These have been difficult weeks.
The practice of medicine is one of the most gratifying careers possible, but it is relentless in its demands and unforgiving of imperfections — both those of the patient and the physician. Surgery in particular — while enormously satisfying in its technical and definitive nature for those physicians so inclined and gifted — is at the same time the most humbling of all disciplines. Despite all the training and experience, the knowledge and technical skill acquired through countless repetitions and refinement, things do not always go as planned.
John (not his real name, of course) was like so many others — in good health, early sixties, found to have a rising PSA blood test, which proved to be the harbinger of prostate cancer, fortunately still at an early stage. Presented with the options for treatment, he chose surgery: radical prostatectomy, the total removal of the prostate gland and biopsy of the pelvic lymph nodes — those filters which are the first resting place for cancer cells migrating outside the organ. It was an operation I had performed hundreds of times over nearly thirty years, and promised an excellent chance for cure, with an acceptably low risk of long-term adverse effects.
Surgery began uneventfully, with good exposure of the pelvic organs and lymph nodes, despite his portly habitus which can make such access challenging. The right pelvic lymph nodes were addressed first. Located in a triangular area demarcated by the external iliac vessels — the main artery and vein to the leg — the obdurator nerve (a large nerve deep in the pelvis) and the wall of the pelvic bone below, the lymph glands therein are gently teased and separated from these structures and sent for biopsy.
Surgeons get to know anatomy intimately, and depend on its predictability for safely performing their craft. In this area, the external iliac artery is reliably and predictably located lateral to the vein — farthest to the outside. At times, it can run a somewhat serpentine course, as cholesterol plaques narrow the channel and changes in flow and pressure lengthen and twist the artery. Such variations are also predictable: the artery courses in front of the vein if it moves toward the midline, or else moves away from it, farther toward the outside.
The bulk of the nodes were out in little time, titanium clips sealing the lymphatic channels and small blood vessels which feed them. The final packet was located near the point of the triangle, at the upper part of the pelvis below the vein. Several small vessels were clipped, and these nodes were removed easily as well.
I inspected the nodes, feeling them for firmness that might suggest cancer spread. One node looked peculiar. Hollow. Lymph nodes aren’t hollow.
Shit.
Inspection of the surgical field confirmed my worst fear: I had removed a short section of the external iliac artery, the main vessel to the leg. Located in a highly unusual location: underneath the vein, rather than above and lateral to it — an aberrant knuckle of vascular conduit enveloped in fat and lymph nodes — a section of artery had been cleanly removed with the nodes.
There was no bleeding, and the ends of the severed artery were easily identified and freed up. Fortunately, John did not have advanced vascular disease, and alternate paths for blood flow to the leg were open. A vascular surgeon was contacted, and arrived within 10 minutes. A short synthetic vascular graft was placed to bridge the gap, and full circulation was restored in less than an hour. There was no evidence of ischemia — a dangerous situation where insufficient blood flow and oxygen causes damage to tissue and the release of high levels of toxic lactic acid into the blood.
But the presence of a vascular graft, while salvaging a serious situation, meant something else: the main surgery, the prostate removal, would have to be canceled until the graft healed. To proceed as originally planned would risk contaminating the vascular repair, leading to graft infection — a disastrous complication. The incision was closed, and the patient arrived uneventfully in the recovery room. Two days later, he was home.
Imperfection in a field which demands perfection is perhaps the burden a surgeon experiences most deeply, with the most fear and respect. We hope, by endless years of study, preceptorship, practice, and experience, to master that which cannot be fully mastered, to control and manipulate our world to achieve that which is unachievable.
A surgeon who has never made a mistake is a surgeon who has never operated; the doctor who makes no errors must be one who sees no patients. The hard truth — hardest of any we healers, so often arrogant in our knowledge and skill, must swallow — is that we are not perfect — and neither are our patients.
Such untoward events may occur for many reasons, of course: a surgeon’s inexperience, recklessness, or fatigue, or his inattention to detail and proper technique. Aberrant anatomy, prior surgery, body habitus and underlying disease processes lay additional mines which trigger in unexpected ways and at unplanned times. But in many cases — perhaps even most — such ethical, physical or technical failings contribute little or nothing to a bad result or a poor outcome. Such a claim seems self-serving — and perhaps it is; hence I leave judgment of my own performance in this situation to those wiser and more objective than I — but it has been my experience that such is so with most good, talented surgeons with whom I have worked. The power to heal is the power to harm; the competence to cure the capacity to kill.
I have long marveled at an observation I rarely hear made: that a patient, a complete stranger, after one or two short visits, allows a surgeon to perform what is often a high-risk surgical procedure on their body, with something approaching blind trust. Granted, there is trust accrued in the degree, the board certification, the training, and hopefully the reputation of the surgeon you (or more likely, your family doctor) have chosen. But in reality, the information gap is real, and the leap of faith substantial. The “eyeball test” only goes so far: is the personable, knowledgeable professional you meet in the office a ham-handed clumsy oaf in the OR? Is the obnoxious, cold, arrogant technician a highly competent surgeon (a dichotomy often imagined as the norm), or instead a hot-headed impulsive boor whose ego trumps caution in surgery while denigrating all around him? Fortunately, neither scenario is typical — most surgeons are well-trained, professional, and highly competent — but how will you know?
But even among the highly competent, unexpected or adverse events in surgery are closer to the norm than the exception. Most are trivial and inconsequential — the small vessel cut and easily secured, the important suture which breaks and must be replaced, the surgical dissection which proves tedious and time-consuming rather than routine. Even more serious surgical problems may end up having no discernible impact on the outcome of the procedure, the recovery, or the end results. But serious complications are the bane and bale of every surgeon: our perfectionistic natures strain to demand that it not be so, but reality too often intervenes to correct our hubris and false hopes.
The dashed expectations and frustrated hopes of perfection fall hard on all whom surgery touches — the patient, the family, and the physician. For the patient, there is of course the harm done: the surgery aborted; the longer hospital stay; the pain of additional surgery or procedures made necessary; a temporary or even permanent disability; the disease not cured or ameliorated; even — God forbid — death itself. Both families and patients must bear these losses — and often suffer financial setbacks as well, both in medical costs, lost jobs, wages and benefits forfeited. And the question of, why has this happened? How could it occur? all too often go unanswered, or at best only partially so. Such confusion and frustrations often lead to anger — a potent cocktail whose dregs are often drained in the cold glare of courtroom lights.
