Revolution of the Soul

In the past several days, through the lens of my profession, I have been given a rather stark and disturbing vision of our current cultural revolution. It is, it seems, a revolution every bit as pervasive and transformational — and destructive — as China’s Cultural Revolution of the 60s — and indeed may be but a different manifestation of a global transformation which transpired in those very same decades in the West. Ideas have consequences, as they say, and we are watching them bear fruit before our very eyes in a slow-motion train wreck which seems now to be accelerating at a disturbing rate.

Exhibit 1: Phyllis Chesler’s recent piece, “Every hospital patient has a story“, at PajamasMedia. It is a piece to be read to completion, including its lengthy comment section. Therein she details a recent experience during a hospital stay for a hip replacement, with a rather remarkable litany of rudeness, neglect, indifference, and suffering sustained at the hands of her healers, at an upscale New York hospital. Her story is shocking enough, and revelatory; the comments provide even further insight, running the expected gamut of such a piece in the New Media. There are those simply shocked; those sharing similar horror stories; those relaying far better experiences in contrast; those defending doctors and nurses, those attacking them. There is the obligate wackjob who blames the AMA, and the usual finger-pointing: not enough nurses, too much paperwork, inadequate pay scales to draw quality; the evil insurance companies and the government. All mostly true, to greater or lesser degree — but all missing the core dysfunction by a wide mark. At the final period of her post, one comes away with a sense of hopeless, feeling out of control and angry, despairing that such a situation may be even a part of our reality (and not knowing how large a part it may be), yet at a loss to prevent its malignant progression through our remaining hospitals which may have been spared to date, the encroachment of such a toxic stew of callousness, indifference, and coldness. There seems, in the end, little cause for optimism.

Exhibit 2: It is late, nearly 9 P.M., seeing a final consult at the end of a punishing call day, in the ICU. The patient, chronologically young yet physiologically Methuselan, lies in his bed, oxygen mask affixed to his face by heavy straps, bleeding, as he has for months, from a tumor in his kidney. He would not survive surgery, nor even radiological intervention to stem the hemorrhage by strangling its arterial lifeline. He is, furthermore, in the parlance of modern medicine, “non-compliant”: refusing treatments and diagnostic studies; rude and abusive to nurses and physicians alike; demanding to go home though unlikely to survive there for any significant length of time.

The nurse — young, competent, smart, hard-working, the very best of the modern nursing profession — apprises me of his situation, closing with this knockout punch: “You know, we just passed that initiative — you know, the suicide one. He’d be an excellent candidate.”

She wasn’t joking.

Taken a bit off guard, I responded that it is most unwise to give physicians the power to kill you, for we will become very good at it, and impossible to stop once we are.

She continued: “No, I would love to work for a Dr. Kevorkian. Be an Angel of Death, you know?”

“I know”, I muttered under my breath, as she ran off to another bedside, competently and with great efficiency, to adjust some ventilator or fine-tune some dopamine drip. And hopefully do nothing more.

These vignettes in modern medicine are really not about medicine at all. They are in truth about a culture which has lost its compassion. Our calloused and cynical society has become a raging river fed by a thousand foul and fetid streams. We have, by turns, taught our children that ethics are situational and values neutral; taught our women that compassion and service are signs of weakness, that they must become hard and heartless like the men they hate; taught our men that success and the respect of others comes not through character and integrity but through callousness, cynicism, and greed; and taught ourselves that we are a law unto ourselves, the sole and final arbiter of what is right and what is good.

We have, in our post-modern and post-Christian culture, inexorably and irrevocably turned from our roots in Christian morality and worldview, which was the foundation and font of that which we now know — or used to know — as Western Civilization. Yes, we have preserved the tinsel and the trappings, the gilded and glittering exterior of a decaying sarcophagus, where we speak self-righteously of rights while denying their origin in the divine spark within the human spirit, made in the image of God; where we bray about liberty, but are enslaved to its bejeweled impostor, the damsel of decadence and libertinism; where compassion is naught but another government program to address the consequences of our own aberrant and irresponsible behavior, duly justified, rationalized, and denied. Others must pay so that I may play, you know.

