Redefining Humanity


Gerard Vanderleun recently posted a thoughtful and moving essay on the topic of abortion, and his own personal reflections and experiences with it.

The crux of the abortion dispute is, as mentioned above, the question of when human life begins. At this point, we all know the opposing political and religious positions. At some point, human life begins and the fate of the fetus is either at the absolute will of the mother or it is not. Nevertheless, it is still hard to say exactly when humanness happens since: 1) We do not agree on the term “human,” and 2) as a result, all evidence on this issue remains anecdotal once you strip away the slant of the “research” that supports your preferred result.

When does the fetus become human?

This question, on one hand, seems all-important, yet at another level seems absurd beyond belief. It is a question which would never be asked were it not for the idea of ending a pregnancy by abortion. What reason would there be for such a question? A woman becomes pregnant, and is expecting a baby: this is the expectation of motherhood since man and woman first began procreating. In its natural course, barring unforeseen problems, a child is born — a unique instance of humanity, a living being like none other before or after. It is only in the context of deliberately interrupting this process — ending the pregnancy deliberately — that the question of of the humanity of the unborn fetus has been raised.

That such a question is raised with any seriousness is evidence of a profound denial — the denial required to end an unborn child’s life in the womb. To raise the issue of the humanity of those not yet born, to imply that the fetus is anything other than a human being, is to salve the deep discomfort of the soul inherent in the termination of a life. For we know, innately, that the unborn is alive, and human, and to justify its extinction we must engage in extraordinary contortions of conscience. Thus we say the fetus is an extension of the mother’s body, which it clearly is not; we refer to it as a blob of tissue or protoplasm, dehumanizing its unique and extraordinary human potential; we call it a “potential human”, as if at some magic point a switch is thrown to turn on its humanity — while never stopping to define what that humanity is, or why there is no humanity in the split second before our chosen transition time. We draw false and foolish analogies: the fetus is no different than a skin cell, or a “sacred sperm”, or a tumor — thus denying the extraordinary creation which occurs when the genetic map of two parents fuses into a new life, with an infinite capacity for uniqueness, change, experience, and creativity of its own. For we are created to create; we are engendered to engender; we are conceived to conceive again in an endless and infinite way: to conceive new ideas, new works, new accomplishments, new relationships, new failures and successes, and new life itself, in the generation which we ourselves engender.

From the moment of its conception, that which we so dismissively call a “fetus” begins a journey extraordinary beyond imagination. Using the inscrutable road map of its unique DNA, the developing human undergoes constant change and growth — a process which ends not at birth but some 25 years later when its full physical maturity is reached. Organs form; primitive cells differentiate into complex systems dedicated to tasks both present and future. Before its mother knows of the pregnancy, at 6 weeks, the heart and circulatory system is formed, and the heart is beating; the primitive cells forming the brain and spinal cord are in place and developing; facial features, including eyes, ears, mouth and nose are evident. By 8 weeks, fingers, toes and fingernails are present, as is the digestive system. By 12 weeks, virtually every organ system is formed and differentiated; the rest of the pregnancy is almost entirely about growth and the maturing of these intact systems. The information map for this extraordinary yet orderly complexity — and for far more, including intellect, personality, gifts and skills, — and yes, liabilities — is contained in the fertilized egg in its entirety. We are what we will be, from the the instant of our conception.

We deny what is self-evidently human for many reasons. Our secular and utilitarian culture has lost its sense of wonder at the miracle of that which is the creation of a new human life. Our children are no longer gifts but burdens, impeding our acquisitional materialism and imposing themselves on our pursuit of self-interest and self-gratification. We must dehumanize first, then destroy, the unborn child, that we may live out the delusional fantasy of unrestricted sexual license without consequences; that we may continue the self-deception that somehow we are masters of our own destiny; that we may perpetuate the fraudulent vision that our relationships are about self-fulfillment rather than sacrifice for the good of our progeny and the society and culture in which they will partake.

In introspective moments of regret we may mourn the potential loss, the wistful thought, that we have aborted a Beethoven or a Ben Franklin. Yet even this mild melancholy misses the point, showing the shallowness of our own humanity, as we find comfort in the rarity of such genius, while dismissing the loss of that far more tragic: the loss of the common, in all its richness and variety. It is not the loss of a Mozart we should mourn; it is the empty place where a merchant, a mechanic, a muse, a minstrel might have stood. It is the compassionate mother, the inspirational teacher, the clever repairman or comical co-worker who will never live to enrich the lives of others in ways trivial and transcendent. Our losses are incalculable, because we have destroyed them before we knew their worth. We sacrifice our hope and our future on the altar of calculated convenience and cold rationality.

It is not merely the loss of those who might have lived which we suffer; it is we who survive, who make these mortal choices, who are changed as well. For if the humanity of our children is fungible, redefined, discarded and spent on the expediency of convenience and self-interest, such expediency will not long remain in the dark chambers of the abortion suite. We will, in banal, measured, rational steps, soon judge the humanity of all with the same jaundiced eye. The disabled, the mentally ill, the elderly and frail will soon find our cold and rational eye cast upon them, as we find their lives ever more a burden, ever more useless and wasted, all too easily discarded as we pursue our utopian vision of perfection through self-worship.

