Guts and Yuck

We're arm deep in guts and fecal matter nowadays in Gross Anatomy, as we're studying the abdominal cavity. I was talking with one of our ethics profs today, and I think what he said captures it accurately: in medicine, there's a revulsion and fascination by the body. The body's disgusting, as my tankmates and I saw so aptly yesterday. Even though we carefully as we tied off both ends of the rectum and intestine, it still didn't keep us from inadvertently smearing bits leftover feces all over our carefully dissected kidneys and abdominal blood supply.

It's really all just digested food, for goodness sake, and after having sliced open eyeballs and sawn through facial bones and done all manners of horrible things that I wouldn't have dreamnt of doing half a year ago, you'd think fecal matter would be a small thing. But it isn't. Fecal matter has its own pedestal of official yuckness. Perhaps it's ingrained in us culturally, from parents telling their small children, "No, don't play in the doggy doo doo. It's disgusting!" The yuckness of feces has a biblical stamp too. I was reading yesterday in Ezekiel that when God commanded him to cook his food over night soil, Ezekiel pleaded mercy - "Please, I've never defiled myself!" and God granted special pardon.

But what I've found really surprising about these lab dissections is really just how beautiful the intestinal system is. Compared with the mess of nerves in the armpit and the sheer minisculeness of facial muscles and arteries, once you slice past the abdominal muscles into the peritoneal cavity, it's like opening a beautiful package: large, neatly and tidily packed together, and shiny. With a layer of fat instead of bubble wrap. It's amazing how much fits in this cavity. And when we dissected the mesenteric arteries, they spiderwebbed out like spokes on a wheel (the colon being the tire). And even though we were pretty darn tired from a long day in the lab, we couldn't help but keep on dissecting, uncovering one delicate pink arterial arch after another. Who knew guts were so beautiful? Even as you could feel, inside, the lumps of semidigested food on its way to becoming feces?

Fascination and revulsion, attraction and repulsion - that captures so much of what medical school has felt like lately. My lower back has been getting pretty sick of the contours of the dining room chair I use at my desk, my throne for two-thirds of every day. It's wearying, studying so hard and yet being in the middle of the pack gradewise. It's hard to to question if I'm not wasting my efforts doing something that I'm not stellar at. I detest the first wave of formalin that washes over me when I open the double doors into the fluorescently lit anatomy lab. Is this worth it? But then there's those small moments - the small treasures you discover like little lymph nodes among a mess of connective tissue. When I can watch House and I yell at Adam, "Hey! I learned about ornithine transcarbamylase deficiency! I know what that does!" Moments when genetics is pretty darn cool, in its simplicity and mystery. When we practice patient interview scenarios in our colleges session and I just love it - I have to restrain myself from totally dominating the entire discussion.

There is something wonderful and fascinating and humbling in how medicine uncovers our common humanity. Yet there is also something that is humiliating too about uncovering our commonality. When the professor tells us that people release 2-3 liters of flatulence a day, there is no hiding. Yet we can't help but shudder at the oozing and leaking and processing that is what it means to live in a body. Our bodies - beautiful, amazing, and downright disgusting.

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Cadavers & Communion

I've been in med school for two weeks now, and it's been exhausting. It's hard to get back in the school mode again, with no time at all to do the little things I enjoy - cooking, painting, reading, thinking, and with paralyzing fears of inadequacy and failure. I've been studying so much it feels like it's been finals-week. Yet despite it all, I've been surprised by how I have enjoyed learning the things I have (sadly, learning seems to be a different thing for me than remembering).

One of the things I find sad is how little time there is really to think, to process what indeed is going on. Particularly the anatomy dissection. I posted awhile back on dissection and cremation, but I'm learning new things from the experience itself. It's been not as horrifying an experience as I had feared, and I haven't had cadavers haunting my nightmares. Because somehow, when you subtract the gripping soundtrack and add a list of things to do and learn, the experience seems much less phantasmagorical and more common-sense. Part of it, certainly, is because the cadavers have turned pink or orange or greenish-grey from the embalming process.

