The Author's Response

The Author's Response

Dear Ed,

It has been some time since our last interaction. If my memory does not betray me, I gave the impression that I would respond to your thoughtful comments. I lost my way in some unforeseen sidetracks. I appreciate your forbearance, though perhaps, with the passing of so much time, some mystery surrounds this preamble.
Recall your closing thoughts:

You are correct that we must compromise somewhere. God help us with such wisdom. We cannot become monastic monks, and neither have we time or opportunity to present a comprehensive position. However, I mentioned one example above: abortion. Can we compromise on that? If we can, then nothing else really matters (in my not-so-humble opinion).

Frankly, I am a little surprised at your challenge. Not that I mind it. If one cannot defend his actions, then they have either never been properly examined or need to be. However, your questions are more superficial that your usual broad and deep perspective. I mildly suspect something else going on in your mind that caused this challenge. I may be, and am likely wrong, but your questions are a little differently formulated than the Brother that I have read in the past.

As always, I am praying that you will be a Daniel in the modern Babylon of medicine. You should not see that mantle as a burden, but one to pursue by hard study and logical thinking. Then, God may or may not provide the opportunities. His yoke is easy and his burden light... we add any weight that we feel.

If I have omitted any questions, or you want further clarification, on the above, I am quite willing to provide them for my Daniel. I don't claim infallibility, but most answers are quite well thought through from a philosophical and Biblical point of view. But, and I have (occasionally) been challenged and changed by another. We all have blind spots, and I have wondered where mine are.

Godspeed, my dear man.

P.S. I would like to post your email and my response to our website <bmei.org>. I have not posted recent material, and this interchange shows some facets of our thinking. If you had rather not post this, then I understand.

First, I have no problem if you post our previous exchange on your web site. I would only ask that my identity be withheld. On this matter, I prefer a low profile, although some mutual acquaintances may not be fooled.

Second, after reviewing my initial exchange with yourself and Hilton, and then your thoughts on the matter, I realized that the pump was primed, unintentionally, for some misunderstanding. To be sure, you did grasp the atypical posture of my last missive, even if the exact nature of that "something else going on in your mind" proved elusive. But allow me, please, to confirm and clarify its context.

Around that time, I was engaged in a personal struggle, trying to define my place in medicine. I had a growing desire to carve out a perspective on medicine as vocation, a vocation at once biblically faithful, theologically beautiful, and personally satisfying. One could pursue different threads of thought in such an endeavor.

I might have wooed two theological companions, becoming intimately acquainted with them in my daily rigors of residency and medical practice, fleshing out the practical implications of a pungent hamartiology, and thus, the utter sinfulness of idolatry. For, on a daily basis, and this does not even come close to hyperbole, I was guilty of idolatry (and still am on many occasions). How many times in medical school and residency did I feel sorry for myself? How often, as I received a page from the ER, and knew another patient was being admitted, did I grumble within? How is it that my affections embraced the slumping trajectory of depression and murmuring rather than the soar of a holy joy in the Lord? The real permutations are literally endless. The strained voice when interviewing another old, demented, woman; the dripping spirit of complaint leaking from my heart during every outpatient clinic day because of the stress, time limitations, and multiple responsibilities crouching at the door, waiting for five o'clock to tone so that I might then race back to the hospital to catch up on ward duties; jokes glibly dispensed at the expense of patients with the imago dei; the sheer happiness that overwhelms the soul when a no-hitter is in the offing, and what dark thoughts noiselessly brood as the sixth or seventh patient, transferred from another hospital, begins to explain his prior 9-month hospital course; in short, these actions flowing out of my heart, exposed my abject failure to obey the two greatest commandments on which hang all the Law and the Prophets. I am an idolater.