Yet our Darwinian dream marches on, leaving the weakest to fall by the wayside in our evolution from compassionate humans to rational beasts. Survive we may — but at the ghastly price of wagered humanity lost.

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The Crush of Covenant

Well, I finally did it: I quit.

Walked into the boss’s office, gave him a piece of my mind, tossed my resignation letter on the desk, and told him exactly what he do with his stinkin’ job. “Take this job and shove it”, as the country song goes.

Felt great. Been wantin’ to do this for a loooong time.

What led me to such a drastic, disgruntled display of ill-demeanor?

Here’s just a few vignettes from the past few days:

Monday 7 A.M: It’s Monday, my regular ER on call day. Full office scheduled. The ER calls — at exactly 7 A.M. Which means the weekend call guy, who goes off at 7:00, hasn’t answered his pages for the last 2 hours. Bastard. There’s a term for this: it’s called “dumping.”

The patient: a 90-something man with Alzheimer’s dementia, from a nursing home. Not any nursing home, mind you: one specializing in the care of Alzheimer’s patients. Ads on the radio about how caring and compassionate they are — you’ve heard ’em. Creme’ d’ la creme, and all that. Chronic Foley (urinary) catheter for incontinence. Despite their fawning attention, he somehow managed to grab his Foley and pull it out — with the balloon inflated, of course. He’s bleeding. A lot. The caring, attentive staff at the home has also neglected routine catheter care, so it has basically eaten its way through his penis. He now pees (if he could) through a hole just over the scrotum.

The ER staff can’t get the catheter back in. Not just because the anatomy ain’t quite normal (the P.A. is still trying to insert the catheter into the end of the penis, and can’t figure out why it won’t go in) — but he’s agitated. Really agitated. 4 nurses and counting to hold him down, still throwing punches. (great left hook!). Clearly this isn’t going to work — he’ll need to go to surgery ASAP, so this can be done under anesthesia — putting in a more permanent bladder catheter through a small hole in the low abdomen. With a big-ass balloon he can’t pull out. Hopefully.

Monday 9 A.M.: Inform my office staff that most of my busy morning office has to be rescheduled, the rest will have to wait. They are not happy. The patients rescheduled will not be happy – most have waited over 6 weeks for their appointment, and probably another 6 for their new one. C’est la vie. They will likely think my “medical emergency” means I’m on the 1st tee with my golfing buddies. Whatever. The more urgent ones will get squeezed into another day, already overbooked. Then they can be even more unhappy because the doctor is running late, and “Their appointment was at 10:00 A.M., dammit, and their time is valuable.”

Monday 1 P.M.: Back from surgery, the few longsuffering and surly patients from the morning clinic seen and (somewhat) assuaged. Short conference with my billing specialist, a soft-spoken pit bull with lipstick who daily does battle with the forces of evil and corruption (a.k.a., insurance carriers and Medicare), and wins an amazing number of battles. But not today.

Mr. Jones, you see, had a prostate problem. So he needed a fairly simple test to check for obstruction, called a uroflow, to evaluate whether his prostate was causing blockage. Charges for this procedure? About $325.

Sounds like a lot of money to pee in a jug. But it’s a very special jug. The equipment which measures and records his urinary efforts cost over 6 figures (it has a number of other highly specialized functions as well, lest you think it’s too extravagant for such a lowly task). The specialized catheters used to measure pressures for the more sophisticated tests cost well over $100 each — and are single-use disposables. Setup, cleanup, patient instruction and assistance by my back-office nurse, about 20 minutes of her salary, benefits, health insurance, 401(k) contributions. Overhead to keep the office open (rent, supplies, maintenance, malpractice insurance, licenses, etc., etc.), about $200 an hour. Oh, and my interpretation of the test and conclusions about how best to treat the patient is included in the fee.

What the insurance usually pays for the procedure: about $125.

What Mr.Jones’ insurance company paid: $0.

The reason? Mr. Jones’ policy doesn’t cover in-office surgery. “But peeing in a jug isn’t surgery!”, you protest. As did I. But the CPT service code has been incorrectly categorized as surgery by our friends at the AMA, in their massive annual tome used by insurers and federal payors to determine payments for medical services.

So I sat down and wrote a detailed appeal letter, explaining in a clear, courteous, and detailed manner that peeing in a jug is not surgery. Dictated, proof-read, sent off. My time? About 20 minutes. My reimbursement for that time? $0 (Called your attorney lately and chatted for 20 minutes, for free? Didn’t think so).

One month later, the response arrived: Appeal denied. The letter explained how the medical situation had been carefully reviewed: first, by their highly-trained Resource and Review Nurse; then by a panel of esteemed physicians and other health care providers; and finally, because of the seriousness of the matter, by their Medical Director (whose 7-figure income reflects the gravity and burden of such decisions). The verdict?

Peeing in a jug is surgery.

Of course, it is never prudent to take the last shred of hope from the hopeless, so they politely inform me that I may submit a Level II appeal — which requires pleading to the AMA that the categorization of peeing in a jug as surgery, in their massive annual CPT coding tome, is an error. And, of course, they will be more than happy to reconsider the matter once the AMA has agreed, and changed their rules.

