost nothing that all of her children are free to graduate high school, dream big dreams, go to college, and live the american dream? That is the problem when freedom is the means to the end, rather than an end in itself.

America may be a nation that boasts of freedom, but we are not people who act as though we are free. We have not yet learned that the freedom to consume one another is really just slavery wrapped up in some fancy language.

From Galatians 5

1For freedom Christ has set us free; stand firm therefore, and do not submit again to a yoke of slavery...13For you were called to freedom, brothers. Only do not use your freedom as an opportunity for the flesh, but through love serve one another. 14For the whole law is fulfilled in one word: "You shall love your neighbor as yourself." 15But if you bite and devour one another, watch out that you are not consumed by one another...

18But if you are led by the Spirit, you are not under the law. 19Now the works of the flesh are evident: sexual immorality, impurity, sensuality, 20idolatry, sorcery, enmity, strife, jealousy, fits of anger, rivalries, dissensions, divisions, 21envy, drunkenness, orgies, and things like these. I warn you, as I warned you before, that those who do such things will not inherit the kingdom of God. 22 the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, 23 gentleness, self-control; against such things there is no law. 24And those who belong to Christ Jesus have crucified the flesh with its passions and desires.

No law will ever say that you want these fruits of the Spirits too much, that it is wrong to desire them, or that having more of them is bad. It is living in the full knowledge of the freedom we've been given that produces these fruits of the Spirit.

There are a lot of important, and in some sense, timeless questions that have floated around as we entered a New Year and a new presidential era. My question is this: How will America define or re-define the purpose of being "the land of the free" in an era where it has become acceptable for freedom and massive inequality to co-exist.

Micro or Macro?

More free time than usual and two 15 hour car rides led to a good amount of reading in the last week and a half. Two books stand out as reflective of a tension I often feel. Jeffrey Sachs' "The End of Poverty;" I finally finished Jonathan's copy of it, and "Finding Calcutta," a quick read about a woman's experience wtih Mother Teresa in Calcutta and what she learned about work and service while there (a Christmas gift from a friend). While the tension is personally relevant, I believe it is one that also inhibits much collaboration and potential for good work in the world.

Jeffrey Sachs is a macro, or big picture, kind of guy. He thinks and talks in terms of systems, structures, societies, markets, and global communities. Yes, he can identify value in one-on-one interactions and even talks about how it is important for policy makers to have face-to-face encounters with the people the policies are for. Still, his mindset is always one of "big picture" work, and clearly, he is pretty great at what he does. (side note- the book was great. Agreed with most of it, and looking forward to reading his next one...ie. Jonathan, hurry up and finish it).

Mother Teresa is very different. She is a micro person. She never (and made a point not to) involve herself in politics and policies, or social systems and structures. She is known for calling herself and her work "a drop in the ocean" or a "little pencil in the hand of a writing God." Momma T writes about herself that she "doesn't agree with the big way of doing things. To us what matters is an individual. To get to love the person we must come in close contact with him. If we wait until we get the numbers, then we will be lost in the numbers. And we will never be able to show that love and respect for the person. I believe in person to person; every person is Christ for me, and since there is only one Jesus, that person is only one person in the world for me at that moment."

Politically minded intellectuals often criticized Mother Teresa for not getting involved in the politics of poverty, for speaking out against abortion and for feeding the poor directly rather than "teaching them to fish." Her response was: "If there are people who feel God wants them to change the structures of society, that is something between them and God. We must serve Him in whatever way we are called. I am called to help the individual; to love each poor person. Not to deal with institutions. I am in no position to judge...All of us are but His instruments, who do our little bit and pass by."

I don't think Jeffrey Sachs and Mother Teresa are complete opposites. They are/were clearly gifted in their respective types of work. Jeffrey Sachs does see value in the individual and reminds his readers that the market/community is made of individual people and it is their interactions, in homes, shops, fields, and street corners, that reflect the effects of policy. Similarly, Mother Teresa certainly had an impact on many people she never met. While she didn't advize any policy or network organizations, her work is known world-wide- it is quoted in speeches and books, and inspires (though often cliched and skin deep) world leaders and common folk alike.

I am tempted to ask the question: which is better? Big picture or little picture thought and work. I can make cases, even biblical cases, for both, and in the end I do think both are necessary and it is unfair to rank them. I don't think the work of big picture policy people lacks emotion, heart, and genuine care for the people they are writing policy for (though this, of course, is not universally true). And I don't think that "little picture" work always makes you more aware of real issues and genuine in heart and care.

