The Fairness Doctrine

It’s been a hellacious month (a hellacious year, actually — more on that in a minute), with big changes at work (two new employees to train), a major home construction/repair project going on, and a near-fatal case of the avian flu (well, it felt like bird flu… ) from which I am just now barely rebounding.

The past year or so has been phenomenally difficult in many ways — with an aging mother-in-law who has had two falls with resulting long-term disability and a rocky recovery (but who is now doing well); a major family brawl arising out of her care decisions; a contentious dispute at work over a 401(k) discrepancy; two car accidents (my wife and I, no injuries, just the expense and hassle of dealing with body shops and car insurance); a medical lawsuit filed against me; a daughter who’s 8-month marriage ended in divorce despite her heroic efforts to salvage it; the death of the family dog; the loss of two long-term employees (in a three-employee practice) which has — temporarily, I hope — nearly doubled my workload as I train their replacements. And this is the short list.

Oh, and one more thing: our house is falling down. Seriously.
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Price, Value & Grace

One of my areas of professional expertise is infertility surgery, specifically reversal of vasectomy. Vasectomy is a very common form of permanent birth control, with an estimated 500,000 to 700,00 procedures performed a year in the U.S. It is a procedure which is devilishly simple to perform, while maddeningly difficult to repair. The vas deferens is a small, thick-walled muscular tube (2.5 mm = 1/10 of an inch in diameter) which transports sperm from the testes to the prostate and seminal vesicals. Its division to achieve sterility is a simple office procedure — but the extremely small diameter of its central channel (0.2 mm), and the tendency to form secondary obstructions after vasectomy in an extremely delicate structure called the epididymis, make successful restoration a daunting challenge, requiring that the repair of the duct system reliably be performed under high magnification, using a technique called microsurgery.

While increasing number of urologists are trained to do this specialized surgery, consistently successful outcomes require many hundreds of cases and many years of experience, a factor which few recently-trained urologists bring to the table. I have had the good fortune to have this kind of experience, going back nearly 30 years, and as a result have one of the largest experiences in this procedure in the country, and have performed reversal surgery on patients from all over the U.S. and a number of foreign countries.

Reversal of vasectomy is rarely covered by health insurance, and the procedure is expensive: costing $15-20,000 and up in some large referral centers. I have over the years, built and sustained a large surgical experience by pricing my services well below much of the competition, creating a win-win situation: higher volume (and therefore greater experience and surgical expertise) while providing a substantial cost benefit to my patients.

But the procedure is still very expensive. Too expensive for many.

I receive quite a few e-mails from my web site, most requesting additional information or expressing an interest in scheduling surgery.

So yesterday’s e-mail came as a bit of a jolt:
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Deep Waters

The following essay was originally posted in June 2005. The story is a true one, although the names have been changed.

 
Lake ClarkThey say that hell is hot. Sometimes, though, it is very, very cold.

Jim loved Alaska–it had been his home since birth. God’s country: wild, unpredictable, spectacular in beauty–there was no place like it on earth. Cities were a necessary evil, with their services and surliness, but out in the wild was where life could be found. Out among the glaciers, the ragged mountains framing the endless blue sky like jagged, broken glass, out where grizzlies snatched salmon from raging rapids, shortening their march to death as they fought wild currents to reach their spawning grounds. Out where eagles graced the sky, soaring above green fir spires and spotless snow fields. Out where God lived, where a man could see His hand, and hear His voice.

Jim lived a simple life of simple faith. He loved his wife as he loved the land, and together they were blessed with six children–three older girls, the twin boys, and a baby son their most recent gift. Each was a treasure greater than the next. Their lives were story book: The lodge they owned nestled near the shores of Lake Clark, a large inland glacial sea, mirroring the snow-peaked mountains surrounding it. Summers were busy–hunting and fishing tours, visitors from afar seeking trophies and photographs, decked in newly-purchased gear from REI in the lower 48. Jim loved to fly–the float planes lifted gracefully from the lake, carrying their awestruck passengers over endless miles of breathtaking beauty to some far-away stream where tied flies touched water and fish broke airborne for their last meal.

Out in the bush, relationships were few in number but rich and deep. Church was more than a Sunday obligation–it was a place where life was shared, joys celebrated, suffering comforted–a place where faith begot works, where love put on snowshoes and helped stack the winter’s wood. Family life was alive, ripe with blueberries picked, hikes to the falls, and quiet nights beside campfires. Summers passed quickly at Bible camp, concentric ripples of cannonballs and giggles of joy rolling across the lake from the old dock. Dates with dad and high tea with mom found no competition from mindless cartoons, and bedtime prayers thanked Jesus for His goodness and God for His gifts.