Another part, though, is realizing how different life is from death. The body, when not animated by life, seems somehow much less human. It has more in common with the meat we buy from the grocery store (indeed, the shoulder muscle we looked at- the rhomboids - look a LOT like beef brisket, which is, after all, beef shoulder.) It really makes me realize that we aren't so different from animals, from the meat we eat. Despite all our efforts to make a separation (e.g. becoming vegetarian), it is indeed our soul which makes us human, the breath of God. There is nothing particularly unique about our bodily form. A sobering, humbling realization. It stands in stark contrast to the exaltation and glorification of the human body in movies and glamor and body-building magazines.

We've been attending a wonderful Vespers service at our church every Wednesday, and one of the things that really hit me last Wednesday was when the pastor said when presenting the communion, quoting Christ, "This is my body, which is broken for you. Take, and eat." And I realized really what it meant, that Christ gave His body. These generous people donated their bodies to us medical students, to be examined, carved apart, learned about. That is what Christ did. And those neat small foam wafers which we took at communion, in remembrance of Christ - they were standing in for the pieces of Christ's body. During the dissection, we cut away parts of the flesh and put them to the side, so that we can better examine particular bones, muscles, etc. That's what communion was - eating those little pieces of Christ's flesh. Gag-inducing? Twisted? Disgusting? Horrible? No wonder the Jews had such a response to this command of Jesus'.

That's what Christ did - He presented His body, broken, for us, for the forgiveness of our sins. He presented it to us that we might take it, and find life through His death. He didn't say that he presents us His soul, broken for us, but His body. What does that mean? What does that mean for the importance of the body? What does His gift to us mean?

1 Corinthians 11:

23 For I received from the Lord what I also delivered to you, that the Lord Jesus on the night when he was betrayed took bread, 24 and when he had given thanks, he broke it, and said, “This is my body which is for you. Do this in remembrance of me.” 25 In the same way also he took the cup, after supper, saying, “This cup is the new covenant in my blood. Do this, as often as you drink it, in remembrance of me.” 26 For as often as you eat this bread and drink the cup, you proclaim the Lord's death until he comes.

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Wizard of Oz, MD

"It is common for an analysand (the patient) to say that the [psycho]analyst is the most important person in his life. When I was in therapy, I thought of this attachment as the "Wizard of Oz" phenomenon. For me, my therapist became a floating head that accompanied me everywhere, with whom I had conversations that extended way past my sessions, late and night and early in the morning. Psychoanalysts often explain these intense feelings as the reenactment of childhood experiences, but they probably owe their intensity to the weird asymmetry of the therapeutic relationship… Therapy, when it is working well, is a powerful, intimate experience. … Their therapist can be their personal, sacred, perfect source of wisdom." (Of Two Minds, 104)

Can you smell the seductive scent of power? You too can be someone's personal Wizard of Oz! It is very sobering to think about the power one person gives to another. Why do we allow people to have such strong influence in our lives? And this really is not only psychiatrists, but extends to teachers, pastors, mentors, role models… Heck, if David Powlison told me that he really didn't I wasn't cut out for counseling, I'd probably drop everything and be a dermatologist or a pastry chef instead.

I think we're all hoping that someone has the answer. It might take a lot of looking under rocks and finding dirt, but we all cling to the hope that someone out there can fix us and all our problems. There's someone out there can understand us truly , can figure out why we seem to get stuck in the same muck, who can speak just the right words that will free us from the spell and hand us the key to life, love, and happiness. I want to believe that there's that perfect counselor out there, somewhere. (Cue Fivel: Somewhere, out there, beneath the big blue skkkyyyy…..)

We're built for worship, as David Powlison and his colleagues at CCEF say, and so we're primed to look for heroes to turn into our gods. And that's the danger of being a psychiatrist - that you could have that much power over a person. The mystique is only increased by the asymmetrical relationship, and you can read the silence of the psychiatrist as the deep brooding of an oracle of truth.

Yet what can be done about this? How do we counteract the tendency towards savior-complex and hero-worship? Jay Adams' solution was through biblical counselors sharing how they worked through any similar struggles, through being honest as a sinner before another sinner. He also proposed interchangeable counselors, so that a patient would come not to depend on having a particular counselor for help, but begin to look to God.

The latter solution doesn't look particularly workable in the psychiatry framework. But how about the former? Some of the best counsel I have received from my mom is when she's shared stories of her related struggle, and how she moves past that. And I think part of its effectiveness is because I start to recognize that I am not the first and only one to struggle with a particular issue, (say, of rejection) , and it gives me a door outside of my prison cell of self-centered thought, to caring and thinking about other people, and recognizing the same symptoms in others.

