KITCHEN TABLE CHATS

Pull up a chair in my domestic church and let's chat!

I have worn many labels (Not in any particular order): Catholic, Wife, Mom,Gramma, Doctor, Major, Soccer Mom, Military Wife, Professor, Fellow.

All of these filter my views of the world. I hope that like St. Monica, I can through prayer, words and example, lead my children and others to Faith.
"The important thing is that we do not let a single day go by in vain without putting it to good use for eternity"--Blessed Franz J├Ągerst├Ątter

Tuesday, September 26, 2017

Disagreement ala Thomas Aquinas

St. Thomas Aquinas by Fra Angelico

This appeared in The New York Times and should be read by anyone who thinks he has a correct opinion on one of the many topics headlining today’s cultural news—in other words, by everyone. The money quote is:

In other words, to disagree well you must first understand well. You have to read deeply, listen carefully, watch closely. You need to grant your adversary moral respect; give him the intellectual benefit of doubt; have sympathy for his motives and participate empathically with his line of reasoning. And you need to allow for the possibility that you might yet be persuaded of what he has to say.

This is really nothing new. It is the method of St. Thomas Aquinas in his Summa Theologica. State your opponent’s position accurately and take the time to understand the support for this position before launching in to your rebuttal of his position.

This piece appeared at a very opportune time for me. I have said repeatedly I do not like to engage in Facebook comment discussions because they deteriorate quickly. My Facebook newsfeed was full of memes and statements regarding the NFL players taking a knee, sitting, or refusing to stand for the national anthem and the flag. My position as a veteran, a military spouse, and a military mom is that these athletes have the right to do this, but they should be aware of how offensive it appears to many in the military community. They may not intend it to be a slap in the face to those who serve, but it is taken as a slap in the face by many, including me. There are ways to raise awareness without being disrespectful. I tried to offer this in what I hope was a reasonable, non-confrontational way on two different Facebook threads. It provided an interesting contrast.

On one thread, the initial position was that how could anyone object to a peaceful attempt to bring awareness to social injustice. There was reasoned discussion on both sides of the issue. In the end, there was an acknowledgement that failing to stand respectfully during the national anthem could be seen as an insult to the military. Many on that thread had not realized how deeply this could hurt the military community. Even if they could not fully grasp the why of the pain, they were empathetic to the pain.

The other thread was filled with #BlackLivesMatter hashtags and repeated references to “white privilege” and the deficiencies of the “melanin-lite” population. Failure to fully embrace the protests was seen as support for social injustice and inequities. People were judged by whether or not they had expressed the proper social justice positions on their Facebook and Twitter feeds. I was basically told that any pain I felt was fallacious and unworthy of consideration. I should just take my white privilege (my Latina heritage notwithstanding) and shut up. The ideology made empathy impossible.


Clearly, one group of people had mastered the art of disagreement while the other had not.

Sunday, September 03, 2017

Imago Dei



The Sinner by John Collier, 1904
There are not over a hundred people in the United States who hate the Catholic Church. There are millions, however, who hate what they wrongly believe to be the Catholic Church — which is, of course, quite a different thing.”—Venerable Bishop Fulton Sheen

The Ruth Institute is a non-profit organization dedicated to strengthening marriage and highlighting the devastating effect that broken families have on children. They are in concert with the teaching of the Catholic Church when it comes to marriage including the belief that marriage is the union of one man and one woman. For this reason, the Southern Poverty Law Center (SPLC) has declared them a “hate group”. At no time has the Ruth Institute ever advocated violence against anyone. There is no evidence that any of their work has inspired violence. However, because the SPLC has labeled them a “hate group” Vanco, a credit card processing company affiliated with Wells Fargo, has severed their ties with the Ruth Institute and immediately, with no warning, stopped processing their online donations. You can read the statement from the Ruth Institute here. You can read good analyses here and here.

There are many topics that could be explored in this situation. For example, by what authority does the SPLC have the credibility to be the final arbiter on what constitutes a hate group?  Why can Vanco refuse to service customers with whom it disagrees while bakers, florists, photographers, and wedding venue owners cannot?