For the physician, the demeanor perceived as indifferent or callous is rather the intellectualization and rational detachment which allows the surgeon to perform the vivisection which the untrained would find ghastly. But the cost of such steely objectivity comes in the relationships with those harmed, as empathy and compassion must be recruited from the dark closets to which they were banished long ago, orphans of the very training needed to excel in this field.
And beneath the professional veneer simmers also a cauldron of emotions. Smashing the idol of perfectionism comes hard — though a fragile idol it be — as false conviction that care and competence can avert all disasters is dispensed by the errant knife or misplaced scissors, by dense scarring or genetic quirk. The confidence which carries a surgeon effortlessly through daunting technical challenges melts away in moments, as simple tasks become feared challenges in the light of recent failure. The trust so critical to the patient-surgeon relationship is shaken and battered, and may not survive the event. And the fear: of unforeseen secondary complications arising in the future; of judgement and criticism by peers; of angry families and damaged reputation; of legal implications in an environment where lawsuits are the answer to every problem.
For some the worst wounds are self-inflicted, as shame, self-criticism and depression set in. Like the trapped wolf gnawing at his own leg, we wound ourselves further in vain hopes of escaping the pain and seeking freedom from its ensnarement — only to end up weakened, more vulnerable, and less able to stand. And we strike out at those closest to us, those who wish to help, deepening our isolation. The results can be deadly: scratch the surface of physician suicide — a problem more common than generally recognized — and you will often find the self-destruction engendered when perfectionism collides with poor outcomes.
To greater or lesser degree, many of these reactions were mine in the aftermath of this complication. And there was one other: I was angry — angry with God.
You see, I pray before surgery — and I prayed before this one, for guidance, wisdom, and good judgment, as I often do. If you are of a skeptical bent, and disinclined to give weight to such superstition, at least humor me by accepting that such an act might focus the mind and center the soul. But only a fool would deny that there is much beyond our control — and few things teach this lesson more clearly than surgery. It was not always thus: I have lived a life where skills and talent were all that was needed to succeed — a formula which led me inexorably on a downward spiral of failure. So I pray.
But to pray is to expect answers — and with that lies the unspoken assumption that all will turn out as I would wish. And so, it is God’s fault — is it not? — if the outcome is not what I would desire. Did I not have my patient’s best interest at heart in this request? Would not a good God answer this prayer to the benefit of both me and those He entrusted to my care? And so it appears, ipso facto, that God screwed up — and I get to take the heat. Bum rap, it seems to me.
But maybe — just maybe — there is a bigger picture in all this. Maybe I get to learn how little really is under my control. Maybe I learn to depend more on Him than on myself. Maybe — and this is a tough one — my shortcomings, my imperfections, which can cause harm as easily as my skills beget good — can work beneficially in some unfathomable way, even for those who must bear the suffering of these very imperfections. Some of the worst, most painful episodes in my own life have proven in the long run to be blessings unimaginable at the time — perhaps it can also be thus for others, even when I am the instrument of such adversity. A frightening thought, this — a terrible power.
And what of John? His recovery has been smooth, his lymph nodes show no cancer. I have apologized to him and his wife for this adversity, though no harm was intended nor evident neglect present to my knowledge. I have offered to assist with any financial burden thus accrued. And they have decided to trust me to perform the second surgery — which is humbling and sobering in ways difficult to express.
May God be with me then — and always.
40 comments so far ↓
Vicki Small // Nov 3, 2005 at 5:54 pm
Wow. Your pain is palpable, and I can only (put that in quotes) pray that your load will lighten and that the body of adverse consequences will prove to be a temporary burden–and that you will forgive yourself. I am glad for you, and for the patient and his family, that they are willing to trust you again; lawsuits are handy for venting blame and rage, but they rarely, if ever, promote healing of spirit, no matter the outcome.
B. Durbin // Nov 3, 2005 at 8:04 pm
My ideal of perfection is not a person who never makes mistakes, but one who is competent at dealing with inevitable problems. The personality which most drives me nuts is the one which seizes up in a crisis. (I’m not saying that’s the worst, just the one that makes me bonkers. There’s a coworker of mine who gets stressed out when things start going mildly wrong and it’s my daily task to not show my irritation with her because she’s mostly a nice person with whom I get along. But sometimes she. just. drives. me. nuts.)
I would be willing to allow a second chance in this sort of situation, particularly in an unusual setup; it seems to me that a surgeon once caught out like this would be more vigilant on the second go-round.
Judy // Nov 3, 2005 at 9:39 pm
While the answer to your prayer might not have been precisely the one you wanted, your patient appears to have been protected from serious harm. I’m not a big believer in coincidence - having the vascular surgeon close at hand to assist was surely an answer to that prayer. Control? An illusion. One we surrender most unwillingly.
Amka // Nov 3, 2005 at 10:56 pm
I’ve thought about this sometimes when I sew and make a mistake, or the fabric slips, or the needle breaks. I understand that it is a far humbler occupation, but for some reason surgery comes to mind. I find myself wondering how awful it would be to be unable to so easily repair a mistake and to have to learn under such unyielding circumstances. I shudder for the doctor that the occurance of an incident doesn’t have mere human vanity at stake, but life.
Thank you all for braving the harsh calling.
Brutally Honest // Nov 4, 2005 at 5:46 am
If I were facing surgery…
… and could choose whose hand might hold the scalpel, I’d choose Dr. Bob:These have been difficult weeks. The practice of medicine is one of the most gratifying careers possible, but it is relentless in its demands and unforgiving of
Shauna // Nov 4, 2005 at 10:46 am
It seems to me that you got what you prayed for…..guidance, wisdom, and good judgement all came to you, though perhaps not exactly when you requested them.
I enjoy your insights and look forward to reading more.
Kitty City // Nov 4, 2005 at 10:46 am
You might be surprised - and possibly relieved - that patients beat themselves up too when things do not go as planned.