So what will be the consequence of handing this power to psychiatry? The ideas of psychiatry inevitably trickle down and wash culture in a bath of theories of the unconscious and guilt and self… What will be the consequence of giving psychiatry the throne of God?

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Bird Taxonomy

You could smell the earth waking up last Saturday, in a riotous cacaphony of chirps and in the warm breath of the wind. I hadn't realized I had been Next to the meadow, I ran into Grady, who had traded in his watch for a pair of binoculars to go bird-watching.

And somehow, we got to talking about how easy it is to flatten people, and make them one-dimensional. When you first meet people, it's easy to be excited and see them as mysterious, full of promise, fascinating. But when the shininess wears off, it's the in-between time that's hard. You know them, enough so that you can move around each other in the kitchen in a careful dance, how to make passable small talk, how not to step on the other person's toes. Enough to close the folder and file away in your list of useful information. But in sorting and labeling people into manipulable categories, you lose something. You lose the color of a person, the look of vulnerability in their eyes, the sound of their joyous laughter, the shimmering beauty of seeing that person at his finest, the sweat of agony on their brow as they decide between the harder higher path, or the easy lowland one. I am troubled by my flattening of people. It becomes so easy to judge, to condemn or, even worse, dismiss (as in, whatever, he's just like that. ) Sometimes, with some people, you get past the flatlands, and they start to pop back into 3-D, and relationships grow deeper, and sweeter, and you learn to cherish their friendship. But how do you get there?

I've been talking and asking about how to choose between different positions on an issue, like women's leadership in the church, or eschatology, or the work of the Holy Spirit. Drew said that it's ultimately a leap of faith. I like that answer. Deciding to believe in God as revealed by Christianity is like choosing to get married to Adam. Or vice versa. You don't have all the information, and you can't really fully objectively research all the possible alternatives. You ultimately have to take the information you know, the place you're at, and commit. And so, whether or not some may accuse it of heresy or fundamentalism, I like biblical counseling. I like biblical counseling because it seems to be the only perspective that really looks at people and sees people - people with stories, contexts, hopes, struggles, joys, sorrows, people who make choices but also suffer. The Freudian psychoanalysts, the biological materialists, the Christian psychology integrationists, the pastoral counseling camp, and the nouthetic counselors - of all the detectives in the business of taking a magnifying glass to a person, I think it's really the biblical counseling people who get it right.

What troubles me about psychiatry is that it is in the business of quickly and efficiently categorizing people, so that you can assign them their appropriate medication and send them on their way. They develop, like bird-watchers, the ability to pick up on small details that help you to identify and categorize a person. There's an anecdote in the book I'm reading, Of Two Minds, about a psychiatrist who can glance at a patient as they walk through the door and have the disease diagnosed before they speak a word. But unlike bird-watching, the difference between manic-depression and schizophrenia aren't like the difference between a sparrow and a turkey vulture. The y lie on a spectrum of characteristics. But the pressure on psychiatry to act like medicine makes them treat the disorders as distinct diseases. "Understanding how psychiatrists see is also terribly important, because madness is both frighteningly palpably present, and yet elusive. There are no diagnostic tests in psychiatry… You cannot draw someone's blood, stick someone into a magnetic resonance imager, or take any medical reading that will tell you definitively whether that person is depressed or not… To understand psychiatric ways of seeing, we have to proceed knowing that what counts as "fact" is a tinted window onto a world you cannot step outside to see." (10)

I enjoyed the show and tell of the boxes we made for Jordan's art therapy teaching day last week. It captured a second dimension to each of you that I had forgotten - the inside to the outside. There is one more dimension to each of us, however, more than the dimension of who you see me as and who I see me as, and that's who God sees me as.