While those are good questions, what struck me was a conversation I observed online where an individual claimed that Vanco’s actions were justified because the Ruth Institute followed the Catholic Church’s teaching that “homosexuals were intrinsically disordered”.

Stop right there! That is not what the Catholic Church teaches. The Catholic Church does not label any person as intrinsically disordered. What the Catholic Church says is that homosexual acts are intrinsically disordered. The full statement from the Catechism is:

2357 Homosexuality refers to relations between men or between women who experience an exclusive or predominant sexual attraction toward persons of the same sex. It has taken a great variety of forms through the centuries and in different cultures. Its psychological genesis remains largely unexplained. Basing itself on Sacred Scripture, which presents homosexual acts as acts of grave depravity,141 tradition has always declared that "homosexual acts are intrinsically disordered."142 They are contrary to the natural law. They close the sexual act to the gift of life. They do not proceed from a genuine affective and sexual complementarity. Under no circumstances can they be approved. 

2358 The number of men and women who have deep-seated homosexual tendencies is not negligible. This inclination, which is objectively disordered, constitutes for most of them a trial. They must be accepted with respect, compassion, and sensitivity. Every sign of unjust discrimination in their regard should be avoided. These persons are called to fulfill God's will in their lives and, if they are Christians, to unite to the sacrifice of the Lord's Cross the difficulties they may encounter from their condition.

What the Church states is that we are each made Imago Dei, in the Image of God. No human person is ever intrinsically disordered. Actions can be disordered. People cannot. No person is beyond redemption. No person is beyond God’s mercy. This includes sinners of every stripe.

Has every Catholic approached homosexuals with mercy and compassion on every occasion? Of course not. But the failures of individuals to live up to the teaching of the Church do not redefine the teachings of the Church. Perhaps one of the best discussions of how the Church should minister to those with same-sex attractions was outlined in Cardinal Sarah’s recent editorial in the Wall Street Journal:

In her teaching about homosexuality, the church guides her followers by distinguishing their identities from their attractions and actions. First there are the people themselves, who are always good because they are children of God. Then there are same-sex attractions, which are not sinful if not willed or acted upon but are nevertheless at odds with human nature. And finally there are same-sex relations, which are gravely sinful and harmful to the well-being of those who partake in them. People who identify as members of the LGBT community are owed this truth in charity, especially from clergy who speak on behalf of the church about this complex and difficult topic.

It is my prayer that the world will finally heed the voices of Christians who experience same-sex attractions and who have discovered peace and joy by living the truth of the Gospel. I have been blessed by my encounters with them, and their witness moves me deeply. I wrote the foreword to one such testimony, Daniel Mattson’s book, “Why I Don’t Call Myself Gay: How I Reclaimed My Sexual Reality and Found Peace,” with the hope of making his and similar voices better heard.


We are each made by God in the Image of God. We cannot be “intrinsically disordered”.

Tuesday, August 22, 2017

Do No Harm

Hippocrates by Ferdinand Georg Walmuller, 1826


Most of the individual health care professionals I know are virtuous men and women. They see their profession as a calling and keep the welfare of their patient front and center. The faceless bureaucrats of health care institutions, professional associations, and medical corporations, on the other hand, are often driven by factors other than good patient care.

I absolutely do not trust the pharmaceutical industry to recommend what is best for me. Merck, Pfizer, et al., are corporations with stockholders and their job is make money for their stockholders. I get that. But it means someone totally independent of these pharmaceutical companies needs to be evaluating and making recommendations about drug therapies. I have spilled a lot of ink on this blog about the HPV vaccine and the great efforts Merck expended to convince states to mandate this vaccine before there were any competing vaccines. There are a lot of concerns that this vaccine has been overhyped and its potential side effects have been inappropriately overlooked.

And what about all of those medical associations that are constantly issuing statements and recommendations? Who are these people? Did you know that less than 15% of American physicians belong to the AMA? When the AMA issues a statement about health care policy or treatment guidelines, they are not speaking as the voice of American doctors but rather as the voice of the special interests of a small slice of American physicians.