After experiencing a rare chemotherapy complication several years ago, I partly blamed myself for the fact that after I reported it, it festered unrecognized for another two months. Should I have known how serious it would get? Should I have been more aggressive in insisting that it be more thoroughly evaluated? How could I not have known it was going to cause a problem?
So yes, I know all too well how incidents like these serve to undermine our trust in our own judgment and our powers of observation.
The physician does not know I feel partly responsible for the outcome, nor that I understand and forgive the role he unintentionally played. He emotionally withdrew immediately after this incident, so there was never an opportunity to talk about it. I regret very much that when the outcome is less than ideal, patient and physician often are compelled to carry their burden alone. You put the emotional complexities into words - so beautifully, too! - and I thank you for that.
Kerry // Nov 4, 2005 at 4:45 pm
I am a woodworker by profession. (Dear readers, do not construe my humor as criticism aimed at Dr. Bob. His post prompted me to share this.) Just before my prostate, surgery, and moments before I succmbed to the anesthesia, the urologist cheerfully leaned in, “How are you doing?” “Remember”, I said, “Measure twice, cut once.”
Grumpy Old Man // Nov 4, 2005 at 5:06 pm
Of course, I admire a conscientious, competent surgeon (especially when I need one, as I just did when I was diagnosed with bladder cancer).
But I equally admire the way you write, both in form and content. I’m not a bad writer, but your writing makes mine look slapdash.
What I don’t quite understand is how you manage to be both a man of science, as you must be, to do what you do for a living, and a man of obviously sincere faith. Sometimes I wish i had that faith, but I don’t quite get it.
And I’d let you operate, if I needed it.
Greg P // Nov 5, 2005 at 11:04 am
Two observations:
1) I am not a surgeon, but I have had patients where I have been involved with helping them decide about treatments which have included surgery. Occasionally, someone will say while I am trying to explain benefits and risks, “That’s OK, you don’t need to hear any of that. I’ll go with whatever you think is best.” When we are discussing treatments with definite morbidity, and worse potential morbidity, I tell them, “This is not acceptable. You must understand what you are getting yourself into. It’s not me who is having this done, and until I might be actually faced with a decision like this, I’m not sure what I would do.”
2) I think your dilemma with God is analogous to what I tell patients sometimes, “This illness is the most clear way that God will speak to you. You have to decide whether you will get the message or not.” And it doesn’t matter if they believe in this or that God or any God at all.
I think your experience was just that — a message from God. Is He showing you your arrogance? Is He testing you? Are you passing the test? You’re the one who must answer these and other questions.
Dr Bob // Nov 6, 2005 at 12:53 pm
Thank you all for your kind words and support–they are greatly appreciated.
In the Brain Jazz which is the world of weblogs, one comment seeds a great question, which I hope to address in a post soon.
Grumpy Old Man ponders:
What I don’t quite understand is how you manage to be both a man of science, as you must be, to do what you do for a living, and a man of obviously sincere faith. Sometimes I wish i had that faith, but I don’t quite get it.
Ahh, the fusion of science and faith–those irreconcilable roommates, partnered yet seemingly incompatible–now that is a subject for reflection. Great question–and ruminations thereupon are coming to a blog near you.
Niels Olson // Nov 8, 2005 at 7:15 am
We’re doing the abdomen and lower limb right now. Our cadaver had lymphoma covering the aorta and posterior abdomenal wall from the inferior mesenteric artery to the the prostate, and we’ve been moaning about it. Sounds like we shouldn’t be complaining. I’m putting together a practice practical for the class this afternoon. I’ll be looking to tag some abarrent iliac vessels for sure.
Moof // Nov 8, 2005 at 8:39 am
After reading this, if I had to choose a medical professional for myself or a loved one, the choice would be simple: you.
You made some comments that address directly an issue I was faced with on Sunday. To emphasize my point, I would like to link to your blog entry, if you don’t mind.
Thank you - for giving yourself to your patients, and for allowing us to see your heart. You’re an extraordinary man.
LJ // Nov 9, 2005 at 3:10 pm
I hope you don’t mind a little irreverence and levity interjected into this otherwise depressing post.
Whenever I hear x-tians discuss prayer (answered or not) I can’t help but ask how one would know if a prayer was answered or not. There is no way to verify the prayer, and God is notoriously cryptic. It seems either way you go, God is cited. It’s what we call an unfalsifiable belief.
Now hear me out. My intent is not to deride and mock (well not merely, at least) but just to point out the way a sceptic like myself would think about such a situation. If the answer to a prayer is indeterminate at best, why should I ascribe this non-activity (as the case may be) to an equally evasive and ambiguious entity I have not met?
The answer is that I wouldn’t. It seems much simpler to attribute the answer or non-answer to chance or blind luck or maybe just stop talking with certainty about that which I know practically nothing–(aka intellectual honesty).
However, the theist is committed apriori to a series of equally unverifiable propositions one of which is that prayer actually does something so they are ready and even commanded to believe without proof. I guess that is what faith is: belief in the absence of proof.
I hope my point is clear. While I do find faith irrational and worthy of mockery, (as do christians when faced with beliefs they view as silly) that is not my intent here. I simply wonder if christians understand the real motives behind unbelief, which are as expounded above. Basically, there is no good reason to believe–at least not in the overly specific way that theology requires.
Now for the funny part (at least to this mind) see this link:
http://www.theonion.com/content/node/28812
Here’s an excerpt:
SAN FRANCISCO–For as long as he can remember, 7-year-old Timmy Yu has had one precious dream: From the bottom of his heart, he has hoped against hope that God would someday hear his prayer to walk again. Though many thought Timmy’s heavenly plea would never be answered, his dream finally came true Monday, when the Lord personally responded to the wheelchair-bound boy’s prayer with a resounding no.
Enjoy your carnival :)
Dr Bob // Nov 9, 2005 at 5:11 pm
LJ,
Thanks for taking the time to read and comment.
