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:
Continue reading “Price, Value & Grace”

Boutique & Box Store

Home DepotA recent article in the Wall Street Journal (subscription required) addressed an interesting new phenomenon in medical practice: the micro-practice. Physicians, weary of being forced to see large volumes of patients because of HMO requirements or financial pressures, coupled with high practice overhead and burgeoning paperwork, are striking out in a very different direction. Some physicians — especially in primary care — are opening small offices without office staff, seeing far fewer patients with much lower overhead, using technology to bridge the gap. As of now, these practices are quite rare, and represent a significant risk to the physician, generally resulting in substantial reduction in income. Nevertheless, it allows these physicians to practice a simpler form of medicine, spending far greater time with patients, having more free time for themselves, and returning to some of the priorities which brought them into medicine in the first place.

Now, I am skeptical that this particular model for medicine will gain wide acceptance. Nevertheless, I believe it represents a trend toward alternative practice models outside the standard framework of large-volume, federal and third-party insurance-driven enterprises. Another similar trend, also small in numbers, is the so-called boutique practice, where patients pay cash, often subscribing on an annual basis to a practice which then provides full services, including appointments on demand, greater access to the physician by phone, routine preventive care, longer appointment times, and other amenities.

I expect to see an increasing divergence in healthcare along similar lines. One analogy would be the box-store versus the boutique. The box store is large, has everything you might need at low prices, provides little in the way of services or amenities — think, Costco or Home Depot-healthcare. For those unwilling to partake of such Wal-Mart style health care, and who have the means to seek alternatives, there will be health care services provided with excellent service and benefits not available in the box store, such as plenty of time with the physician and short waits in the waiting room.

When talking about the social economics of providing health care, it is useful to think of it as a triangle: at one point is quality, and a second point, affordability, and a third point, access. There’s only one problem with this unlovely triangle: one can only have two of the three points at one time. Hence, if you have widespread access to health care which is very high quality, it will not be affordable; if you have broad access and affordability, quality — perhaps not necessarily medical quality, but service quality and access to more expensive or optional medical services — must be constrained. We are currently seeing in large measure the third side of the triangle: we are providing very high quality healthcare, which while expensive, is still relatively affordable — but the cost we are paying is limited access. There is simply no way to have all three points of the triangle.

There is a huge and growing access problem in American health care today, with tens of millions of Americans without insurance, and many more — especially those at or below the poverty level on Medicaid — who cannot find access to physicians because of their own limited financial resources, or the inability of physicians to accept reimbursement from federal programs which pay below the costs to provide the services. The pressure to resolve this dilemma at the political level is very large, and some form of universal coverage seems inevitable in the relatively near future.

In order to provide such broad-based coverage, however, the necessary limit on financial resources — whether federally financed, or paid for through employer-funded or personal-based insurance — must by nature result in a reduction in quality. This is not to say that substandard medicine will be practiced, although there is an increased risk of this; more importantly, there will be significant restrictions in access to optional, high cost technology, and an inevitable decline in service. Universal health care coverage, while critically important, will invariably lead to long waits for an appointment, very little time with the physician, seeing a different doctor at each visit, and having to wade through many levels of support staff to communicate with your doctor. This is already becoming far too common even under our current system due to intense cost-cutting pressures.

While such a universal coverage arrangement may prove very functional from the standpoint of providing basic care for large numbers of people, it will not prove satisfactory to many Americans who have become accustomed to a far more personal and consumer-driven model of health care delivery. There will, therefore, be strong financial incentives to provide alternatives to box-store medicine — and in fact, we are already beginning to see this.

The best contemporary examples of this alternative system of boutique medical care can be seen today in plastic surgery clinics, LASIK eye centers, and the growing trend toward high-end specialty hospitals catering only to orthopedics or other subspecialty care. While social engineers tend to decry such two-tiered healthcare systems, in fact, these alternatives respond far better to true market forces then does the lumbering dinosaur of federally-funded or third-party insurance-controlled health care. Plastic surgery clinics compete on price, service, and quality for a facelift, tummy-tucks, or a breast augmentation; high-end clinics charging more must be a higher standard of quality as well as provide extraordinary service. Consider the dramatic decrease in cost for elective corrective eye surgery with LASIK: prices have dropped dramatically over the past few years as high-volume LASIK clinics compete for patients. Hospitals, faced with a drain of better-paying patients toward specialty hospitals which provide a higher quality of service and a more satisfying patient experience must now re-examine their own quality issues, and are pressured to provide nicer facilities, better food, more nurses per patient, and other service-oriented improvements.