I need God. I need God desperately. My mentor, Sonya, suggested that the reason I might be struggling with my relationships, why I'm finding it difficult to love and be curious about other people, might have something to do with my relationship with God. I've been running on recycled fumes. Who i know myself to be will spill over into how I perceive others. I know the answer is in here somewhere, a clever turning of the metaphor of bird-watching, people-relating, and psychiatry, but I'm not sure yet what it is. Perhaps you have a suggestion? But I think this is what it would mean to see people rightly:

It is a serious thing to live in a society of possible gods and goddesses, to remember that the dullest and most uninteresting person you talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship, or else a horror and a corruption such as you now meet, if at all, only in a nightmare. All day long we are, in some degree, helping each other to one or other of these destinations. It is in the light of these overwhelming possibilities, it is with the awe and the circumspection proper to them, that we should conduct all our dealings with one another, all friendships, all loves, all play, all politics. There are no ordinary people. (C.S. Lewis, The Weight of Glory)

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Sleep On It

Just sleep on it. I'm sure you've heard that before. But why does it work? I have a theory.

Emotions are strongly related to what's happening bodily. That's what Piper and C.S. Lewis suggest when he says, "When the music of spiritual joy plays in the soul, it gets 'transposed' into physical sensations. But since the spiritual "orchestra" is richer and more varied than the physical "piano," the same piano keys have to used for sounds that in the orchestra are played with different instruments." (When I Don't Desire God, 180)

Piper gives an example of the difficulty between distinguishing love from lust when looking at your lover (which I don't think is a very good example). But there's more than Piper recognizes to the idea that the same piano key must be used for varied spiritual emotions. The interesting thing is that the same 'piano keys' are used for the same physical emotions as well.

For example, how do we know we are afraid of something? Our heart beats faster. Our palms sweat. Maybe we pee our pants. Yup, if all that is happening, I must definitely be afraid.

Wait a minute, you might say. You've got the causality all wrong. It's because we're afraid that our heart rate quickens and our palms get sweaty.

Not necessarily. There's an interesting study that had men perform a dangerous task, I think it was cross a narrow rope bridge over a river. The experimental group had a woman approach them in the middle of the task and offer them a drink of water. The control group had a woman approach them before the task and offer them a drink of water. When the men were asked to measure their attraction to the woman, the experimental group rated their attraction to the woman as significantly higher than the control group. The scientists concluded that the men who were in the middle of the task, who had their adrenaline pumping and sweaty palms, read their physical state as meaning that they were attracted to the woman. So the study suggests that even very different emotions play on the same piano key. Apparently our body responds physiologically to outside events more quickly than our brain recognizes, and our brain has to catch-up and translate one step later. We have to be careful how we read our bodies and translate our bodily experiences into emotions and thoughts.
motions are strongly related to what's happening bodily. That's what Piper and C.S. Lewis suggest when he says, "When the music of spiritual joy plays in the soul, it gets 'transposed' into physical sensations. But since the spiritual "orchestra" is richer and more varied than the physical "piano," the same piano keys have to used for sounds that in the orchestra are played with different instruments." (When I Don't Desire God, 180)

Emotions are indivisible from our physical bodies. That is evident in a study of amputees that measured their emotional states. The study looked at their experiences with depression, phantom limbs, etc. But what the scientists were surprised to discover is that the amputees reported having lower levels of emotion than they did before losing their limbs. They experienced less happiness, less grief, less anxiety - all of their emotions were muted. Apparently, when you don't get sweaty palms, you don't feel as nervous. Isn't that fascinating?

So how does sleep play into all this? Well, say late one night I've thought up this terrific idea to make mountains of money by opening the Five Guys franchise in India, and I'm feverishly excited, and my heart is racing, and I'm imagining my glorious retirement to my magnificent mansion in Mumbai. I go to bed. But somehow, when I wake up in the quiet blue calmness of the morning, I can't remember what got me so excited about the idea the night before. The idea seems pretty stupid. Especially when I realize that a lot of Hindus don't eat beef and Five Guys with Chicken doesn't seem so exciting. I used to think that because I couldn't rouse the same emotion, whether anger, or passion, I must be forgetting the really good ideas. But I'm beginning to think that we put too much stock in our emotions.

So beyond the memory consolidation and 'learning' that occurs during sleep, my theory is that sleep also serves to reset our bodies, and by doing so we are more clear-eyed about our thoughts. And that's why it is often a good idea to sleep on big decisions.

The resetting of each morning is a blessing. The anger, the passion, the despondency which settle like a blight to the soul, may prove to be a passing storm that clears in the morning. And because we aren't hanging on to our emotions , our bodies' forgetfulness may be for us a healing.