Your thoughts are appreciated, and raise valid and reasonable questions. A reasoned response would be far too lengthy to bury 15 comments down on an already long post. I’m planning another on science and faith in the near future (see my above comment) which will touch on these issues at least to some extent. That assumes, of course, that your skeptics’ theology (to use the term loosely) leaves any openings to challenge your own motives for believing as you do–and dismissing the rather vast numbers of people who seem to think that prayer is something more than a delusional random answer generator. If you are, then check by periodically, and leave a comment or two. If this is just a drive-by dissing, well, at least you can go away a little more pleased with yourself. Glad I could help you in that.
Anyway, have a great day, and thanks for stopping by.
LJ // Nov 9, 2005 at 5:51 pm
Well, I am not the type to give and not receive so I will check back.
Please, however, do not waste our time by attempting to attribute any “theology” to me. The burden of proof is on you sir to demonstrate why your explanation is as valid as the myriad of others. If anything, I claim an epistemology that does have what you would call “theological” repurcussions I suppose, but I will not be constrained by your worldview, nor should you be by mine. Let us, instead, find the common ground.
Additionaly, assuming Romans 1 as your axiom will not help, because this also undermines all human attempts to understand reality (which includes composing Romans 1, various attempts at translating, interpreting, harmonizing, reading, etc).
Moreover, your arumentum ad populam holds no water, as millions believe other than you do and you certainly wouldn’t grant them the same latitude. It is the heighth of dishonesty and poor form to claim that my dismissal of a claim without proof is somehow out of bounds. In truth, the need for external verification looms for the honest seeker, because, as Edward Carnell, late professor of Fuller Theological Seminary puts it, “it is always theoretically possible that what has been conceived to be God…is in reality nothing but the fruit of an auto-projection”
To return to your post on prayer: please explain an objective way we can decide, and, absent that, why you or I should accept your explanation while denying the same to competing unverifiable faith claims.
I hope this does not come off as rude, but it seems to me, sir, that the whole of theism, especially as it becomes over-specific and sectarian (e.g x-tian), is founded on special pleading.
Thanks for talking with me. Enjoy the rest of the carnival :)
Barb // Nov 9, 2005 at 8:25 pm
Dr. Bob,
Being someone who has undergone MANY operations over many years, I’ve been most fortunate to have praying Drs. The last was a badly broken hip 4 years ago and I had to have a full hip replacement(BAD fall). My daughter works for a DR and she called and got his opinion on who to trust (we do check you out (smiles).. and I respected him enough to take his opinion to heart. And, I’m glad I did. I found I had one of the best Drs around, very humble, great bedside manner, and best of all, a Christian who prays before every surgery! And, he didn’t mind talking to me and my husband about God! I so appreciated that.
He made one comment that will always stick with me. He said, “I’ve only been a Christian for 5 years, but I knew God’s hand had to be on mine, each time I went through an operation, because I couldn’t have done it on my own.” I know this has to be a difficult job, but you sound like a DR like mine above - very humble, and not afraid to say I goofed, forgive me. In my book, that goes a long way in saying what a good DR you must be!
As someone else said, your prayer was answered, maybe not in the way you asked, but it was answered. We often think we know what GOD will do in answer to our prayers, but He often does right opposite. And, in each answer, He teaches us just a little more of how much He is in control of every facet of our lives.
Tidbits And Treasures // Nov 9, 2005 at 8:42 pm
Christian Carnival XCV Is Up!
Chad, at Eternal Revolution, has done a great job in putting on the Christian Carnival this week. And, there are some great entries! I just got through reading a couple, and one among them, That Terrible Power by Dr. Bob, at The Doctor Is In, is a must…
Vicki Small // Nov 10, 2005 at 7:22 am
There have been scientific studies done–one began, I think, back in the 60’s, and others have been done more recently–on the power of prayer. Notice I said *scientific* studies. Every one I have read about concluded that individuals who were prayed for, even anonymously, even without their knowledge, and without the pray-ers knowing the specifics of the need, fared better than those who were not.
Do I think such studies are going to convince a skeptic? No. Such people love to read and gather “knowledge,” but the wisdom of God is foolishness to the “wise” of this world.
There is always the possibility, however, that a person such as LJ, in a moment of deep need that is unmet by personal control and intellect, will cry out to God and find that He really does answer.
Greg P // Nov 10, 2005 at 6:48 pm
Just as I believe that everyone has need for and derives some benefit from the touch and kindness of others, I also believe that everyone has some kind of internal spirituality which may manifest itself in belief in one religion or another, or perhaps no religion at all.
It is this spirituality that we face at the major defining moments of our lives, and at the moment when we see the end of our life coming. We also face it when we get the fright of chest pain or warning of a stroke, and we must decide what about our lives has been meaningful, and how we will face the challenges of changing old and bad habits.
In the end, we all care about something, and somehow we should be trying to understand what that something is.
LJ // Nov 12, 2005 at 2:11 pm
Vicki et al,
I have already found out that God doesn’t answer prayers, or if he does there’s no way of being secure in the knowledge that he really did. The only thing I learned was a condition called learned helplessness.
I decided that I owed myself and (if there turns out to be a deity) I owed the author of truth and freedom my best efforts to come out of the mind control that religion is and.
Maybe I followed his will?
Chris Rangel MD // Nov 13, 2005 at 9:00 am
I am curious. Why do you pray before each surgery? The obvious answer would be something along the lines of asking God to guide your hands and for her to give you the skill and wisdom to cure this patient and avoid badness etc. etc. etc. But you yourself admit that complications are inevitable no matter how skilled the surgeon. Why then pray for a skill that you already have and for a no serious complication rate that you know is impossible?
The most important part of your story is the part that you dwelt with only briefly at the end where you mentioned that you “apologized to him and his wife for this adversity”. Two few physicians apologize when something goes wrong. Studies have shown that not only is this a very good way to avoid a lawsuit but patients and their families significantly appreciate when their doctor admits a mistake and gives them a sincere apology.
Do you pray for the strength and wisdom to admit your mistake(s) and to offer an apology and to ask for forgiveness? To ask for and to grant forgiveness is the most Christian of attributes. This is what I would pray for . . if I prayed.