Oh, and have a wonderful day! We cannot tell you how much we appreciate your outstanding care for our insured clients!

Monday, 1:10 P.M:: Billing conference, part II. Mr. Smith, another nursing home patient, had blood in the urine. Came to our office for a cystoscopy, a visual inspection of the bladder. Found he had a small bladder cancer, and was scheduled for surgery in a few weeks. Went back to the nursing home until then.

In the past, billing for such a procedure was simple: submit the claim to Medicare, get paid (about 40% of my billed fee, about 10-20% less than my overhead to perform the procedure) by Medicare a few weeks later.

Then Medicare changed the rules. Since Mr. Smith is in a nursing home, the nursing home must now bill for my cystoscopy, get paid by them — and then pay me, if and when they get around to it. But, of course, they have no motivation to do so — since I have no recourse against them if they fail to bill it, or bill it incompetently and get denied, or refuse to pay me.

So the executive summary: I get nada for Mr. Smith’s procedure.

The unintended consequence of this little change in Medicare regulations? Urologists and other specialists now refuse to do procedures in the office on nursing home patients, since they don’t get paid. The procedures either don’t get done — or the patient has to be admitted to the hospital when his bleeding gets bad enough, where his cystoscopy will be performed at a cost to Medicare of, oh, about 500-fold what it would have been if I did it in the office.

Medicare, of course, will be ecstatic: their payments for office procedures will plummet, after their careful review of regulations helped trim “wasteful and unnecessary medical spending” from their budget. The jump in costs for hospital procedures which results from this shell game are, of course, because of greedy health care providers, fraud and abuse, and more wasteful medical spending — and come out of a different pocket, so’ll they’ll never make the connection. The politicians are sure to trim those frivolous expenses as well, by carefully reviewing the regulations and implementing more “fraud and abuse” abuse, as they seek high quality, affordable health care coverage for all.

Tuesday, 1: P.M: Mr. Smith’s nurse from the Alzheimer’s Home calls, and says he has some blood in the urine from his new bladder catheter (which is expected). “How much?” “Dark pink, no clots.” “Have you irrigated it?” “Yes, and we’re sending him back to the hospital.” “Is the catheter draining well?” “Yes, but we’re going to send him back.” “Is he stable, blood pressure OK, any pain, blood count OK?” “Yes, do you want him to go by ambulance or do we call 911?” “He doesn’t need to go back to the hospital.” “Well, he’s going anyway. We can’t handle this.” Yeah, I guess that’s why they call it a nursing facility. God forbid you should deliver, you know, nursing care.

14 hours later he returns to the nursing home after an ER visit, perfectly stable medically, just as he was when he left the nursing home. About an $8-10,000 medical junket, because a nurse couldn’t, or wouldn’t, handle basic nursing care.

Wednesday 9:00 A.M.: Mr. Johnson is waiting when the office opens. His is a sad story: prostate cancer, had successful surgery to remove it, and is cured. Developed scar tissue afterward and couldn’t pee. Opened it up and he couldn’t not pee — bad incontinence. Had a prosthetic device placed, an artificial urinary sphincter, nine months ago. Worked beautifully, Mr. Johnson is happy. 8 months later, leaking again: Mr. Johnson is not happy.

Took him to surgery yesterday to repair it. A tiny leak had developed, and the pressure on the sphincter cuffs was lost — an uncommon but known problem with these devices. Replaced the components, hooked it up, tested it thoroughly, worked great. The device has a control valve located in the scrotal area to open the cuffs when you need to pee, which was one of the components replaced. It has a locking button, which holds the cuffs open, as things are too swollen and tender for the patient to use it for a while. Locked the cuffs open, tested it again several times, everything’s perfect.

He goes home, and can’t urinate. Somehow the lock released on its own — which isn’t supposed to happen. Goes to the ER, where they try to put a catheter in, rather indelicately, and left it in — which greatly increases the risk his sphincter prosthesis will get infected, and have to be removed. And he needs to go back to surgery, since it is far too painful to try to lock the cuffs open now, and he will need a temporary bladder drain through the skin until the swelling goes down.

Mr. Johnson is not happy. I am not happy.

Not to be too whiny, but the responsibility of this profession at times can be crushing. At the risk of seeming hyperbolic, you really do, to a greater or lesser degree, take patient’s lives in your hands when you assume their care. Not just the life-and-death stuff, although that’s sometimes part of it too. No, it’s the rest of their lives which come under your responsibility. It’s the drug to treat a serious disease, which causes serious side effects or unintended adverse effects on their other diseases. It’s the surgery to cure cancer which can have painful, disruptive, frustrating complications, even when the cancer is cured — and even when the surgery is competently and expertly performed. You are, in the end, responsible. When the side effects happen, you are responsible. When the patient fails to follow treatment advice, or has unrealistic expectations despite your best efforts to temper them, you are responsible. When the pharmacist sends the wrong drug; when the nurse fails to notice an important problem; when the technician doesn’t properly clean and sterilize the instrument; when the prosthesis fails to operate as designed: you are responsible.