I got the results of my mammogram. Praise God, they were normal. But at the end of my report it stated that the American College of Radiology Guidelines recommend screening mammograms every year beginning at age 40. I bet they do. There is a lot of money to be made by radiologists if every American woman over 40 gets a screening mammogram every year. Where is the data to support this recommendation? The US Preventive Services Task Force did not find any. They recommend screening to begin at age 50 and to be done every two years until age 74.  The radiation exposure of mammography itself can induce breast cancer. The benefit of moderate screening probably outweighs this risk, but the risk is increased with both a lower age at the initiation of screening and an increase in screening frequency.

I must be clear that this pertains to screening mammograms in the asymptomatic patient with no known significant risk factors such as relevant family history or genetic markers. As soon as you have any sign, symptom, or significant risk factor your mammogram goes from screening to diagnostic and these recommendations no longer apply.

The same goes for the cervical cancer screening. How often is your doctor recommending a pap smear? The data says every 3-5 years, depending on whether or not the pap smear is used in conjunction with HPV screening.  And if you have had regular screening, you get to stop the screening at age 65! If you have had a hysterectomy, you do not ever need a pap smear. The pap smear is only designed to detect cervical cancer. If you do not have a cervix, you will not get cervical cancer. It is not going to detect vaginal cancer in the asymptomatic woman. It is not going to detect ovarian cancer. There is no effective screening method for ovarian cancer in the asymptomatic woman with no known risk factors. So if you have no signs, symptoms, or significant risk factors, you do not need an annual “well-woman” exam.

Some may ask, if insurance pays for it, why not? Screening is not necessarily benign. I have already mentioned that the radiation from mammography has the potential to increase the risk of breast cancer. But there are also the risks of overdiagnosis and over testing. Every time you screen for disease you get one of three answers: an accurate diagnosis, a false negative, or a false positive. With most screening modalities currently used, it is the risk of the false positive that is most concerning. Suspicious findings on a screening exam that turn out to be nothing are common. However, in order to find out that they are nothing there must be more testing and this follow-up testing is often far more invasive than the original screening test and fraught with its own set of potential side effects and complications. Therefore, the goal is to screen just enough to pick up the disease without unduly risking unnecessary follow-up testing. The risks of adverse effects due to screening can outweigh the risks of the disease being screened for if the screening is done too frequently or in the wrong patient population.

Medicine has the potential to do great good. However, the foundational principle of medical practice must be Primum non nocere or First do no harm.






Friday, August 18, 2017

Journalism, Journalism, wherefore art thou Journalism?

Romeo & Juliet, Frank Dicksee, 1884

My newspaper habit with the Washington Post these days amounts to a quick perusal of the Sports section, working the crossword puzzle, and reviewing the Metro section. They actually do some pretty good investigative journalism on local issues. Their national and world news is so biased and sensationalized it is not worth my time. I usually read the BBC to keep up with international and national headlines and then dig deeper for items that I find interesting or pertinent.

So I was sorely disappointed to see The Post give so much coverage to DC Councilman Vincent Gray's "inspection" of a local Safeway store. Really? With all the issues facing Washington DC, Councilman Gray felt his time was best spent harassing a private business because he thinks the produce and meats are not fresh enough and the store hours are not long enough? And of course he alleges that the Safeway corporation is doing this in order to unjustly discriminate against his Ward 7 constituents.

Councilman Gray assumes that if he goes to any Safeway in a more affluent neighborhood he will not find moldy strawberries or meat that has aged to a brown color. He did not actually visit another Safeway to verify that. He just asserts that is true. If you read the comments to the article you will see that there are lots of patrons of suburban grocery stores who have found similar produce and meat. That is consistent with my experiences as well.

And in truth, Vincent Gray has no standing to micromanage Safeway's business. There are no city regulations that require a grocery store to have specified cashier wait times or be open during certain hours. There could be numerous non-nefarious reasons that Safeway is choosing to do business as it does. For example, maybe it is too difficult to find employees who want to work the late night shifts due to security concerns. Maybe customers do not want to shop during the late night hours due to security concerns. Maybe the cost of security during the late night hours makes it cost-prohibitive to be open later.