I find this above dynamic so exciting that, at the risk of needlessly digressing and boring you, I shall try to tease it out further (though I will keep it relatively simple). For instance, my disappointment with receiving yet another patient on call often reflects my desire for more time to sleep, to relax, to study, or any number of things. The desire itself is not always sinful. Indeed, when it is an ordinate desire, I have not sinned against God. I desire a legitimate thing, a blessing from God. But, when the heat below the crucible of life experience is providentially ratcheted up, and the desire causes me to sin against God or my neighbor, it has then mutated into an inordinate desire, and thus, become idolatrous. It has taken the place in my affections that is alone God's preserve. Or again, "You brood of vipers, how can you who are evil say anything good? For out of the overflow of the heart the mouth speaks" (Matt 12:34). It is a core argument of Scripture, I think, that the fundamental orientation of the heart is either for or against God. Almost every single grumble, complaint, or sigh that I utter, implicitly denies the sovereignty and love of God. I am sinning against God. As I become a better physician of the soul (starting with myself), I begin to see how my emotions, reactions, behavior, etc., betray the inescapably Godward orientation of my heart. Knowing that there are specific life experiences that more easily elicit the idolatrous tendencies of my heart-just as fatigue, sickness, pain, etc., more easily elicit the wickedness that already resides in my heart (Edward Welch's articulation of this dynamic in his Blame it on the Brain is classic)-I am then empowered to pray more specifically, to seek the face of God more fervently, to know myself more deeply (Jer 17:9 notwithstanding), to repent more intelligently, and thus, to mature in the faith, becoming more like the glorious, ineffable Christ. Any one example above may seem trivial, an estimation that could betray an inadequate appreciation of personal sin and God's holiness. But an ongoing application of these principles, married to a vital relationship with Christ and His eternal Word, in the power of the Spirit, would produce an exponential effect, much like the multiple snowflakes in a Minnesotan snowstorm. Frankly, as I ponder these things (I am indebted to Dave Powlison for much of this), and think about its implications in medicine and life, I become embarrassingly pre-syncopal.

As I alluded earlier, I could have fleshed out these above ideas, applying them to my heart and life. But I did not, for my concerns were too narrow at the time. The question of what godliness would look like as a believing physician, however, was still on my mind. But I was chasing its theoretical facets, rather than the more practical texture. Now, while the great Herman Dooyeweerd and Abraham Kuyper might protest, I feel that the latter [the practical contour of our lives] is surely closer to the heart of God. It brings more intimate access to the bosom of Christ. The former, though eminently desirable, is dry and lifeless without the latter, something I have only recently begun seriously to grapple with. That opinion aside, when I broached my queries to you, my concerns were primarily weighted toward the theoretical end of this tension, although overlap is inescapable. Some of these ideas were already woven into the discussions with Larry, Eric, and others on that discussion group. It was a model seeking to carve out the intellectual, theoretical, presuppositional modes of thought in medicine as they related to God, bringing them into a coherent life principle. You are already familiar with this, but I shall include a brief summary as put to a friend some time ago:

I had perceived the myth of religious neutrality, understanding that life-all of life-is profoundly religious. The way I live, eat, drink, work, play, theorize, think, practice medicine-all of it-to one degree or another, will reflect my opinion of God, my true allegiances, the commitment of my heart and, indeed, of my entire being. The implication of this, as physician, is that glorifying God in my vocation is not necessarily any different, in principle, from gardening or eating breakfast, for whether I eat or drink I [should] do all to the glory of God. So then, while the texture of my medical practice, given my faith commitments, will entail distinctives, e.g. evangelism, peculiar convictions, etc., these are not the sine qua non of a vocation that is under the Lordship of Christ. My whole life, my work and play-everything-belongs to Him and is for Him. There is no secular-sacred fallacy here, though there is a biblical place to speak of the providential provision of opportunities, opportunities to uniquely bring the sweet savor of God into our specific areas of vocational (and other) influence. In any case, I mention this perspective because I deny that all believing physicians should write articles or books; that they should all engage in public battles on behalf of God; that they should all-in a professional capacity at least-challenge the secular hubris that flirts with scientism and biological reductionism as if these views are remotely attractive. The manner in which we carve out our professional niche, our vocational emphases, etc., might have a lot to do with natural gifts and such that God bestows in His sovereignty. I have with time found mine to be in the areas of thinking, reading, writing, etc. I hope by God's grace to do more "apologetic" writing in the future, if only, in some limited way, to salt some of this barren earth. Or, to adopt a more aggressive stance, "demolish arguments and every pretension that sets itself up against the knowledge of God, and [take] captive every thought to make it obedient to Christ" (2 Cor 10:5).