Perhaps in some alternate universe, where Gucci-loafered lawyers with fat cigars parse guilt in mahogany-gilded chambers, the responsibility would be meted out in scrupulous fairness to all involved. But as a physician, where our relationship with the patient is one of covenant, not contract, those responsibilities become ours, because we commit to the patient’s best interest, no matter what, while orchestrating the complexities and complications of this enormous technological beast we call 21st century medicine. This gleaming beast can accomplish enormous good — or ghastly harm. And much of the behemoth we seek to command is not under our control — yet we remain responsible nevertheless. So we lash, kick, prod, and goad the monster, trying to reign in the mind-numbing complexity and tie up the endless loose ends, as the monster snarls back and snaps at your head or pummels you with its tail. And never forget your own frailty: perfection is unattainable despite your most obsessive, strenuous efforts. The country doc with his black bag could do little good and cause little harm; small errors today, even unrecognized, can multiply and spiral into disaster at frightening speed. This fact alone crushes many a doctor with its gravity, as witnessed by the high rates of physician burnout, suicide, divorce, and drug and alcohol problems.

The feeling is like a punch in the gut, only worse. I am not happy. I am depressed, and angry, and fearful, and discouraged — and convinced that with my level of competence I should be flipping burgers at McDonalds. Self-condemnation is a narcotic, savored and craved by perfectionists: noxious in flavor, but oddly salutary in the self-pitying comfort of its dark and fetid euphoria.

It does not pass easily.

Wednesday, Noon: Mr. Smith, with the Alzheimer’s, is back in the ER, and they are calling me. No preliminary call to me this time from his nursing home — they just sent him back. His 4-by-4 inch gauze dressing around his new bladder catheter is bloody — about a silver-dollar sized area. The ER doc sees and evaluates him: still demented, still medically stable as a rock, blood count unchanged. The ER doc changes his dressing, and sends him back to the nursing home. So, here we are, some $20-25,000 spent on this poor man, because his nurses are inept, lazy, incompetent, and can’t change a g*d-damned dressing. No one at the nursing home will have their pay docked because of this travesty; no one will be fired or fined. Medicare will pay its fractional part of the costs, oblivious to the incompetence which triggered it. The hospital will eat the difference.

And life in the circus of 21st century medicine will go on.

And so, enough is enough: the camel’s back has snapped. I quit. It’s not the first time, by any means; likely won’t be the last. My boss is very understanding, and he’s been through this all before. That’s one of the skills you need when you’re a self-employed, solo physician.

He knows I’ll be back at my desk tomorrow, as if nothing happened. Ready to start it all over again.

* All names are, of course, fictional.

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God of Loss and Grace

The Anchoress tells of receiving heartbreaking news: the prospect of losing her hearing:

Yesterday morning, though, came a straw I have dreaded my whole life, and I finally drew it: the “you are losing your hearing” straw…

The loss was discovered, of course, due to that dismal ear infection of the past two weeks, but the hearing in that afflicted ear is only slightly worse than the other. Upon reading my test results the doctor asked if I had worked around airplanes for the past 20 years, or if I had fronted a rock band. “Severe degeneration! hearing aids!”

The pain of such a loss is real, and it is deep — it can neither be trivialized nor ignored. Some will deaden the pain by drink, others by denial or depression, or one of a host of other means whereby we mitigate the pain while refusing to embrace it.

We live with sense of entitlement: we should be free of pain and suffering. For most, such dire news — particularly about health and well-being — is a devastating blow, devoid of meaning and justice, a cruel trick of fate, perhaps, or some sort of karmic retribution for evil done in this life or one prior. It is at best random misfortune, at worst a cruel robbery, a brutal injustice. There is no making sense of it — it is without reason or purpose.

Yet for the Christian, things are supposed to be different. We serve — as an article of faith — a God of love, and when one has committed their life to such service, the reward of such a severe trial raises a host of uncomfortable questions: Is God unfair? Is this punishment for sin? Is He capricious, toying with me, playing me for the fool, demanding my obedience then rewarding me with pain and loss?

The Anchoress responds as many would — with rage:

“I drove home pounding the steering wheel and telling God I thought He was pretty damned unfair, after all. I demanded that He listen to me and make me a sensible answer about why things were going as they were, why at only 46 years of age I was increasingly debilitated, increasingly arthritic, increasingly feeling like a 65 year old.

It’s not enough that I must sometimes use a cane, or that I wear glasses, not enough that I am constantly bruised, often fatigued into stupidity and inarticulate, stammering aphasia, not enough that my body is scarred all over and that my skin is under seige simply because I am Irish! now I am going to need hearing aids? Now I am going to be deaf? What has my husband ever done to you, that you need to inflict this sort of wife upon him?

Oh, I howled. I ranted.

And it was so out of character for me to do so – this has not been my way, to shake an angry fist at God and make demands. I didn’t like doing it – it felt so wrong. So wrong, not to simply be thankful for my blessings – for all the good things, and all the “not too bad” things.

But I was so angry.

Anger at God — a frightening, even terrifying thought. At worst it presents images of lightning strikes, fire and brimstone, judgment, destruction. Better to pretend you’re not angry, hide it from God lest He send another, more awful plague in retribution.
Continue reading “God of Loss and Grace”

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The Celebration of Hope

 
The lady on the morning “news”, in her warmest and faux-sincere voice, said it sweetly: “This is the season of hope and joy” — and moved on quickly to tug at the heartstrings with some touching story of the downtrodden redeemed, a perfect production for this “holiday” season.