Vicki Small // Nov 13, 2005 at 5:26 pm
Before I go into surgery, I would like to know that my surgeon is going to be praying for clarity of mind and sight, for intuitiveness, for steady hands, a steady mind and hand when complications are encountered, and for freedom from arrogance that might lead him to take less care than he should. I would be thrilled to know that my doctor did not consider himself the highest form of intelligence, or infallible, and that he was able to admit any mistakes and ask for forgiveness.
And in case I had missed any cues in prayer, I would pray that God would give the surgeon all that he needed in order to handle whatever he encountered.
LJ // Nov 13, 2005 at 5:49 pm
Vicki,
I am curious about the thought processes of x-tians that pray. Regarding your statement above, do you mean to imply that your God would not grant these attributes unless asked?
If yes, then what kind of god is that?
If no, then what is the point of prayer? Is it some sort of focusing technique for the person praying, or is the creator of the universe an active participant in the proceedings?
I am a bit confused on wht the expectations and purpose of prayer is.
Dr Bob // Nov 13, 2005 at 10:06 pm
Hi folks,
Sometimes the comments section is more fun–and interesting–than the post.
I’ve got some heavy-duty issues that need time and focus (and prayer–sorry LJ) for the next several days, but a lot of good points have been raised in the comments which I hope to ponder in full or part in a separate post.
Visit Charles Rangel’s site (comment 22 above) in the meantime–it’s excellent, and a regular stop for me. Top-notch commentary on medicine in the real world.
In the meantime, here’s a previous post on prayer as an assignment, which may cover some of the thoughts and questions expressed by my ever-thoughtful, probing, and intelligent readers. (I try not to be probing–as a urologist it makes people–especially men–ill-at-ease).
And by the way, I appreciate the courtesy and restraint of all despite disagreements.
Hope to get the post up soon, depending on how things evolve over the next few days.
Back soon–and thanks for reading and contributing.
Cardiac » Fantastic Hurt and Faith from a Surgeon // Nov 14, 2005 at 2:10 am
[…] sted in Arteries at 10:10 am by Cardiac Men of science can certainly be men faith. This ones a must read. Inspection of the surgical field confirmed my worst fear: […]
Rundy // Nov 14, 2005 at 4:31 pm
Hello All -
I’ve followed this thread with interest. Here are a few crumbs I’ll throw into the ring.
The statement in comment 24 by LJ “I am curious about the thought processes of x-tians that pray” struck me as rather sweeping. You’re likely to get a different answer on prayer from every Christian that prays. No homogeneity here.
“What is the point of prayer?”
Good question.
Biblically, prayer is not defined by (or consist solely in) making requests. Thus, while the question of efficacy of petitionary prayer is a valid issue, reducing biblical prayer to this one aspect is to have already distorted it.
For a Christian, the touchstone for prayer ought to be the example of the one we claim to follow—Jesus Christ. He said, “This, then, is how you should pray: ‘Our Father in heaven, hallowed be your name, your kingdom come, your will be done [. . .]’” (Matt. 6:9-10, NIV).
And further on the night he was betrayed he prayed, “My Father, if it is possible, may this cup be taken from me. Yet not as I will, but as you will” (Matt. 26:39).
. . . Hollowed by Your name
. . . Your kingdom come
. . . Your will be done
. . . As you will
It is the nature of man to be focused on the I and the My. What I want, and my will. In contrast, the example of Christ in prayer is a seeking of, and focus on, the will of the Father.
Food for thought.
LJ // Nov 16, 2005 at 6:29 pm
(Will of the Father=best humanitarian intentions as far as we can tell.)
So prayer has no function or effects we can readily discern, but we still persist in doing something to achieve an unknown end of an unknown Super Vagueness–all because of tradition?
If that’s the case, I’ve got an email “friend” from Surinam who needs your bank account number. Don’t worry if you don’t recognize the benefits of this blind act right away, I assure you, we always treat our email “friends” honorably. Your selfless act of submission is important in the process of your sanctification.
(See how you require proof and reason in every other part of your life?)
LJ // Nov 16, 2005 at 8:20 pm
Ok Dr. Bob,
So I read your 7/20 post. I’ll say this much: you sure write purty.
As for your circular incoherent pseudo-reasoning, that’s another matter. But hey, it’s your illusion (or not)–bon apetit!
Moof // Nov 16, 2005 at 9:15 pm
I think it’s sad that some people leave a comment only to heckle. It makes me wonder why they’re even drawn to take the time to come to a place they seem to be so disdainful of.
.:.What kind of need are you trying to fill?.:.
Whether I were a believer or not, I don’t think I would be able to get my jollies out of rubbing other people’s noses in their own faith - or lack of it.
This particular post is the most memorable post I’ve read so far - anyplace. I’d like to copy it and send it to every one of my own physicians … and to a few other people who could benefit from it.
… Maybe that’s why some people just can’t leave it alone.
Dr Bob // Nov 16, 2005 at 11:22 pm
LJ,
Aww, shucks, you’re too kind–that’s the nicest thing anyone’s said to me all week! “Circular incoherent pseudo-reasoning”… if I didn’t know better, I’d think you were coming on to me–very sexy.
But seriously, what specifically did you find circular, incoherent, and pseudo-reasonable (is that a term?) in that post? I’ve been a software developer for years, so I realize that logical errors and circular logic (called recursion by gear-heads) are often hardest for the developer himself to see in his own code. So if there’s flaws in the logic, I’d be indebted if you’d point them out. I’m a pretty logical-sequential guy by nature–though reason and logic do have their limits.
And BTW, I don’t mind someone challenging my thought processes or beliefs, if respectfully done–as you have been, by and large.
And thanks for the compliment on my writing, too…
Rundy // Nov 17, 2005 at 3:07 pm
LJ (and Dr. Bob) -
My apologies in advance. This is a long comment.
In this comment thread it seemed the discussion of prayer had gravitated toward the issue of “what do I get out of it.” This is quite natural. Pagans religions through the ages were about greasing the wheels of deity for one’s own benefit.
People who considers themselves rationalists (I presume you characterize as such) would also see the only reason for prayer being self-benefit–either the avoidance of evil or the earning of good. Unfortunately, too many Christians also give this impression–either because of flawed thinking or carelessness in their communication. Too often God is portrayed as some big goodie machine which–if we only work the prayer levers long enough or hard enough–we get a reward plunking out.