This toxic stew of self-centered callousness has percolated into every pore of our society. In health care, the effects are universal and pernicious. Patients demand perfection, trusting the wisdom of a web browser over the experience of a physician — then running to their attorney to redress every poor outcome which their disease or their destructive lifestyles have helped bring about. Physicians, hardened and cynical from countless battles with corrupt insurance companies, lawyers, and Stalinist government regulation, forget that they exist solely to serve the patient with compassion and self-sacrifice, and that financial recompense is secondary to healing and empathy. Nurses have in large measure become administrators, made ever more remote from their patients by mountains of paperwork and impossible nurse-to-patient ratios, their patient-critical tasks delegated to underlings poorly trained and ill-treated. Hospital administrators are MBAs, with no interest or clue about what constitutes good health care, and are indifferent so long as their departments are profitable and their marketing wizards successful as they trumpet “Care with Compassion” in TV ads, radio, and muzac on hold.

The list could go on far longer, but the theme is clear: we have as a culture become utterly self-focused, trusting no one, demanding our rights while neglecting our responsibilities, seeking to be profitable rather than professional. We have abandoned the responsibility to be patient and caring of others, forgiving of human shortcomings and humble about the limits of our abilities — a responsibility not merely of those in health care but of human beings in civil society. We have, through the dubious gift of extraordinary technological advances, industrialized our profession, and replaced a sacred covenant of commitment to the patient’s best — and its corollary of the patient’s trust in the integrity and motives of physicians and nurses — with the cold legality of contract medicine. Small wonder we are treated as fungible commodities in doctors’ offices and hospital beds. Small wonder we will be euthanized when we have exhausted our compassion quotient, dispatched by highly efficient providers delivering “Death with Dignity.”

This utter self-obsession and cynical callousness is by no means limited to health care. We long for “bipartisanship” in government (by which we hope for reasoned men of principle to come together for the good of those they represent), but get instead the blood-lust of modern politics, where power trumps principle, money is king, and votes are bought and sold like chattel. Lawyers sue everything that breathes — and much that doesn’t — raking in billions while their “victimized clients” get pocket change they can believe in. Airlines pack in passengers like cattle, lose your bags, and toss you a bag of peanuts for your trouble. Road rage is rampant, rudeness rules, rip-offs too common to count. The coarseness in culture is extraordinary — in language, art, media, fashion, and behavior. It is revealing how shocked we find ourselves when encounter someone — regardless of the venue — who is actually pleasant, helpful, courteous, and kind; we have come to expect and tolerate far worse as a matter of course.

The revolution which started in the 60s with the “me” generation is bearing its bitter fruit — though its aging proponents will never admit it. And sadly, there’s no going back: the changes which have infiltrated and infected the culture, inoculated through education, media, entertainment, scientific rationalism, and a relentless and highly successful assault on reason and tradition, are permanent, and their consequences will only grow in magnitude.

So it’s time for a counter-revolution.

There is an alternative to our current cultural narcissism with its corrosive, calloused, destructive bent. It is not a new government program, nor a political movement; no demonstrations in the street, no marches on Washington. Its core ideology is over 2000 years old, and the foot soldiers of the revolution are already widely dispersed throughout the culture.

This revolutionary force is called Christianity, and it’s long past time to raise the banner and spring into action.

The true antidote to the nihilism and corruption of the age will be found, as it has always been, in the church. It has since its inception been a revolutionary force, transforming the hopeless and purposeless anarchy of the pagan world of its infancy by bringing light, hope and joy where there was none before.

It can happen again.

The church, of course, has to no small degree been co-opted by the culture it should have transformed. From TV evangelists preaching God-ordained health and wealth to liberal denominations rejecting the core truths of their foundation and worshiping instead the god of government and humanistic socialism; from pederast priests to episcopal sodomy, Christianity in the West has whored itself to a prosperous but decadent culture. Its salt has lost its saltiness, and it has, not surprisingly, been trampled underfoot by men.

It is time to return to our First Love. It is time once again to become light to an dark and stygian world. It is time for a revolution of the soul.

We must, first and foremost, be about grace and truth. We must begin with the truth of our calling: to be holy, transformed by the power of Christ and the work of the Spirit. We are, by nature of our new birth in Christ, His ambassadors: we are to be the face, the hands, the heart, the words, the compassion of Him who saved us.

The task is enormous, yet for each of us, the steps are small, easily achievable yet enormously powerful.