I don’t really think she understands the things of which she speaks.

I often wonder, when watching the scrupulously secular stars of media utter such banalities: what, exactly, is the basis of your “hope”? Is it the optimism of wishful thinking, the notion that in our oh-so-progressive world, things will simply get better and better, hurtling at light-speed toward an inevitable utopia? Is it the hope of new politics, new icons of power to guide us out of the wilderness of war and hatred with an enlightenment found nowhere else? Or is it simply the Big Lie, repeated ad infinitum until it becomes Truth, designed to deaden terrifying voices of angst and uncertainty which screech like harpies just beneath a consciousness deadened by frenzy, acquisitional obsession, and the myriad addictions which numb our fears and deaden our souls.

Yet it is a season of hope — or more precisely, a season to celebrate a perpetual and profound hope, not the emotional hopiate mainlined by the hopeless, dragged out like some green plastic tree from a dusty closet to adorn a meaningless holiday, no longer called “Christmas.”

So what is this true hope, this enduring and transformational power which we celebrate this season, yet abide in throughout the year?

It is the hope of true harmony, God and Man in right relation, the only source for Peace on Earth.

It is the hope, beyond reason, of forgiveness of the unforgivable, of acceptance of the rejected, of healing of sick and mortally wounded souls.

It is the hope of conquest of the demons which drive us, enslaving us in what masquerades as freedom.

It is the hope of deep joy, not mere shallow happiness.

It is the hope of a purpose beyond self-satisfaction, of a meaning beyond random chance, of direction for the lost and aimless.

It is about God becoming small that Man may become great, in Him.

It is about sacrificial love, the emptying of self, the death of pretense and a life of humble dependence.

It is about a Child who became Man so that men might reclaim the wonder and joy of children.

It is about infinite love, abounding mercy, endless grace, transformational power.

It is about Christ: humble in birth, extraordinary in life, sacrificial in death, glorious in resurrection.

It is about our hope — the only true and certain hope — the hope of those who know, and serve, and rely on Him, and His gentle hands which lift us up, and cherish us, and carry us home.

It is about Christmas, when Light entered the world and changed it forevermore.

That is our hope, and nothing less.

Have a most blessed and Merry Christmas, and may the peace of God rest upon you and yours.

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On Assisted Suicide


In a previous post on physician-assisted suicide, I had the following exchange with a commenter named Van:

Van: I take it you are are against assisted-suicide?

Let me ask you this – how can we say we live in a free nation if we cannot do what we wish to our own bodies, as long as we do not impact the life, liberty and safety of others?

I have mixed feelings on the subject, but I really have a hard time with others telling me what to do with my body.

Dr. Bob: Yes, very much against it.

You are, of course, perfectly free to end your own life, with or without such legislation. A handgun and a single bullet will do the job very nicely–along with a hundred other ways.

The issue with this public policy is that you are asking your physician to kill you — and therefore it is no longer just about what you do with your body, but very much involves other people–the doctor, the families, and society as a whole.

The problem with the “it’s my body” radical self-autonomy is that it focuses solely on the self, while conveniently ignoring the enormous consequences of such legalization on others and society as a whole.

Van: So your key issue is the doctor assisting in the suicide, thereby involving others?

Let’s say you have a 90 year old individual with no family, suffering from cancer, who has no meaningful impact on others. If they take their own life, you are OK with it?

Just trying to understand where you are coming from.

Van’s question is a valid one, to be addressed shortly, but in a digression, one should note what often passes for arguing from principles in our current culture: the argument from the exceptional. When promoting or defending some contentious social or moral issue, we seem always to find the most extreme example imaginable and argue from this specific instance, then applying our conclusions from the specific to the general.

So, for example, when arguing for government prescription health coverage, we must first find some old woman who has to eat cat food in order to pay for her prescriptions; when discussing gay adoption, we must find the idyllic gay couple, lifelong partners (or so we are told), ecstatically happy with nary a relational dispute, as parents; when arguing for assisted suicide, we must find the patient in unbearable pain with a loving husband passionate about ending her life “in dignity” by slipping her a deadly cocktail — or one who is dying utterly alone, with nary a friend or family member to share their suffering. That such argumentation almost invariably presents a false dichotomy is never considered: that far better alternatives might exist to solve the problem is never pondered; that applying the suggested solution based on emotion without consideration for its broad implications or ramifications may well prove disastrous — such complications are never considered as possibilities. We press for great social and policy changes with profound effects on culture and society using pop emotionalism and pulp fiction.

But I digress. So, to answer the question: I would not find suicide of such a sadly-abandoned individual justified, simply because no physician was involved. Suicide is the ultimate repudiation of life, of relationships, of hope, the product of the deep hopelessness and self-absorbed insanity of depression. My point was simply this: we all have free will. Each of us may choose, if we decide to do so, to end our own lives. There is a pernicious distortion of the idea of freedom which is a product of our radical individualism, to wit: I live in a free society, therefore by necessity I must be free to do whatsoever I please. Others must not only allow me to do so, but must bear the consequences of my actions, and must be actively engaged in enabling my behavior, because it is my right. Hence, I must be free to say anything I wish, without consequence, including any criticism of my speech; I must be free to terminate my pregnancy, without guilt or restriction, though my unborn child pays the ultimate price; I must be free to end my life when I wish, and my physician must be required to deliver the lethal potion — or at least must be coerced into finding another doctor who will, if his “values” (defined as mere subjective opinions) don’t agree with mine.