You put the emphasis on getting something for oneself out of prayer. I do not deny that requests are a part of Christian prayer, but in my previous comment I sought to stress that the focus of Biblical prayer is not self-centered.
Christ prayed that he would not have to go through the suffering on the cross (see Matt. ch. 26 again), but at the end of that prayer he prayed that the will of God the Father would be done. And so Jesus Christ was crucified. If Jesus, the most, (and only,) righteous person can’t come to God in his moment of extreme trial and cash in his chips for a “get out of jail”–if, instead, his prayer is answered with the most terrible death–then either God doesn’t answer prayers, or else Christ and his followers are nuts. Because, being righteous and praying to God doesn’t seem to accomplish much as far as saving our own skins.
See, I’m not disagreeing with you that Jesus and his Christian followers are nuts. Rather, I’m trying to elucidate how nuts we are.
Rather than working the prayer channels as hard as we can in hopes of eking out a gift we are called to seek the will of him who sent us. Since the many prayerful Christians of ages past have died many a horrible death either God isn’t very good at accomplishing his will, or else his will seems rather sick, not to mention unpleasent.
This recognition of miserable deaths and suffering by the great prayer warriors of the past gets around to your comment of “(Will of the Father=best humanitarian intentions as far as we can tell.)”
Who is defining “best humanitarian intentions.”? Ask ten different people in ten different countries and you’ll probably get ten different answers. Whose standard of humanitarian intentions is God accountable to? The UN? Yours? Or mine?
A better statement would be “Will of the Father=that which is best.” The will of the Father might not be your health. It might not be your wealth. In fact, getting back around to all that suffering and death bit, it seems like the will of the Father might not be all that pleasant, humanly speaking.
Moving along, you say prayer has no “function or effects we can readily discern”. That depends on who the “we” is, and what the we holds as a litmus for “readily discern.” Some people say that prayer does have an effect which is readily discerned. Others say not. This is the point in discussion where the contention first began in this thread.
Your statement that seeking (or praying for) the will of the father is persisting in “doing something to achieve an unknown end of an unknown Super Vagueness” does bring up what many see as a problem. A bit of clarification, then.
Biblically, the end is not unknown, strictly speaking. “Thy Kingdom come.” When the kingdom comes that is the end. As for issues of vagueness–unless one claims to know all the thoughts of God there will always be some vagueness. Nobody in the New Testament claimed to clear all that vagueness up.
Have we been given some knowledge? Yes. But, “what we will be has not yet been made known” (1 John 3:2). If we knew everything there would be no need for trust, for faith. If we knew everything, we would be God—or, God would be nothing more than man with the added feature of being able to throw down lightening bolts from on high. So yes, I posit that God cannot be fully encompassed by our minds. Define this human inability as you like.
Prayer is not rightly continued because of tradition. Perhaps you mis-understood what I meant by our prayers being focused on the will of the Father. I was not suggesting that prayer is supposed to be the daily repetition of “Thy will be done,” as if we just drone those words on in an endless monotone until we tire of praying for the day.
The idea of “Thy will be done,” which is contained in the Bible is fully expressed in ones whole being–thoughts, actions, and innermost desires of the spirit. Prayer does not consist of saying “thy will be done” in as many variations as we can happen to think up. Prayer is communication. It consists of petition, praise, thanksgiving, and so on. In prayer we seek to praise God for what he has done, to be like him, and to understand him–because all of these things are his will. We ask God for “things” (whether it be for wisdom or for more tangible things) because we know that it pleases him to answer our prayers. In answering our prayers God shows us who he is—revealing his power and his will. Note: In “answering” I do not mean to imply that we get what we wanted. Even the apostle Paul received the answer of no, “My grace is sufficient for you” (2 Cor. 12:9). This gets back to the whole thing of praying to God and still dying, suffering, and living in poverty. Not a great selling line to most people, but I don’t see the Bible as exactly be shy about the facts.
About your Surinam “friend” . . . I also have a “friend.” He said, “Go, sell everything you have and give to the poor, and you will have treasure in heaven. Then come, follow me.” Your Surinam friend was probably at least smart enough to tell you that you would earn a lot of money if you gave him your bank account number. In whatever feeble way, he at least tried to make you think you would gain something tangible that would improve your health, wealth, and prosperity. Not my friend. He says sell everything you have and you’ll have treasure in heaven.
Can’t top that. Get rid of all your earthly possessions and come follow me to suffer every form of pain and deprivation so you can have treasure in heaven. Just trust me on this one.
Want some beach front property in Nebraska?
See, we don’t need your friend from Surinam to make your point about proof and reason . . . Jesus Christ servers your example well enough, don’t you think? (My quote was from Mark. 10:21.)
We’ve been discussing prayer, but really the problems present here are only extensions and manifestations of something deeper. The lack of proof or reason (as you define it) strikes to the heart of the gospel. Why not skip this whole issue of prayer and face the fact that the founding stone of Christianity is God taking on the form of man, born of a virgin, killed and brought back to life so that the punishment for our sins might be paid and everlasting life belonging to those who believe, that we might dwell with God eternally when he returns. I think every point just made breaks your reason and your need for proof. And, we haven’t even got to prayer. Focusing on the dubiousness of prayer (Christian prayer that is) is rather like straining at the gnat while ignoring the camel. If you can accept the whole Christian spiel that comes before getting down on your knees and praying to that God, then the problems with prayer seem rather small.
Rephrasing the question implicit behind your “Surinam friend”, you want to know what authority I am accepting that leads me to believe this unbelievable stuff, and what experience can I claim as backing up that authority.
Ah. This is where we get into the supernatural. That’s our little bone of contention–the spiritual, the supernatural. Neither of these things fits within the rationalist framework. How can you hold the intangible. How can you touch the untouchable?
Let’s go back to your Surinam friend. Let’s say I was dead, long dead, and your friend from Surinam came along. He looked at my dead bones lying on the ground and he said “live.” And then I was standing before him, alive. Then he said, “Give me your bank account number. In fact, give me all your money. Even more, spend your life living for me.”