Winter was time for quiet reflection, as the short days and deep snows kept sportsmen far away, and school and indoor chores made the time pass slowly but with purpose. The plane was their lifeline: what few roads there were became impassible in deep snow, and flights to Anchorage a necessity for supplies and health care. The girls came along often, although the younger boys stayed with friends and relatives for lack of space.

Jim had tens of thousands of hours of flying experience, a skill which paid rich dividends in the harsh, capricious winters of south Alaska–there was little in the way of flying conditions he had not challenged and mastered. So this flight to Anchorage in February was a pleasant surprise: the low gray skies broke open to display the rare winter glory of sunshine on pristine snowfields, the glorious tinted rim of Alaska Range peaks and deep seas of Cook Inlet. The supplies garnered and the girls’ dental care completed, they took off for the return flight to home and hearth.

The storm struck without warning, a white she-devil blown in from the Gulf, the Cessna buffeted by sharp, hard winds as visibility and ceiling dropped precipitously. The instruments held true, and countless hours of difficult flying forged Jim’s nerves steely and his focus intent. Mom held the girls’ hands, distracting them from natural fears with songs and stories and heads held to breast, her own pounding heart betraying her calm demeanor. “Will we be OK, mommy?” “Jesus will bring us home, honey.”

The GPS told Jim they were indeed near home–the lighthouse in space beaconing safety and rest. By reckoning they should be near the lake, just a few miles out from the landing strip. But Nature had not finished yet, her rage reserved for one final blow.

A whiteout in a small plane is dreadful beyond imagining. Suspended between earth and sky, with no point of reference, no sense of up or down, sensory deprivation in a aluminum rocket. Your training trusts your instruments, but instinct and eyes scream for visual confirmation. There! On the right! Through a brief window in the suffocating white blindfold, a dark line: the outline of the lake shore. Jim banked the plane toward this beacon of hope. “Are we home yet, daddy?” “Almost there, honey.”

But wild Nature held one last vengeance: an atypical winter thaw had opened a long dark crack in the ice, normally frozen solid in February. The line Jim saw was not the shore. The plane hit water at airspeed.

The prop and windshield exploded. The cabin filled instantly with icy water, as Jim craned his neck to reach the fast-retreating air, still restrained by his harness. Years of wilderness training sprung to life, as without a thought he grabbed his Bowie and cut free the webbing. He struggled with the girls’ restraints, hopelessly locked between seats crumpled by the impact. His wife was nowhere to be seen. Time was up–the air was gone. He broke from the cabin, gasping for air at the surface, hoping to dive and try again to free his treasures. It was not to be: the plane sank like a millstone, 600 feet to the bottom of the frozen fjord, entombing the family he worshiped.

In shock, he looked around. His wife, by some miracle, thrown from the plane at impact, had struggled to the surface and clung to a floating berg. Spared from a frigid tomb, they stood on a fragile shelf of thin and breaking ice. Over two miles from the shore, clothing soaked through in sub-zero temperatures, their survival was still a loser’s bet. Slowly they worked their way shoreward, breaking through the ice at times, body temperatures dropping despite their exhausting physical efforts. Guided by some hand unseen, they finally fell exhausted on shore, finding shelter in an empty lodge. Blinded by cold and head trauma sustained in the crash, Jim was led into the cabin by his wife, who cut off his frozen clothes and started a fire.

Friends awaiting their arrival grew anxious, and the Air National Guard was called. A Pavehawk helicopter–battling the same merciless weather–located the crash site, and ultimately reached them at the cabin. Even then, they could not be evacuated, as conditions grounded the rescue helicopter until morning. A friend flew a Piper cub–braving the same horrendous storm–to bring arctic sleeping bags and warm food. Bravery, love, and duty had spared their lives.

Months passed. Physical healing came quickly, but the rawness of heart wept like an open sore, gently salved by friends and faith, prayers and potlucks, tears and thankfulness. The boys were precious as never before, but the emptiness of heart left by a lost child cannot be filled. The rage at God passes–slowly–as strength flows from trust born of countless old decisions to set aside self and act in faith. But the memories remain–the laughter lost, the peace of a sleeping child, the love of a flower picked, the unexpected hug. There is no answer to “why?“–only time, and trust, and talk, and the tender whispering of a gentle Spirit. Yet one haunting regret refused to die: the vasectomy Jim had undergone after their last son–expeditious at the time, financially prudent–was now a self-imposed prison in a home filled with people, yet achingly empty.