Many of the “rights” which are being promulgated and promoted by today’s secular culture are in reality straw men, fine-sounding proxies for demands and desires far less salutary than they sound. Thus, gay marriage is not about gays getting married (hence the lack of enthusiasm among gay rights advocates for civil unions which provide all the legal benefits of marriage), but is instead an effort to undermine traditional heterosexual marriage as normative in culture, thereby removing not merely legal but cultural restraints on all forms of sexual and relational heterodoxy. The high standard — heterosexual marriage, with its enormous advantages in the raising of children and establishment of societal self-restraint, morality, and relational stability — must be brought down to the lowest common denominator of any two (or more) people getting “married” — with the sole purpose of muting societal condemnation for self-gratifying, dysfunctional and heterodox partnerships. Unrestricted abortion, a.k.a. “freedom of choice” — or, “women’s health care”– is about the uncompromising (albeit delusional) demand for unconstrained sexual license without consequences — especially for women, but also for their sperm donors who want no responsibility for their casual hookups: dispose of the unplanned pregnancy, move on to your next “partner”, and you have achieved the perfect “zipless fuck.”

Likewise, physician-assisted suicide is not at all about “death with dignity”, but rather about actively enlisting the culture in support of radical individual autonomy. Not only must we exert full control over the time and manner of our death — which we have always been able to do, by simply killing ourselves — but we demand that society support, honor, and praise this decision, without the faintest whiff of criticism or condemnation. It is not sufficient that we be able to kill ourselves. Rather, it is necessary that we actively kill those societal sensibilities and strictures which condemn such a choice as morally misguided and potentially destructive to our human dignity and social fabric.

Were some silver-suited alien from Alpha Centuri to visit our noble globe, he would no doubt find our passion for self-extinction puzzling, to say the least. What manner of sentient being seeks to facilitate its own demise, only to perpetuate the illusion that they control their own lives? Has their existence no purpose but to be ended at their own discretion? Are their relationships so shallow that they choose death over life; has their suffering no meaning; will their precious time with life partners, friends, and offspring be traded for the dark comfort of a deadly cocktail? Who are these intelligent fools, our visitor would ask, who hand over the power of death to their doctors, oblivious to the evil which dwells in the hearts of men, waiting to be empowered by cold rationalism, scientific professionalism, self-justification, and sterile repetition?

Yet were our starship sojourner to examine the society which breeds such nihilism, he would, by turns, find his answer: we are, for all our technological advances and unbounded prosperity, a culture without meaning, a people without purpose. We have embraced unquestioningly the mantra of materialism: we have come from nothing, and to nothing shall return. Our relationships mean naught but what we may gain from them; our suffering gains us nothing but rage and resentment; our deaths are like our lives — without hope, without a future, joyless and empty. We desperately push the buttons and mix the potions which promise to make us happy and whole, yet find they only echo forlornly through our hollow souls, singing that siren song:

“I am my own master.”

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Assisted Suicide: Coming to a State Near You

I hope to have more to say on the issue of euthanasia and assisted suicide in the near future. In the meantime, I highly recommend this article by Herbert Hendin, M.D. Dr. Hendin’s book, Seduced by Death: Doctors, Patients, and Assisted Suicide, is an excellent resource on the topic, the result of extensive research and multiple interviews taken while studying euthanasia practices in the Netherlands. This article provides a nice summary of his research and experience, which builds a solid case against euthanasia and physician-assisted suicide.

Washington has recently become the second state to pass an assisted suicide initiative, and, legislating from the bench, a Montana judge has ruled that man has right to assisted suicide.

This movement is on a roll, and you will want to be informed about why this is such a ghastly public policy trend.

A few highlights from the article:

Concern over charges of abuse led the Dutch government to undertake studies of the practice in 1990, 1995 and in 2001 in which physicians’ anonymity was protected and they were given immunity for anything they revealed. Violations of the guidelines then became evident. Half of Dutch doctors feel free to suggest euthanasia to their patients, which compromises the voluntariness of the process. Fifty percent of cases were not reported, which made regulation impossible. The most alarming concern has been the documentation of several thousand cases a year in which patients who have not given their consent have their lives ended by physicians. A quarter of physicians stated that they “terminated the lives of patients without an explicit request” from the patient. Another third of the physicians could conceive of doing so.

An illustration of a case presented to me as requiring euthanasia without consent involved a Dutch nun who was dying painfully of cancer. Her physician felt her religion prevented her from agreeing to euthanasia so he felt both justified and compassionate in ending her life without telling her he was doing so. Practicing assisted suicide and euthanasia appears to encourage physicians to think they know best who should live and who should die, an attitude that leads them to make such decisions without consulting patients–a practice that has no legal sanction in the Netherlands or anywhere else.