Now, whether you think your friend for Surinam would be fair in demanding all these things, I think you would agree that he has demonstrated some proof, and some authority, in his act of raising me from the dead.
You reject the spiritual, the intangible, the unseen. Nonetheless, if you are interested in understanding my “thought-process” it is something like the example above. I was spiritually dead. Dead beyond all hope. Worse, I did not even know I was dead. When I was dead I thought it was normal and natural. Then God said to me, “Live!” and I was alive. Only then did I see how dead I had been, and now how alive I was. The presence and power of God in my spiritual life is the proof, the reason, and the authority.
Is that tangible? Is that something you can discern with your eyes, hear with your eyes, taste and feel? We can digress into philosophy, metaphysics, and existentialism, but why bother? Certainly by all tangible standards James, Peter, Paul, and Jesus Christ didn’t have it very hot. If the very ones I claim to follow failed to show tangible, rational, worthwhile benefits for their employment by God, what makes anyone think any Christian will?
“If there is no resurrection of the dead, then not even Christ has been raised. And if Christ has not been raised, our preaching is useless and so is your faith. More than that, we are then found to be false witnesses about God, for we have testified about God that he raised Christ from the dead. But he did not raise him if in fact the dead are not raised. For if the dead are not raised, then Christ has not been raised either. And if Christ has not been raised, your faith is futile; you are still in your sins. Then those also who have fallen asleep in Christ are lost. If only for this life we have hope in Christ, we are to be pitied more than all men” (1 Cor. 15:13-19).
There you have it from the very mouth of the apostle Paul. If only for this life we have hope in Christ, we are to be pitied more than all men. I don’t know if you would call your reaction to Christians pity or contempt, but Paul puts it rather well, don’t you think?
Vicki Small // Nov 17, 2005 at 7:01 pm
LJ, I just saw your questions of me; I’ve been away for a few days. I would need to look up precise references, which I’m willing to do tomorrow or Saturday, but Jesus Christ told us, several times, to ask: “Ask for anything in my Name, and I will do it,” is one example. God knows our needs, yes, but He clearly–according to scripture–wants us to be involved, to acknowledge our dependence on Him (a really tough thing for the intelligent person, especially, to do), and to ask. Our asking also gives Him the chance to answer: Yes, No, or Not yet. And no, I don’t often get an immediate reply, although that has happened.
I’m sorry–I’ve just been called to another room. I think scripture is quite clear that God wants us to acknowledge our dependence on Him, and that He wants to be very involved in our lives…as do many parents. More later, if you wish!
LJ // Nov 17, 2005 at 8:05 pm
In my previous post, I commended your writing and your acknowledgment that your faith could be an illusion. Indeed this is nothing new to the honest x-tian, and you seemed to admit this in your 7/20/05 posting. I found that admirable, which is why I attached the caveat “(or not)” to my claim you may be deluded.
I am willing to concede that the logical possibility remains that your worldview—and attenuating tale of a bloodthirsty deity who couldn’t figure out any other way to cure the universe except through the suffering of innocents—may be the correct one. I shudder to think what a tenuous and bland eternity in which we will live. But hey, that’s just an outsider’s perspective on your graceful creator. I was trying to show respect in that last brief post, yet you call me out, so I will respond.
And though you enjoy the status of revered apologete, and your fans here at your blog may think your creative non-fiction is the height of contemporary evangelical engagement with the (gasp!) godless, through straw men, equivocation, and category error, you mislead them into a false security. Not only that, you end by confessing your allegiance to the only view of the world that we have, that of reason, and for which I commend you.
To begin, you do sum up the problem nicely:
“Are [answered prayers] mere chance, wishful thinking, psychological crutches, neuro-endocrine surges that my highly-evolved cerebrum maps into culturally-molded thought patterns?”
Unfortunately you do not answer this question, leaving the specter lurking in the corner. Instead, you respond to doubt in the following manner:
“The questions I ask, the problems I present, are answered–always. But not in words, almost never at the time I speak or ask. But I know they have been answered–although the fruition, the language, the form of the answer may be hours, months, years away” (emphasis added).
In a nutshell your “argument” flows like this: You don’t always see proof of prayer working, and, in fact, prayer may be an illusion, yet you still know they are answered (though you admit your “knowledge” is often postponed).
However, when you employ the word, “know,” you equivocate. Knowledge is precisely what you don’t have; in fact, you pride yourself on operating in the absence of knowledge. So, to bandy the term “know” around misleads your followers into thinking they are on rational ground, when in actuality they have never left their lofty nest on Faith Mountain.
What’s worse, you convince yourself and consider your “argument” to have moved somewhere, when, in fact, you have basically said something to the effect of, “I believe prayer works, though (and because) I may not believe it for years to come.”
Please note how “know” functions in your “argument.” It stands in as a rational imposter and presents an illusion that something positive is occurring in your sweet rhetoric, when you are really whispering into a mud fence. What you have is belief, not knowledge.
Fearing the rejoinder, you remark:
“Of course, the skeptic’s challenge contains a presumption–one rarely recognized, in fact: that everything which exists, all that is real, can be measured, tested, analyzed, proven, and recorded. But much which is human–perhaps all which makes us uniquely human–is beyond such simple means of measurement and proof.”
Rather than retreating from your proud claims, you instead erect a convenient straw man that will enable you to persist in your special pleading.
I do not recall stating this, nor have I met any skeptic that maintains this position. This was the error of positivism, and one I do not endorse. There are many elements to reality that are unquantifiable and immeasurable yet remain objectively observable and do not need an appeal to mystical irrationality.
Further aiding your immolation of the straw man you have erected, you conveniently ignore the psychological science that does address these immaterial realities without resorting to an extra-natural concept to do so. Nicely done, Doc.
But I need not digress into “psycho-babble” to answer your charge. Consider, for instance, that love is something all cultures attest to, as is smell, or a failed marriage. Courage is a culturally dependent judgment but something many will agree has been exhibited. These are objectively observable, though they are not physical. Hmmm…does that mean we have all become x-tians now? Not in the least.
But look what you do next. Here’s where your “argument” becomes most incoherent: you make an equation between your pet mystery and everything that is particular and beyond mechanistic explanation in the human experience.