And so they sat in my office, seeking my skills to restore what no man should be asked to provide–hope and happiness. And they told their story, my heart aching with each small detail disclosed. Jim was a man of enormous character and strength, his wife still bearing the unspeakable pain on her face–yet there was no shame in the tears that welled up in their eyes. As I gently probed deeper with almost unseemly curiosity, I was drawn in by the most remarkable revelation: these two would stand. Theirs was a strength not merely of hardiness, or training, or steely denial hiding a dying heart, but of power beyond the means of any mortal. They had faced the hell that men fear even to consider, and conquered it. There was glory in their weeping, victory in their agony. They would never be alone, and never be defeated. I, the proud expert, felt strangely insignificant in their presence.

The surgery went well, and early recovery smoothly. As I spoke with Jim before he left for home, he talked about the girls who had loved their daddy and whom he still loved so deeply. “You know, if I could fly to heaven and bring them back, they would not want to come. Their happiness is complete, ours still unfulfilled. Jesus has indeed brought them home.”

On Faith II: The Transaction

waterfallIn my prior post on the subject of faith, I addressed some of the tensions between faith and reason, pointed out the tightly-constricted world of those who embrace the material while a priori excluding the transcendent, and attempted to make the point that faith of any kind — be it as simple as starting your car or as mystical as praying for healing — requires both a trust based far more on experience than knowledge, and a trustworthy, dependable faith object.

But faith requires more than simply trust in a reliable object — it requires that such a trust proceed from the true nature of that object. Thus when we talk of religious or spiritual faith — and this is the faith of which we are most concerned — it is not simply sufficient that our trust in God (whom we understand to be completely trustworthy) will invariably bring results. Our trust must be consistent and harmonious with the nature of God to bear fruit. These conditions or constraints which dictate and direct the faith relationship I have called — for lack of a better term — the transaction of faith. To simply trust, while disregarding the true nature of God, is to practice mere wishful thinking or magical projection. And a trustworthy God in whom no genuine trust (or misdirected trust) is vested will likewise avail us nothing.
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On Faith I: Faith & Reason

Grand opening, first Tacoma Narrows BridgeIn July 1940, an engineering marvel was completed: the first Tacoma Narrows Bridge. One of the longest suspension bridges in the world at the time, it exemplified the light, graceful architectural trend of suspension bridges built in this era. Called the crowning achievement of his career, designer Leon Moisseiff — the architect of the Golden Gate and Bay bridges in San Francisco — later declared “our plans seemed 100% perfect.”
 
 
Yet 4 months later, on November 7 1940, the Narrows Bridge catastrophically collapsed in a windstorm into Puget Sound.

Gertie collapsesLeon Moisseiff had unshakable faith in the reliability of his newly-completed masterpiece. He would have had no qualms whatsoever trusting its dependability in any weather conditions. Yet had he stood upon his own creation on November 7th, 1940, his faith would have been fatal. The object of his faith was unreliable, and the strength of his faith irrelevant.
 
 

Faith has become the diametric of reason … practiced only by deluded fools who reject the graceful catenary and steel-plate certainty of scientific rationalism.

Faith is an idea frequently voiced, but little understood. It is commonly mentioned in the pejorative sense in today’s secular society, where it has become a proxy for belief in the unbelievable, the unprovable, the superstitious and the mythical. Faith has become the diametric of reason — unreasonably so, as we shall see — practiced only by deluded fools who reject the graceful catenary and steel-plate certainty of scientific rationalism.

Yet faith–not love–makes the world go ’round. You exercise faith when you place the key in the ignition and start your car. You have faith when you flip a switch, expecting light to rush forth from a fixture, or music from stereo speakers. You have faith that your coat will keep you warm and dry; your plane will stay aloft; your surgeon will bring you through a heart bypass. The atheist has utter faith in his reason, that belief in God is beyond logic and therefore must be rejected. Such faith is nothing more than trust: a confidence that the object is reliable, the tool is trustworthy, its behavior predictable, its nature dependable. In the physical realm, such trust may be based in part on knowledge — one can study the flow of electrons and principles of resistance which make a light bulb glow — but such erudition is entirely optional, and rarely grasped by those who rely on its behavior. The object of faith may be entirely reliable yet utterly beyond our comprehension — or, as Leon Moisseiff discovered to his great dismay, deeply understood yet profoundly unreliable.
 