Beware of those — especially of the political persuasion — who promise unlimited, high-quality health care which is affordable. It does not, and cannot exist. We clearly need to address coverage for those in need of health care who cannot currently afford it, for health care, while not a right, is most certainly a very large part of our quality of life and well-being. The boutique model of health care service will not address this problem, in spite of the pipe dreams of libertarians who believe that free market solutions can solve all problems. This two-pronged approach may well provide a uniquely American solution to the worldwide dilemma of providing high-quality care, excellent service and access, and affordability Virtually all countries providing socialized, government-funded health care are struggling with the box-store problem. Poor service, long waits for care and “elective” surgery (like heart bypass and cancer surgery), and spiraling costs are the rule. But we in America have become accustomed to the highest quality of health care in the world, delivered quickly — for those who can afford it.

Perhaps it is time we abandon a utopian vision for health care, and settle on something, though imperfect, which may end up working quite well in the American healthcare system. It may well come from the ground up rather than from the top down.

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.”

Moving the Ancient Boundaries – II


This is a series on the erosion of moral, cultural, and ethical boundaries in modern society:
 
 ♦ Part 1 — Moving the Ancient Boundaries

 
stone wall

Do not move the ancient boundary stone set up
   by your forefathers.

        — Proverbs 22:28 —

 
The societal trend evident today — the gradual and progressive shift from spirituality and faith-based life principles, to scientific secular rationalism, and ultimately to postmodernism, which is the triumph of tribalism, radical individualism, and emotionalism over faith and reason — has many manifestations. The frantic pace of a society filled with countless pressures and endless distractions permits us at best to focus only on the immediate details of our lives — jobs, children, hobbies and activities. Rarely do we take the time to stand back from our culture and society at large to contemplate the profound changes taking place around us. We wake up one day wondering how things have changed so profoundly, with a sense of discomfort over where we are and confusion about where we they are headed.

As our society drifts away from core principles and absolutes established by faith, culture, and tradition, it has done so in a manner which is subtle, yet highly effective. Many of the ways in which this cultural shift has taken place are ancient; many more are a function of a technologically advanced and media-saturated environment. The underlying forces which erode the safeguards which have protected and stabilized society for centuries are not new; they are, however, more rapid and effective in a culture distracted by material wealth, information saturation, and instant gratification.
Continue reading “Moving the Ancient Boundaries – II”

More Embryonic Stem Cell Info

I’ve recently referenced an excellent article on the huge gap between hype and reality with embryonic stem cell research (as opposed to the real and growing applications of adult stem cells), and Michael Fumento again points out the huge gap between myth and reality here (HT: Instapundit). Maybe the word is starting to get out — although I’m not holding my breath.

On a separate note, I’ve been quite busy lately, with several personnel changes in the office in the works, but have a few essays near completion on the Faith series (part 1 and part 2 here), Moving the Ancient Boundaries, as well as updates on the Narrows Bridge construction — so stay tuned.

God bless, back soon.

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.
Continue reading “On Faith II: The Transaction”

On Faith I: Faith & Reason

On Faith I: Faith & Reason

Grand opening, first Tacoma Narrows Bridge
In 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.

We want to understand before we trust — and labor under the pretension that we cannot trust until we understand …
It is in the realm of the immaterial and the spiritual where faith comes most under scrutiny and is the subject of much skepticism. Such skepticism is of course most profound in the materialist, the agnostic, or the atheist—but each of us has a strong strain of suspicion about that which cannot be weighed, measured, seen, or felt. We want to understand before we trust — and labor under the pretension that we cannot trust until we understand, until such trust is “reasonable” to the input of our senses or the perceptions and insights of the mind.

Yet the countless small acts of faith which allow us to move through life are far less frequently grounded in knowledge than they are in experience. We do not think twice about starting our cars, because we have, a thousand times before, turned the key in the ignition and had the engine roar to life. We cross the suspension bridge without hesitating because millions have done so before us—or more proximately, because the cars in front of us are passing over safely. Such experience may be personally acquired, or may be derivative: we trust the surgeon to remove our gallbladder, not because we have directly evaluated his skills and performance, but because others have trusted before us: his reputation about their satisfactory outcome has been imputed to us. Because others have trusted before us, and their trust has been rewarded, we find ourselves inclined to trust as well.

It is common for the skeptic to argue that spiritual or religious faith is “believing things for which there is no empirical evidence.” But contained within this erroneous definition is the very seed of its fallacy: it demands of the spiritual and immaterial realm that it be subject to the measurements, the rules, and the limitations of the material, and presumes the non-existence of anything beyond the empirically determinable. The skeptic and the materialist are boxed in; their world is small indeed, allowing for nothing but that which the eye may see, the hand might touch, the mind may comprehend in its finite measure and the incompleteness of its intellectual grasp.