So which am I wired for? I am not as extreme as either Jeffrey Sachs or Mother Teresa. Do I have to pick? Can I do both? Am I allowed to want to do some kind of great work in the world?*

The tension between the two brings up a fear of mine. I am afraid of forgetting the personal, intimate, and unique person-to-person value when I think/work in a "big picture" setting. And I am afriad of not having any kind of sustainable or lasting impact through my work if I work for and serve only on a person-to-person level.

The first fear seems pretty legitimate; the second, untrusting of God and prideful. I have certainly seen how very small words or actions have made large impacts on people and even whole communities and I believe that God magifies our feeblest attempts at serving others. I'm comforted by the fact that we are saved by grace through faith, and not by works, and yet I easily become frustrated when I feel like what I do or say doesn't have any or a big enough impact.

Like with so many questions and tensions, I end up with a need for greater trust and humility. Wanting me/my work to be more than a "drop in the ocean" diminishes the size of the ocean. To do justice, to love kindness, and to walk humbly, that is the call.

It is a New Year, and so these verses from Psalm 7 come to mind as I think back on the year and as I think more about what it looks like to have humility as I ponder the tension between big picture and little picture. **

3O LORD my God, if I have done this, if there is wrong in my hands,4if I have repaid my friend with evil or plundered my enemy without cause,5let the enemy pursue my soul and overtake it, and let him trample my life to the ground and lay my glory in the dust.

6Arise, O LORD, in your anger; lift yourself up against the fury of my enemies; awake for me; you have appointed a judgment.7Let the assembly of the peoples be gathered about you; over it return on high.

8The LORD judges the peoples; judge me, O LORD, according to my righteousness and according to the integrity that is in me.9Oh, let the evil of the wicked come to an end, and may you establish the righteous—you who test the minds and hearts, O righteous God!10My shield is with God, who saves the upright in heart.11God is a righteous judge, and a God who feels indignation every day.

*sorry friends, no straighforward answers to these. I do think God works through people to do great things, but it seems rarely seems to be the people you would expect, and often the 'great work' isn't what you would expect either. We are saints, not saviors.

**by little picture, I don't mean "little" as inconsequential or un-important

The Body

I went to my church in San Diego today for the first time in about six months. I've never really gotten to know anyone there since I am in SD so infrequently, but I love this church a lot. Every time I go I'm newly amazed at how strongly I feel and see God though I'm away from friends, a home church, and a supportive community.

I went a few minutes early this evening and sat in the parking lot in my car, not in the best of moods. I hate being the perpetual new person at this church since I've never really gotten to know anyone. I prayed really briefly but strongly, "God, I need to feel welcomed tonight. I need to feel the church really and actually be the church for me tonight." Then I rushed out of the car because I thought I saw someone I knew- turned out it wasn' them.

I was confused when the main sanctuary was closed, but saw the fellowship hall open instead. I went in, and the room was set up with round dinner tables, chairs, and a cup of wine and loaf of bread on each table. I didn't see anyone I knew so I stood awkwardly near the side twirling my hair and hoping someone would come talk to me. It is strange, that even though I am in church and Christian settings all the time, I still feel intimidated and awkward and shy as the new person.

The assistant pastor, Josh, whom I had met before, came over and talked to me briefly, asked about how IV was going, and introduced me to a couple who then asked if I wanted to join them at a table. Josh said that the first Sunday of the month they have been setting up the room with these dinner tables and chairs in order for a more family-like atmosphere. We were to listen to the sermon, worship, serve communion to one another around the table, and then enjoy a pot-luck dinner together. Even before sitting down I could tell God was answering my prayer....it doesn't get anymore welcoming and community-church like then that.

Before the service began, another couple came to sit at the our table, Ramiro and Wendy. After a few minutes of conversation, I discovered that they were the IV staff for UCSD and Cal State San Marcos. We talked and clicked immediatly, and that feeing of being the new person no one knows felt a couple light years away.

Worship was great. The sermon was the second half of Mark 1. We talked about leadership, and how it is leaders are called to commit, risk, and follow together, and never alone. And that leadership is not defined only by what you do, but by what you have left behind in order to pursue that leadership. I was struck by Peter, still called Simon in Mark 1, and how chances are that never in a million years he would have imagined himself as the Peter of Acts 2.

Service came to a close and it was time for communion. We passed the bread and wine around the table, saying to one another "the body of Christ, broken for you," and "the blood of Christ, shed for you." It was really powerful to say those words and to have them said to me in such an intimate setting yet among people I didn't know at all. I was not just partaking of the body of Christ, but was in it as well.

I couldn't stay for the pot-luck because mom wanted me home for dinner. I left feeling so uplifted and amazed at how perfectly and immediatly God had answered my prayer in the car before church.