Sometimes a light surprises
The Christian while he sings;
It is the Lord Who rises
With healing in His wings:
When comforts are declining,
He grants the soul again
A season of clear shining,
To cheer it after the rain.

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Bodies of Death

I have to confess that I've always found the body, though fascinating in how it works, to also be repulsive. I don't like the reminder that we are just really food processing machines, not so different from earthworms: food in one end and excrement out the other. I don't like that initial slice during surgery, where you cut through the wholeness of the skin and see the stuffing of a person, the messy, squishy, bloody, pulsating mess inside. If only humans could look more like plants, with their neat compartmentalized structures and pretty colors.

So I guess it's pretty ironic that I'm going to medical school, huh? I'm already steeling myself for anatomy. Dissection tresspasses completely on the sanctity and dignity of a person. Curiosity, I think, will be the only motor pulling me forward to cut and examine, while the rest of me grimaces and digs in my heels hard. It's hard not to think that when you cut off chunks of a Bob's pickled body and throw it in a trash bag, you aren't also carving up Bob himself. After all, this was the physical form that Bob's family and friends hugged, shook hands with, and knew to be Bob.

But, we reassure ourselves, this is not Bob we're dealing with. This is simply his physical shell, left behind in this mortal world. It's okay if we take it apart. The real Bob is in a better place. Or, if you're an atheist, Bob, well, Bob is no more.

I was horrified the first time I passed by a body parts shop as a kid. I imagined spare arms piled on the shelves, and extra heads lined up against the wall. But you know, beyond the freaky image (and increasing possibility!) of human body shops, being a doctor is really not so different from being an auto mechanic. You get in there, adjust some valves and pipes, give it a good kick, and send it on its way. And eventually it's not worth it to replace the parts because it's just too expensive, and you might as well junk this car and get a shiny new one. A doctor, however, is a poor man's auto mechanic, who ends up patching up decrepit old jalopies just so they can chug painfully along. The poor man's never going to be able to afford trading in his car until he dies. And unfortunately, people are taking a whole lot longer to die now. All and all, a pretty depressing situation. Bodies that start dying from the day they are driven off the lot.

The resurrection of the body lends a new dignity to the human body, for it means that there is something essential about the body to being human. The body is necessary for us to serve in the role God designed us for, because if we could better glorify and serve him by being simply spiritual beings, God would not have given us bodies in the New Heaven and New Earth. The resurrection of the body means that there is something to caring for the body and providing for the needs of the body here and now, in this world. It gives significance to all of creation. The redemption of all of creation means that our work on this earth isn't just done on old jalopies that will be traded in. If it will pass through fire and not go up in flames, it will last and become part of the New Heaven and New Earth. We can store up eternal treasure.

Yet if we exchange our Platonic view of the body as a shell for the sanctity and importance of our bodies, indivisible from who we are as humans, what does that mean for dissection? Can we in reverence reduce a whole human body down to parts, small scraps of muscle and bone? It's hard not to imagine that you're not fragmenting the soul itself.

If you trace the history of anatomical dissections, unsurprisingly, it reflects the history of thought on the resurrection of the body and soul. Dissection was suppressed by the Catholic church, and it reemerged with the Reformation. How does our reconsideration of the resurrection of the body affect what we think about the practice of dissection?

When you consider that cremation is not so different from dissection, just faster and with less careful observation, perhaps we need to think more carefully what cremation might imply about the current thought on the resurrection of the body and soul. Cremation is growing in popularity: one in four deaths end in cremation today. While it is true that God's resurrection of our bodies is not dependent on our preserving our dead bodies, what does the popularity of cremation reflect about our culture's current attitude towards death and life after death? Cremation is mandated by Hinduism and Buddhism, and in the scattering of ashes, there is a sense that one's life will join in the life of the rivers, oceans, and trees. There is also a sense of final obliteration in cremation - there is nothing more left of the dead person, so why waste space and hurt the environment for the living? Personally, I find the idea of cremation attractive because I don't want to be remembered in cold, still death, and I rather don't like the idea of having my body decay in the ground. Better to hasten the process of nature and go to ashes directly, rather than linger in the ugly in between stages. And I remember one impression I had of cremation, is that the last time you loved ones will see your physical body is when it's shoved into a furnace and goes up in flames. Perhaps you think of a Viking king going out in glory. Curious how the hell-fire imagery doesn't seem to scare anyone anymore.