But even that articulation seemed like David against the Goliath of academic medical culture. What I needed was a slingshot to resolve this unwelcome discrepancy. It was at that point that I turned to you and Hilton. You were men, physicians, whom I deeply respected, had emulated in many ways, even if only from a distance. I had been challenged by your strong minds, your boldness, and the apparent audacity of your biblical convictions. So, with the limited information I had (primarily published material), and having no biographies available (!), I tried to discover how you had carved the biblical way ahead. I tried to understand what shape godliness had taken in your lives as physicians; again, my bias being weighted towards the "theoretical" facets of that picture. As I searched my books, articles, literature, etc., it seemed to me that there was a relative inactivity in the public arena, contrary to other (to my mind) less thoughtful physicians (Orr, Collins, Young, Cutrer, Eck et al). I found this curious, and since I was grappling with how best to use my abilities (whatever these may be) for the glory of God, the issue was like a banana, ripe for the peeling. In any case, I then very self-consciously, and perhaps selfishly, wrote the initial epistle to elicit answers to these questions. Ed, your response was exactly what I wanted - it spelled out many things I was unaware of and helped me better understand your journey. Several other arguments may have come to the fore, and I think, on some points, I did not articulate myself well enough. Hopefully, the above has clarified rather than confused the matter. Your response served as a needed corrective, as did Hilton's sane words: "Realize that you are seeing only what has been visible through a narrow, published window." Amen.

Lastly, I might have ordinarily ended here. But there is another element that has since arisen. To be sure, some of my struggles alluded above probably played into this development, although I doubt they were causative. Providentially, these were symptoms of a deeper issue, although secondary means always loiter in the background. The fact of the matter is that medicine, as such, has never been my first love. This element arose not so much because ungodliness has metastasized the entire profession; because we blame so much sin on the body; because we are such rank reductionists; because our collective hubris boggles the godly mind, though these all present problems (as they do in many secular vocations), but rather, because whatever warmth I had toward medicine had long since frozen over. The things that animated me; the things that hounded my thoughts, chasing my mind day in and day out; the things that I dreamt about, pondered, mused, theorized; the things that I delighted in, savored, enjoyed, relished; all those things were eminently theological. So often, I tried to beat medicine into the vocational shape I had envisioned. So often, I prayed to God to honor that desire. I thought He would. I felt He must. He did not. This issue, like a chronic, gnawing peptic ulcer, kept me quietly dissatisfied and frustrated. Strangely, it was while reading Iain Murray's (relatively) unexceptional Puritan Hope that my life changed. To borrow John Piper's words, I knew then "irresistibly and (I believe) irrevocably" that I was going to seminary, and perhaps, God was calling me to the gospel ministry.

I had always maintained that D. Martyn Lloyd-Jones' reasoning for leaving medicine was dubious. I had always maintained that I, on the other hand, would glorify God in medicine. It was a fearful day when I made peace with God's providential irony. My view on these matters has not changed. I pray that God would bring godly, thoughtful, courageous, bold men into the medical profession. We need them. The Body needs them. But my path has taken a different route.

As D.A. Carson wrote in his The Gagging of God: Christianity Confronts Pluralism: "We simply must smash down the various bifurcations. We must have theologians who are pastors and evangelists; we must have evangelists who think biblically and theologically" (p.479). Making no apologies for any romanticism, I aspire to be a pastor who is at once a theologian, scholar, evangelist, teacher, apologist. I passionately desire to spread abroad the aroma of the supremacy of God to as many people in as many God-glorifying ways as I can! I love teaching theology, breaking it down into bite-size pieces, infecting others with an irresistible passion for God. Theology is in my blood. I was made for this. If-God forbid (!)-with the passage of time, it becomes clear that I do not have the spiritual gift of preaching and teaching; that I am not able to communicate truth in the palpable vitality of the Holy Ghost, I can always teach in seminary (admittedly, I assume a legitimate distinction between heralding God's Word and academic teaching in seminary). Even that concession would be an inestimable privilege!

While I plan to continue interacting with the ethical and moral aspects of medicine, not least in writing, I doubt I will be engaged in actual practice beyond residency. Though, with due reverence to providence, nothing is impossible (James 4:13-15).

Enough. I must stop.

Succinctness, I have been told, forever eludes me. I continue to be hopeful.

Warmly,

Your brother in Christ

P.S. I plan to attend TEDS in the fall of 2003.

P.S.S. I have forwarded a copy of this to Hilton.