G.K. Chesterton, in his typically lucid and insightful way, described this straight-jacketed state of mind in his book Orthodoxy:

… [T]he materialist philosophy (whether true or not) is certainly much more limiting than any religion. In one sense, of course, all intelligent ideas are narrow. They cannot be broader than themselves. A Christian is only restricted in the same sense that an atheist is restricted. He cannot think Christianity false and continue to be a Christian; and the atheist cannot think atheism false and continue to be an atheist. But as it happens, there is a very special sense in which materialism has more restrictions than spiritualism. … The Christian is quite free to believe that there is a considerable amount of settled order and inevitable development in the universe. But the materialist is not allowed to admit into his spotless machine the slightest speck of spiritualism or miracle. … The Christian admits that the universe is manifold and even miscellaneous, just as a sane man knows that he is complex. The sane man knows that he has a touch of the beast, a touch of the devil, a touch of the saint, a touch of the citizen. Nay, the really sane man knows that he has a touch of the madman. But the materialist’s world is quite simple and solid, just as the madman is quite sure he is sane. The materialist is sure that history has been simply and solely a chain of causation, just as the interesting person before mentioned is quite sure that he is simply and solely a chicken. Materialists and madmen never have doubts.
Reason set adrift from the divine logos floats like an airtight bottle on a sea of confusion. It fashions tightly-woven arguments from false premises and faulty knowledge. It rejects the unprovable while proving the irrational. Reason may even conclude that its very foundation does not exist: that truth is a cultural artifact, that there are no absolutes. Such is the basis of the postmoderism which currently infects the lofty heights of academia, an insidious virus now replicating rapidly in the intellectual slums of public education and the irrational irrelevancy of college classrooms.

Furthermore, reason detached from the transcendent—the same reason upon which the materialist and the skeptic rest their insubstantial security—must itself be the subject of skepticism. For in the purposeless, deterministic world of random chance and unordered events, who is to say that reasoned thought and scientific inquiry is anything but the random neural energy of an accidental life-form, no more connected to cause and effect than the spark which shuffled amino acids like cards into something we now call “life”?

Again, Chesterton states the problem succinctly:

[The] peril is that the human intellect is free to destroy itself. Just as one generation could prevent the very existence of the next generation, by all entering a monastery or jumping into the sea, so one set of thinkers can in some degree prevent further thinking by teaching the next generation that there is no validity in any human thought. It is idle to talk always of the alternative of reason and faith. Reason is itself a matter of faith. It is an act of faith to assert that our thoughts have any relation to reality at all. If you are merely a skeptic, you must sooner or later ask yourself the question, “Why should anything go right; even observation and deduction? Why should not good logic be as misleading as bad logic? They are both movements in the brain of a bewildered ape?” The young skeptic says, “I have a right to think for myself.” But the old skeptic, the complete skeptic, says, “I have no right to think for myself. I have no right to think at all.”
Faith embodies the confidence in that which we do not necessarily understand, but have found to be experientially reliable. One can, almost surprisingly, have a profoundly misguided or erroneous understanding of a trustworthy object—and still that object will remain trustworthy. Cro-Magnon man, magically transported by time machine to the twenty-first century, might well believe that switching on a light is black magic or the work of the gods—but when he flips the switch, the bulb will still emit light. Thus faith depends, not merely in the confidence that its object will be reliable, but on the inherent reliability of the object itself.

Thus the poles of faith are opposite yet complimentary: there must be trust, even without understanding, and the object of trust must be reliable and dependable. This dialectic is at the heart of religious faith: the trust in something unseen and poorly understood, which nevertheless proves experientially trustworthy, because its object is utterly reliable. It is here that reason and faith coalesce: reason, guided and given purpose and boundaries in the transcendent, points to that which exists but is beyond our capacity to comprehend with intellect alone. Faith beckons us to span this intellectual chasm with the bridge of trust, drawing us to experience that which we lack the means to grasp without it. Reason may block us from faith, constricted as it often is by self-imposed constraints—or reason may confirm and reinforce that which we experience by faith. Trust in the transcendent transforms us, expanding the limits and restrictions which we arbitrarily place upon reality.

The man of faith sees an effect, and attributes its cause to the transcendent, while open to the possibility that the cause may be random or material in nature. The skeptic has no such freedom: the cause cannot be the transcendent, for the transcendent does not exist. His viewpoint is “reality-based” only insofar as the reality he trusts excludes the transcendent. The man of faith can afford to be wrong, and may often be so; such is the process of growth in the unseen world. The skeptic cannot be wrong—for if he is, his worldview is utterly demolished.

There is, however, another aspect of faith which must be met, if this trust is to bear fruit in deepening our experience and our understanding of the transcendent. This is the transaction of faith: the trust must be grounded in and bounded by the nature of that which is trusted. A light will not illuminate by flipping a switch unconnected by wires; a car will not start by placing your house key in the ignition, or your car key in the door. The nature of the object demands that the action based on trust be within fixed parameters dictated by the object’s design or character.

There is more to be said about this transaction of faith, integrating reason, experience, and revelation into a working dynamic which broadens our horizons far beyond the restrictive limits of the material and intellect constrained by its finite vision. Such thoughts must await another post on another day—which I trust will be soon forthcoming.

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.

Continue reading “Delivering the Cookies”