Again, you equivocate your terms. It is far different to say that you cannot measure the smell of a rose and that you cannot measure the results of prayer. Though the “weight” of an aesthetic experience is difficult to ascertain, the brute fact of smell is not. Try cutting off your nose and see if you don’t arrive at an objectively verifiable measure of smell (or the lack thereof.)
The aesthetic category is far different from the theological category; speaking of despair is not the same as positing an invisible deity with whom you correspond and who does or does not answer prayers that no one knows how or when or if.
I hope the distinction is clear.
Attempting to clothe your religious speak in respectable garb, you have conflated the two categories, thus shielding all manner of religious irrationality. This is quite a leap and I feel your category error is dangerous, because it allows solipsistic demons to arise and all manner of epistemic claims.
Further, even if I were to concede the reality of prayer and the spiritual realm , notice that only your chosen irrationality of x-tianity need apply. No room for the Poseidonist, or the Taoist, or Koreshians at this inn.
“He knows how to listen to what I ask for and give me instead what I really need, and truly want.”
You finally circle back to your theme of prayer, one you admitted above you may not “know” the answer to for years (if ever), and now say, “see, since I cannot measure it, prayer has as much validity as other naturally occurring yet unquantifiable events,” and the answered/non-answered prayer becomes proof of this deity and “evidence” of the efficacy of prayer. Whatever happens, your prayer theory is preserved. Wonderful! What amazing theosophical acrobatics!
But here’s where your diatribe really gets interesting and reveals the x-tian anxiety.
So far we have been told x-tians are beyond proof, yet you slip and advise what sort of prayer we try. Start small you say. Don’t worry about world peace (perhaps because you know it is futile to try?). Yet you are not able to suppress your innate need to know, and for this I am still hopeful for you.
“Then open your eyes, your ears, your heart for the response.”
Wait a minute! This sounds like an attempt to understand and observe. Hmmm . . . I guess if you use terms like “open your heart,” it’s got a nice soft x-tian ring to it and it’s passable, but if someone is brash and radical enough to ask for some sort of assurance or want to live their lives in a rational sphere, thenn they are to be castigated for a lack of imagination or insensitivity; all the while religious division runs roughshod through our histories.
Doc, you can’t have it both ways. You, too, wish to know; you, too, cannot help but seek explanation and observe even in the midst of your pious contractions. Unfortunately for your “argument,” your language gives you away. Your anxiety and lust for knowledge shines through even while you extol the virtues of a spiritual realm and a prayer process that is beyond our knowing.
What I have shown is a x-tian playing loose with his language; fooling some, but not all. You claim to know something about prayer, yet knowledge is exactly what you do not have.
You try to equate objectively observable immaterial realities that are beyond our ability to mechanically gauge, with an abstract theosophical category. This is an equivocation and your entire argument rests on this conflation.
Lastly, for all your theological bluster, you reveal your latent need to know, a desire you would criticize the godless for and say that we are proud or controlling or want to be our own gods or other such nonsense. If nothing else, I hope you will admit that the rational impulse is not devious.
Of course you need to know and there is nothing wrong with that. I don’t blame you.
Ultimately, though your prose is fluid, your argument fails. Your language unmasks your fearful heart and indicates the vacuous reality of living on prayer.
Dr Bob // Nov 18, 2005 at 5:32 am
LJ,
Thanks for taking the time to respond, thoughtfully. You’ve helped me in ways you cannot know.
I’ve set aside a couple of upcoming posts, and will compose some thoughts about yours in another. I’ll be in surgery most of the day today, so it may be a few days.
Thanks again.
All Blogged Up: A Moof’s Tale » Blog Archive » Shattered Trust // Dec 6, 2005 at 1:04 pm
[…] translate the concept from the realm of knowledge to the realm of realization. Dr. Bob: That Terrible Power .
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Arlan // Dec 22, 2005 at 6:07 pm
The frustrating thing about making a brilliant point is the trouble getting anyone to understand it. (Please step in, Mr. Jaques Derrida.)
I recently finished a term paper on Leszek Kolakowski’s The Presence of Myth. Therein Mr. Kolakowski argues that meaning is myth. Myth, to scholars of myth, does not imply falsity or denigration. It means “signifcant story”. Kolakowski takes this back a step, saying that anything significant is mythical.
It is a short but thoroughly intellectual book. He relies, I think, on David Hume, but he makes a lot of his own connections. Kolakowski is not a Christian. He avows the utter contingency of the universe. And yet he says that there is no way to say that anything has any value, reason, worth, moral, logic, or significance without simply presuming it (the way classical myths, such as Christianity, are presumed).
Like most modern thinking, this doesn’t leave much room for anything to be said. Obviously, Mr. Kolakowski’s conclusions mean that those conclusions themselves are only to be believed if you hold certain beliefs/myths a priori to support/validate his conclusions.
In other words, Kolakowski’s view puts Dr. Bob and LJ on equal footing, as arbitrary adherents to signification schemes.
As I said, it is thouroughly modern, rational, and intellectual. And interesting, once you make some sense of the philosophical jargon.
ThirdAge Blog » Blog Archive » Legacy Blogging // Jun 18, 2006 at 1:21 pm
[…] We spend so much time working, yet speak very little outside our work world about what we feel about the work we do. The Doctor is In writes about the terrible power of being a surgeon that will be eye-opening to his children one day and is to us right now. […]
The Choice of Fools | The Doctor Is In // Jan 1, 2007 at 6:28 pm
[…] An earlier post, on surgical complications and their challenges, generated a rather lengthy comments section (surprisingly), largely engendered by my discussion of prayer. If you have read it in its entirety, you have too much time on your hands; if you have posted comments — while greatly appreciated — it may be time to get a life. And if you spend time you do not have writing such a blog — well, in the word of one commenter, you are fully qualified as “nuts” — to which I must confess. So cuff me and read me my rights. […]
Essay of the Week: 3/18/07-3/24/07 » The Ethereal Voice // Mar 18, 2007 at 4:21 pm
[…] week’s essay is called “That Terrible Power.” Dr. Bob wrote this essay while reflecting on an incident where he cut someone’s external […]