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Delivering the Cookies

It is, after a fashion, a legend of the fall.

Not mine, mind you — although one could say my fall was in some ways greater.

My wife’s mother was, though elderly, quite strong and independent — alert, cantankerous, losing a little memory here and there, in nearly constant pain from vertebrae once tall and straight but now arched and foreshortened. It seemed simple enough: bend down to retrieve the dropped utensil, a task done mindlessly a million times before. But this time, different: muscles weakened by nearly nine decades, joints worn thin and crepitant by a century’s steps, she could not maintain balance and fell backwards to the floor.

The call came shortly thereafter, and was not the first: a prior fall six months before had broken no bones but nearly broken her spirit — months of slow recovery, fighting pain and hopelessness, had by some small miracle been conquered, with much relief among us but a lingering fear of an even-worse encore. The curtain call came, to no applause and much apprehension.

The hospital stay was long, and replete with the consequences of falls in the elderly: rapid loss of strength from recumbency; mental confusion from requisite opiates; quiescent health problems charging to the fore to complicate a recovery trivial for the young but disastrous and often deadly in the eighth decade of life. When she was finally discharged to the nursing home, she was hardly recognizable as the same individual who had fallen little more than one week before.

She had sustained no fractures, but there were fractures aplenty developing. The enfeeblement of an elderly parent quickly finds the fault lines in a family, as the stresses of disrupted schedules, new financial strains, and disputes about responsibilities and recovery find old tapes playing and new resentments kindling. The lid blew off at mom’s birthday dinner, when a planned family meeting found my wife and her siblings squaring off, two on two, with one storming out and all looking for lightning rods to discharge their pent-up passions.

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Libertarianism & Morality

This essay was originally posted in November 2004.
 
nebulaOn April 25th 1990, the long-awaited Hubble space telescope was launched. In the planning stages since 1967, delayed in deployment for 4 years by the Space Shuttle Challenger disaster, scientists were ecstatic at its potential to view deep space as never before from above the atmosphere’s distorting optical envelope. Within days their excitement turned to dismay, as pictures from Hubble returned out of focus.

The giant mirror, 94 inches in diameter, had a spherical aberration. When the mirror was being polished to its correct shape, the device used to test its curvature–called a null corrector–had been made to the wrong specifications. Thus, when the null corrector indicated that the mirror was perfect, it was in fact slightly aspherical. The extremely faint light of distant celestial objects could not therefore be sharply directed to the focal point, resulting in a halo effect and a fuzzy image. Upon investigation, the problem was found to be due to the interchange of metric and English measurements when engineering the testing device. Subsequent space shuttle repairs rendered the optics perfect again, giving rise to the spectacular photographs which the Hubble telescope has since obtained.

In the case of Hubble’s mirror, an inadvertent change of standards, resulting in an aberration 1/50th the diameter of a human hair, nearly doomed a multi-million dollar space project. Consider the likelihood of success if each of the engineers on the project had been allowed to use their own set of standards. Yet in the realm of human behavior and morality, an idea preposterous to a scientist is widely accepted as legitimate, even desirable.
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The Engine of Shame – Pt II

This essay, the second of a two-part series, was originally posted in October 2005.
 
DRGWIn my previous post on guilt and shame, I discussed their nature and differences, their impact on personal and social life, and their instrumentality in much of our individual unhappiness and communal dysfunction. If indeed shame is the common thread of the human condition–fraught as it is with pain, suffering, and evil–it must be mastered and overcome if we are to bring a measure of joy to life and peace to our spirits and our social interactions.

Shame is the most private of personal emotions, thriving in the dark, secluded lairs of our souls. It is the secret never told, the fears never revealed, the dread of exposure and abandonment, our harshest judge and most merciless prosecutor. Yet like the Wizard of Oz, the man behind the curtain is far less intimidating than his booming voice in our subconscious mind.

The power of shame is the secret; its antidote, transparency and grace. Shame thrives in the dark recesses of the mind, where its accusations are amplified by repetition without external reference. Shame becomes self-verifying, as each new negative thought or emotion reinforces the theme that we are rejected and without worth. It is only by allowing the light of openness, trust, and honesty that this vicious cycle may be broken.
 
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