Assisted-suicide laws are always framed as being “compassionate” — appealing to the universal fear of dying a prolonged and painful death. Yet the unintended consequences of giving physicians the unrestricted power of life and death are often anything but:

Compassion is not always involved. In one documented case, a patient with disseminated breast cancer who had rejected the possibility of euthanasia had her life ended because, in the physician’s words: “It could have taken another week before she died. I just needed this bed.”

He also extensively studied Oregon’s experience with assisted suicide — the legislation which served as the model for Washington’s law — and found plenty of problems here as well:

Oregon physicians have been given authority without being in a position to exercise it responsibly. They are expected to inform patients that alternatives are possible without being required to be knowledgeable enough to present those alternatives in a meaningful way, or to consult with someone who is. They are expected to evaluate patient decision-making capacity and judgment without a requirement for psychiatric expertise or consultation. They are expected to make decisions about voluntariness without having to see those close to the patient who may be exerting a variety of pressures, from subtle to coercive. They are expected to do all of this without necessarily knowing the patient for longer than 15 days. Since physicians cannot be held responsible for wrongful deaths if they have acted in good faith, substandard medical practice is encouraged, physicians are protected from the con-sequences, and patients are left unprotected while believing they have acquired a new right.

The idea of assisted suicide has enormous allure in a culture of self-gratification and increasingly-shallow moral and ethical principles. Don’t be surprised when it comes your way — be prepared.

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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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Surveying the Abyss

Those who know me best have little doubt: I am irrepressibly optimistic. Not naive, mind you — at least from my perspective — but whether by personality, disposition, or faith, I am wont to believe the best about people, and circumstances, and the future. I drive my wife nuts, she being of a decidedly more pessimistic bent.

But I must confess of late to a recurring sense of foreboding, about a great many things. Now, prognosticating about the future is a fool’s game, to be sure; a review of most any futurist’s predictions invariable shows a predictive rate substantially less than could be had by tossing a coin.

But I do have eyes, and ears, and over half a century of something one less circumspect might call “wisdom” — and a sense of the spiritual sharpened mostly by ignoring its promptings, with the invariable consequences. Wisdom, as they say, is gained by experience — and experience is gained by lack of wisdom.

In a world which incessantly rips its cultural chords at rock-concert levels, it is no small feat to listen to the still, small voice — and harder yet to distinguish it from the countless seductive whispers and wishes of life long lived in self-gratification and indulgence. Yet that voice ever quiet is nevertheless persistent — and it seems to be speaking with an urgency and clarity which is hard to dispel.

We are standing, I sense, at the edge of an abyss — and the earth beneath our feet is shifting and unstable.

We live in a society saturated with information. The paradox of this spectacle is that we no longer possess the ability to integrate and evaluate the information which assaults us from every direction. One moment the news ticker at the bottom of the screen shows some mind-numbing drop in the stock market; the next moment, we are enthralled with some bitch queen trying to kick the shins of his lesbian competitor on Project Runway. The news media jumps from the crisis of the second to the latest Hollywood dalliance, and from there to some hopeless hyped hysteria about global warming or the health scare of the week, providing no sense of perspective about which of these might be the more important.

So it behooves us to stand back; to turn off the TV, shut down the browser, put down the paper, turn off talk radio, and truly listen — not to the screeching banshees with their banal hysteria, but rather to that inner source, be it spirit, or soul, or mind, or the wisdom acquired by life’s experiences.

Take a moment, if you will, for a brief look around, surveying our 21st-century world. Let yourself absorb the panoramic view, all 360 degrees, not averting your eyes at things which are unsettling or fear-provoking.

Glance first dead ahead: we are in the midst of a financial meltdown. Of course, there have been many financial crises in the past, many “Black Fridays”, where years of accumulated wealth have disappeared almost in the twinkling of an eye. Yet our current crisis seems different. The past 50 years in the West, particularly in America, have brought about an extraordinary increase in wealth. This increase has only accelerated, although with periodic painful retractions, as the speed and complexity of our financial systems has increased exponentially. Derivatives, globalization, computer-driven investing, complex financial instruments and securities, have greatly increased both the profitability and the instability of financial systems. Even those who should understand these complex financial instruments and systems can be blindsided — as they were in our current credit crisis.

Much like a complex computer software program, its programmers understand how it should work, and make assumptions about the parameters — which, when when fed unexpected values, leads to catastrophic failure. Our financial wizards lost the ability — or more likely never had it — to control for every eventuality, including those which could cause catastrophic economic failure. We stare in amazement that seemingly no one anticipated our meltdown in mortgage equities; but our hope in and expectations of “experts” will invariably be dashed as system complexity and instability increases.

So now, glancing around, we look to government to save this from the “greed” of Wall Street — although we have long celebrated Wall Street’s greed as long as our profits and portfolio values were rising. It’s Wall Street’s job to be greedy — we have demanded it of them. So we look to government institutions never designed to moderate or correct such lightspeed instability — and are angry when we find them unable to intelligently address this implosion. Even in a perfect world, our elected leaders would have no more wisdom or ability to correct a highly complex and increasingly unstable economic system, where events half a world away can send your nation’s economy reeling in ways you could never have anticipated.

And this is no perfect world, by any measure.