If Safeway is leaving open an unmet need in Ward 7, another grocery store is free to open up and meet that need. The fact that no grocery store has seized this opportunity indicates that there is something about the business climate in this area that is not conducive to profitable operations. Perhaps rather than standing there with a finger pointed at Safeway, Vincent Gray should be looking at what are the factors that have created this inhospitable business climate and what can he do to fix them. Instead, he chooses to grandstand and whip up outrage among his constituents and let them know he is on their side without really doing anything to improve the situation.

And the Washington Post played right into his hands. Where was the journalistic discernment that considered whether this was really news or just another politician pushing propaganda? Why did the Washington Post follow Vincent Gray like a little lap dog and blindly give credence to his publicity stunt? Why didn't a reporter raise the issues I just raised? Why did they just accept his narrative without question? Is it because they are not really an objective news organization but an agenda driven promoter of a specific ideology? Their new tag line is "Democracy dies in darkness". Darkness descends when critical thinking is missing.


Monday, August 14, 2017

Fruits of Our Labors


 


It has been ages since I blogged. No major story. Just never could bring myself to sit at the keyboard and share. The internet has turned much darker than when I started blogging a decade ago. I didn’t want to add to the darkness but wasn’t sure how to open the window and let in the light. There is a great deal of evil in the world that needs to be confronted. But when I address it in writing and shine a light on it to reveal its true form, it casts a shadow. And that shadow is permanent because words on the internet never really die. So while I have written dozens of blog posts in my head, none have made it through my fingers to the keyboard and resided on this virtual page. Until today.

Last week I read Back to Work by John Waters in the First Things journal. Like many of the articles in First Things, it is a longish piece that is best read slowly in a comfortable chair with a relaxing beverage in hand. Like your drink, this pieces needs to be sipped and savored. Mr. Waters points out that with the development of modern technologies, many of us find ourselves several degrees removed from tangible productivity. We are extraordinarily busy but at the end of the day, what can we touch and say, “I did this”? There is an emptiness that accompanies all of this virtual work.

My youngest son expressed something similar. He has done manual labor and he has done office work. He laments that his college education has “promoted” him to the clean and comfortable cubicle but it does not feel near as satisfying as sweat producing physical labor. His peers are similarly disillusioned. What is the point of all this number crunching and report producing?

When I practiced clinical medicine, I loved doing medical procedures. They were the antidote to visit after visit that focused on treating lab numbers and vital signs. Sewing up a laceration or reducing a dislocated joint offers immediate feedback about my intervention.

Now that I am in academia, the feedback is much slower. I give my lectures and answer student questions then give exams to see how much information was absorbed. But I am not educating these students to pass exams. I am preparing them to go out into the world and be nurses, doctors, pharmacists, dentists, or other health professionals. I will never know the impact of my class for most of my students. I treasure the occasional note announcing an acceptance to medical school or dental school because it lets me know that, yes, my work has meaning.

This need to be tangibly productive is probably why my hobbies include cooking, gardening, sewing, and occasionally refinishing furniture. Preparing a simple meal that is perfectly seasoned with herbs from my garden gives me far more pleasure than elucidating the intricacies and complex interactions of the endocrine system. I love medicine. I love talking about it. I love teaching it. But when I am done talking and teaching, what do I have to show for it? Tender ravioli with just the right amount of chopped sage leaves, colorful chopped peppers and garlic in a browned butter sauce ignites the physical senses of sight, taste, smell, and touch. Canning twenty-five pounds of tomatoes into quarts of tasty sauce feels like a crowning achievement. Last night I finished my first experiment with chalk paint and turned a dated thrift shop wine cabinet into something a little more cute and trendy.

So perhaps that is another reason why these blog pages have been silent for so long. I needed to experience real people in my real physical world. The internet can be a powerful connector across the miles. It can offer words that need to be heard at just the right time. But it is a mistake to let it replace live person-to-person interactions. Just as we sometimes need to physically see the fruits of our labors, we need to physically experience the fruits of our relationships.