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A Human God

The part of Jesus that I find so easy to forget is His humanity. I can believe that He was God, that He is Lord of all and existed before time. What's harder to remember is that not only am I to be like Him, but that He actually became like me.

Why does this matter? Because if Jesus wasn't very human, I would find it hard to understand His suffering. To be human would mean that He could doubt, He could fear, He could know what it is to plunge into a bottomless pit of pain and despair. And it means then that He could pay the price for sin with a pain that I could understand.

That is why I found The Passion so powerful. There are always going to be inadequacies and failures in trying to depict Jesus, but I think one thing I think is good about depicting Jesus in movies is that you realize that Jesus wasn't just an abstract nice idea, but Jesus is a human. I could see what it cost Him to lay down His life, to not deliver Himself from each lash of the whip, from the coarse sharp mockery, from the excruciating pain. And this is where His divinity does not lessen His sacrifice, but makes it deeper. He was not helpless in the face of His suffering - He could have ended it at any moment - and yet He chose to endure the pain because He loved those who inflicted the pain on Him. He sought to win for them something they neither desired nor deserved - reconcilement with God. And the blood spilled by Christ - the blood that poured out of the wounds from His body, the pools of it staining the white floor, the blood that spattered and dripped on onlookers - this is the blood that won us life. This is the blood that cleansed us of our sin and freed the earth from the curse. The Passion was gory and it was violent, but the torn up body and oozing blood we see is the self-same blood which we are to remember:

Now as they were eating, Jesus took bread, and after blessing it broke it and gave it to the disciples, and said, “Take, eat; this is my body.” And he took a cup, and when he had given thanks he gave it to them, saying, “Drink of it, all of you, for this is my blood of the covenant, which is poured out for many for the forgiveness of sins.” (Matt 26: 26-29)

Last Sunday, my chief thought when we were passing the bread around during communion was how to tear off the piece of bread where every else's germy hands hadn't touched. With the shiny silver sterility and pretty ceremony of the communion we receive on Sunday mornings, it's easy to forget how ugly and visceral Christ's death was. Experientially, it seems more akin to the act of cutting a lamb's throat for the Passover supper, draining it of its blood, and smearing it over your doorway. It's even a little sickening as you read it:

The Lord said to Moses and Aaron in the land of Egypt, “This month shall be for you the beginning of months. It shall be the first month of the year for you. Tell all the congregation of Israel that on the tenth day of this month every man shall take a lamb according to their fathers' houses, a lamb for a household. ..Your lamb shall be without blemish, a male a year old...and you shall keep it until the fourteenth day of this month, when the whole assembly of the congregation of Israel shall kill their lambs at twilight. Then they shall take some of the blood and put it on the two doorposts and the lintel of the houses in which they eat it. They shall eat the flesh that night, roasted on the fire; with unleavened bread and bitter herbs they shall eat it. Do not eat any of it raw or boiled in water, but roasted, its head with its legs and its inner parts. And you shall let none of it remain until the morning; anything that remains until the morning you shall burn. (Exodus 12:1-10)

It is significant that for the first time, we are commanded to drink blood, and the blood of a human who is God, no less. God had declared, “If any one of the house of Israel or of the strangers who sojourn among them eats any blood, I will set my face against that person who eats blood and will cut him off from among his people. For the life of the flesh is in the blood, and I have given it for you on the altar to make atonement for your souls, for it is the blood that makes atonement by the life. " (Lev 17:10-11) This time, it is not just God consuming the blood offered on the altars as atonement. It is we who drink the blood. Physically, His body and blood become nourishment as they are incorporated into our bodies. We take His life into ourselves, and it is His blood that runs in our veins, and we are His body.

Jesus was physical, he was a human. And the sacraments which commemorate and make God's work real to us - baptism, the Lord's Supper - are physical acts too, which care and renew our bodies. A burial and washing away of our filthy selves, a rising and blessing with water. A slaking of hunger and thirst through eating His body and drinking His blood. We have a new Spirit because of our reconciliation with God. But Christ's humanity - His incarnation, life, crucifixion, and resurrection - all point to a renewal and redemption of our bodies as well.

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