For years we have tolerated incompetence, corruption, dishonesty — and yes, greed — in government while looking the other way. On those rare occasions when politicians have made principled stands, we have rewarded them with a firestorm of political assault, full-throated media ridicule and criticism, and enormous financial pressure from lobbyists pouring money into the pockets of those who purport to represent the people. We have elected a government of the people, in the most literal and disgraceful sense: we have elected, and kept in office, those who share our desire for self-gratification and materialistic acquisition at the expense of character, moral integrity, honesty, and prudence. The cesspool which is our current Congress is what we have reaped by our own actions — or perhaps more accurately, by our inaction. We have elected those politicians who are like us in every way — and we hate them for it. They are, after all, created in our own image.

Glance a bit in another direction and you will find a host of unsolvable problems of a magnitude as great or greater than our current credit crisis. Social Security and Medicare roar down the tracks toward a washed-out bridge, with no engineer at the throttle; massive budget deficits balloon as we pour trillions into a war that no one seems interested in fighting; trillions more pour forth in political favors and pork designed to maintain our corrupt politicians in their unchallengeable congressional seats. $700 billion in bailouts will seem chump change when our bills for this fecklessness come due.

Glance yet again, and watch a presidential election wherein we seem poised to elect a candidate without portfolio, with a long history of association with corrupt political machine pols and leftist bomb throwers, including those both rhetorical and literal. This is the Messiah to whom we look for the solutions to our increasingly intractable problems, setting aside all rational thought for the opiate optimism which sees salvation in smooth words and sage assurances. Indeed, we seem eager and ready to bring to fruition the revolution of the 60’s: with clenched fists thrust skyward, the age of peace, free love, drugs, irresponsibility, and emotional feel-good policies is upon us, based not on experience nor any understanding of human frailty and corruption, but rather on a blind idealistic utopianism.

Then glance around the world, where the Russian bear roars menacingly; where Iran races to nuclear capability while diplomats twiddle and dither, driven by a religious fascism which glorifies death as they bow down to the false prophet; where an increasingly impotent Israel is surrounded and threatened by massing forces zealous for its destruction; where China pursues a massive military buildup as it eyes Taiwan and Southeast Asia; where Korea cranks out nukes and missiles, selling them to the world’s most wicked regimes; where Europe is ludicrous in its impotence, ever seeking our protection when desperate while hating us ever the more; where the sun has finally set on the British Empire, leaving only a pathetic pandering jester where a mighty force for civilization and law once stood; where a thousand failed states are seething cauldrons of violence, and poverty, and hatred, engendering transnational terrorists now empowered by the same technology we hope will save us. The world, like its financial systems, is extraordinarily unstable, with powerful centrifugal forces breaking apart even once proud and powerful nation-states. The parched, cracked grasses await but a spark to start an inferno.

Then glance at culture (if you can stomach it), where the decadent is celebrated, where the good is ridiculed, where the satyr is worshiped, where no pillar of tradition may stand nor bulwark of morality may endure. Our media promulgate not truth but narrative, not fact but fabrication, a fully empowered propaganda machine entirely co-opted by postmodern secular culture and messianic politics.

And yet, here we sit, watching on our flat screens in full HD the celebration of androgynous eunuchs in staged competitions about who can create the prettiest dress or redesign the penthouse of some satyrical single, who long ago decided that life was about getting laid, leaving the emotional, physical, and social tab for someone else to pay. These are the individuals we celebrate and elevate with our eyes, our time, our adulation, our admiration, our money.

The extraordinary instability in the world cannot long endure — and I fear we are ill-prepared in the extreme for the abyss which will follow. We have raised generations to believe they are entitled to ease, wealth, and prosperity; we have taught them through our easy divorces and casual shack-ups that commitment only lasts as long as it feels good, and that love is all about sex; we have failed to provide any framework of character, morality, integrity, and perseverance upon which to rest when all we have taken for granted — the wealth, the comfort, the false security, the easy irresponsibility — crumbles to the ground.

It is long past time to get back to basics — to faith, to church, to principles, to relationships, to integrity. We are, I believe, about to be tested in a most difficult and frightening way — a darkness the likes of which we have not seen before, and may never see again. The provocation may be known, or unknown, be it nuclear terrorism, or some yet-unseen financial collapse; a cataclysmic natural disaster; or a butterfly in some unknown location flapping its wings and setting off a chain reaction which ignites the world in conflagration.

Of course, such prognostications may well be wrong; perhaps naive optimism would be the better course and certainly more pleasant to entertain. But as for me, it is time to focus: to look hard at my spiritual, financial, and relational assumptions, to tune out far more of a chaotic and decaying culture, to prepare for the worst while hoping for the best, while asking God to shine his light of conviction on my life to purify and strengthen it, and hopefully grow in some measure of wisdom. It is time to simplify, to prepare, to fast, to pray, to repent. It is time to stop spending on the frivolous and start giving more generously.

If you are a person of faith, it is time to dig in, hard, and quit playing games — your life may depend on it. If you are skeptical of such matters, consider: upon what will you lean when your world collapses? Will your considered indifference and intellectual smugness about us fools of faith save you? What will you do when all that matters to you is taken, and you are left, finally, profoundly alone with naught but that frightened face in the mirror?

I have slept for too long, as have all of us. It is time to fill the lamps with oil lest they be found empty when the bridegroom arrives.

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