It must begin with a renewed commitment to obedience and submission to Christ, a willingness to fully subject ourselves to His will, rather than trying to bend His will to ours. It means getting serious about church attendance — not merely as a consumer but as an active participant. We need to renew our devotion to prayer, to Scripture reading, study, and memorization, to fellowship with other Christians. These are simple steps which ground us in truth, and give us access to that power which can first of all transform us, then radiate out to all around us.

Then we must act like the counter-culturists we claim to be. Be patient with those who are difficult; be generous in time and money; express gratitude to those around us (when was the last time you wrote a thank you note to your doctor, your contractor, your attorney, to the manager of the store employee who helped you?). Lose the profanity; guard your tongue. Repair broken relationships, as best you can. Be joyful in difficult times, knowing that God is at work in your life despite your difficulties. Be compassionate rather than judgmental to those whose life choices are destructive or misguided. The tattoos and piercings we ridicule are cries of desperation from those hungering for purpose and meaning.

These things will not come easily to many of us who claim to be Christians, as we have become complacent in our self-gratification and comfortable compromises, fearful of being viewed as extremist or weird, rejected and ridiculed.

Get over it.

You may just find that such renewed passion for Christ and love for others might, just might, transform your life.

And you might just find that it will change the world.

Got a better idea? Good, I didn’t think so.

Let’s get started.

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38 thoughts on “Revolution of the Soul

  1. Reading the two preceding comments reminds me of C.S. Lewis’s description of Hell in the Screwtape Letters as a vast bureaucracy– and of St. Augustine’s remark that government is one form of punishment for original sin.

  2. I was in Georgetown hospital in DC last year. Every one was gentle, kind and patient. I may have gotten lucky but I also was too sick to whine and complain and tick off the nurses. Treating an RN like a servant will not end in a good result.

  3. It is one thing to realize that government and other large bureaucracies are wasteful, inefficient , and amoral (which they most certainly are). It is another to ask why.

    1 Lack of accountability: Humans removed from the consequences of their behaviors find their behaviors rapidly devolving toward indifference, neglect, and even evil. Accountability to others is a restraining force on evil. It is, ironically, the very reason we have government: to restrain evil. But when government reaches a critical size, it increasingly becomes a force for evil rather than a restraint thereupon, as accountability to those they ostensibly serve disappears.

    2. The Law of Rules: When individuals are guided by inner moral and ethical restraints (implanted by religion, conscience, social constraints, and traditions), there is relatively little need for formal law and punishment; the inner morals restrain outwardly evil and harmful behavior, at least in some measure. When inner morality atrophies and the influence of absolutes wanes, government is forced to pass an ever-proliferating set of new rules and punishments, which work poorly to restrain evil and have many unintended consequences. This ultimately ends in tyranny, as humans will happily trade freedom in exchange for an end to anarchy and chaos.

    Thus, Benjamin Franklin’s wisdom: “We will be ruled by God, or by tyrants.”

  4. John,

    Thanks for your thoughtful comment (and those of everyone else as well).

    As far as universal health care is concerned, remember the unattainable trifecta: low cost, high quality, universal access. Pick 2; you cannot have all three.

  5. Thanks for your indulgence, anyway.

    And about that “unattainable trifecta,” that first item, low cost, is driven by no less than four additional variables: operational profits for the institutional providers, additional profits for individual providers (physicians, clinics and ancillary services), more operational profits for non-medical administrative infrastructures where ever they are, and finally, enough additional profits to satisfy stockholders in insurance companies.

    Somewhere in that ecosystem it’s time for some “mergers and acquisitions” to reduce replicated administrative costs and profit demands.

    I have always known from the food business that size is the enemy of service. The larger the operation, the less likely it is to deliver a decent level of care and individual attention to the customer. Fortunately this is not a prindiple cast in stone. The healthcare system for which I worked is a community-based non-profit which includes five hospitals and a raft of other interests. In a determined effort to change the corporate culture to one of top-quality service and image, the leadership began a comprehensive program that started about two years ago using some Baptist hospital system in Florida famous for high marks on patient care, outcomes and patient/family satisfaction scores. Progress has been slow but solid and I have watched this system move slowly but surely from the nightmare images of these two essays to a level of caring stewardship that will soon match the best systems in the country.

    It is possible to improve and be big at the same time. I have seen it up close and personal.

    I am now employed by a senior care agency as a sitter and non-medical personal care provider. My client is an older man who broke an ankle and must be attended round the clock until he can manage to toilet himself without assistance. (He is fortunate to have laid by enough money to pay for my assistance. One sentence that jumped off the page at me from one of Ms. Chesler’s articles was “Pity the person who cannot pay for private assistance.”) I was present for his surgery and follow-up visits and can tell you that the level of care and professional excellence I saw was top notch.

    And about that “universal” part, all I can say is that some measure of universal is not optional. Rationing is inevitable, to be sure. Not everyone will be able to have the organ transplants, expensive drugs and end-of-life heroic measures that are now available only for the well-heeled and well-insured. But those people and those measures will always be available for those who can afford them. But for those who cannot afford even a baseline of care there has to be a better safety net than “get sick and die.” Tens of millions of uninsured people is not an acceptable state of affairs in today’s world.

  6. I have practiced family medicine for 26 years, and the drop in quality of care has been precipitous. The best people used to go into medicine; now they go into engineering and they will live longer and healthier lives as a result of less stress. It’s sad and it’s accelerating. Life has become cheap, expendable, almost disposable. If your physician doesn’t respect and value your life, who will?

  7. Two thoughts:

    All the horror stories are true. But I recently had a prostatectomy at the City of Hope in So. California. Everyone was extremely kind, thoughtful, and compassionate. So it ain’t all bad.

    I believe true Christianity can be found in the Orthodox Church, because I have experienced it. It’s a “hospital for sinners.” Your sensibility and thoughts are very close to the Orthodox way, which has continuity going back to the Apostles.

  8. I noted this comment: “This relationship is enabled by so-called “not for profit” outfits who must pick up the social pieces (uninsured people who by law and good public relations must receive at least life-saving emergency treatment) and pay for them by “writing off” unpaid expenses by overcharging insured patients enough to generate at least a little black ink for operational profits.”

    Questions and Comments in response:

    On what do you base your supposition that Government, the ultimate “not for profit” agency, would “pick up the pieces” or behave any better? Under a nationalized healthcare system, how will all this “free” care be funded?

    When something we want appears to be “free,” the human tendency is to use too much of it. This is abuse. Government has never, and will never, be able to legislate morality or stewardship; those are individual decisions. Is it valuable to consider that sometimes, the greatest freedom is the freedom NOT to consume something even though we can? Taking better care of our individual health (using our freedom NOT to consume too much of the wrong foods, NOT to consume too much couch time when we could be moving around, etc.), could translate into *better* use of the healthcare system. Might such self-stewardship also allow physicians – and nurses- to practice the kind of medicine that matters, rather than having their professions drain their passion? Can individual accountability function properly in a socialized framework?

    Free enterprise is what leads to innovation. Take that incentive away, and we wind up like other nations with three-plus year wait times for cancer treatments, a death sentence in many cases. There’s a reason American “medical tourism” exists: we still reward innovation that results in amazing technology. Compare our technologies with theirs and consider the implications. How can it all be evil?

    Insurance companies provide a financial service: spreading risk. If there was no demand for that service, there would be no supply. Why would you expect these businesses not to consider their bottom line? If they don’t watch the dollars and cents, the lights go dark and the doors close. I’m not saying there’s no greed. I am asking, do *you* work for free? If not, why should they?

    Who exactly are the 46 million uninsured? Some are the genuinely American poor of various ages. Others are working Americans, but choose not to part with the income to cover the premiums. Others have entered our country illegally and using our system anyway. Should all of them receive equal treatment?

    Is healthcare a right or a privilege? And for whom? Socialized medicine would say it’s a “right for all” with no rationing mechanism to limit it (except that each day has only 24 hours in it and our docs need to sleep sometime).

    I don’t know the right answers – people far more brilliant than I continue to grapple with these issues. I can say, though, that I’ve seen the best answers offered on smaller scales by a free enterprise system that promotes human compassion. While such examples are not common, they cast their lights beautifully in the dark. And I thank God.

  9. I want to answer that storm of questions but time and space do not allow. I’m starting to wish I had never left my comment. I’m having flashbacks to forty-five years ago when I was trying paitently but mostly in vain to convince Southern-born and reared family, peers and neighbors that segregation was a poisonous problem that had to be resolved. And soon.

    I’m not arguing a case for “nationalized health care” or “Government as the ultimate provider. I am pointing out that the messy collection of well-meaning, individually well-run overlays of enterprises to which you alluded are the medical equivalent of the banking and credit mess now crippling the global economy. Securitized debt (an oxymoron if ver ther was one), massive insurance schemes that cannot insure (can you say “credit default swap”), and hedge funds that no longer “hedge” are recent illustrations of private enterprise in pursuit of innovation. Individually they all made sense, but the effect altogether was something like a chain letter. The delivery of good health care should not have a multi-level marketing business plan. Two or three levels will do just as well.

    In another comment above someone quoted my remarks about the waste of material and human resources I saw in the not-for-profit health care operation where I worked for five years. My point was not that we had “the same considered and measured courtesy, efficiency, veracity, motivation, goodness, logic and concern of one’s local DMV” but that the place was swimming in revenue, so much that working conditions and benefits were way out of synch with comparable for-profit enterprises in the same line of work. In fact, it was that swollen but well-managed revenue stream that enabled the place to become one of the finest systems of its kind in the country. My point was precisely the opposite: health care should be provided, NOT sold for profit.

    The reason that non-profits are often able to take in so much money is that many of them are gaming the system by sucking up to both well-insured and Medicare/Madicaid patients while minimizing service to those who do not fall into either of those two revenue-producing groups. Why else do you suppose charity hospitals all over the country are in danger of shutting down? I don’t know about the rest of the country but I can assure you that when Grady Hospital here in Atlanta was threatened every other hospital in the area was praying that a way could be found to save it so they would not have to absorb the results if the place closed. I’m still waiting for someone to point out the importance of geography to the delivery of health care.

    Insurance companies are critical to the economy. We all need to insure against property damage, liability and loss of income. A good case can be made for life insurance (although I did read a book years ago promoting the notiion of “buy term and invest the difference”). But insurance companies do not provide health care. Their mission is to ration health care. Physicians and nurses, hospitals, clinics and laboratories are the providers. Insurance companies, however, are administrative, not medical. And their real mission is only partly to manage the delivery of health care. The other part is to provide dividends to shareholders and good benefit packages to their employees. And the only way to do that is to do a good job finding the right population of “customers” who need just enough health care to make those profits. As you correctly pointed insurance companies provide a financial service (not a medical service) by managing risk.

    The reference to “medical tourism” is interesting. I can’t tell from the context, but it seems you are referring to people from other countries who come to America for treatment because health care in their home countries is not as good. I can tell you that in the health care world (I think Dr. Bob can verify this) the term “medical tourism” refers instead to Americans going to other countries, notably Thailand or India, to get organ transplants, expensive cardiac care or other high-end treatments because they can get the same care at those destinations, including round-trip air fare and family accommodations, for as much or less than the same procedures would cost in America. Correct me if I’m wrong, but when I heard reference to “medical touorism” where I worked, that was the meaning.

    As I said before, I’m tired of references to socialized medicine and Government health care. That’s never going to happen in America. But what is happening, if I may correct and repeat what I said in my first post, is that we now have five different delivery systems, one of which, the VA, is “socialistic” by anyone’s understanding. Three others are Tri-care (for military and their families), FEHBP (for federal employees) and Medicare/Medicaid, managed (more or less) by CMS. The fifth “delivery system” if it can be called such, is the snatch-and-grab, messy, totally ineffective byproduct of the best health care system in the world by which the uninsured (read unemployed, not old enough for Medicare and those with chronic expensive and/or pre-existing conditions) receive whatever they are fortunate enough to get at the bottom of the system.

    I’m all for operational profits.But I’m NOT in favor of making money by rationing health care, and that is the mission of insurance companies. It’s called by many names: PPO, HMO, managed care. More recently a Medicare spin-off called “Medicare Advanage” is a for-profit hybrid which costs more than Medicare.

    The system we have is not working as it should. It’s not necessary to destroy it. It’s time to fix it and make it better.

  10. Mr. Ballard, it is well that you have raised the issue your moral and ethical superiority so evident by your actions of forty-five years ago or I should have less confidence in your prophecy that socialized medicine will never happen here.
    I would have thought there is not one thing you believe to be true that is not false. But in my world progress is formed by a simpler prevailing discipline, that of constant failure. You have all the formulas for avoiding them. That is precisely why we approach disaster.

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