How Doctors Think

I ran across this book on the Fairfax County Library Audiobook site. Not only has it provided an interesting perspective on how human medical doctors think through cases, but it has provided plenty of material for self-examination. There are many cognitive errors that can compromise a diagnosis, such as from being satisfied with the first answer we have evidence for (search satisfaction) to letting our relationship with a client unduly affect our recommendations (affective error). Dr Groopman illustrates these with real life examples and follows up with questions that you can ask your doctor when you think something might be being overlooked, such as "What else could be causing these symptoms?" A worth while read for anyone who might have to navigate through the human (or veterinary) medical landscape, and that means most of us.

Wild Wonderful West Virginia

Three days of Class IV kayaking is a good way to celebrate Spring!

Day 1: Top Yough (Maryland)

Day 2: Middle Fork Tygart

Day 3: Upper Meadow

We started out with Swallow Falls near Deep Creek Lake. Plenty of other fun and challenging rapids, but not quite so impressive!

Perspective

I have befriended a Pakistani gentleman in a nearby business and stop in occasionally to discuss his native country and the current political changes taking place there. Yesterday, in the context of law enforcement corruption in Pakistan, he told me of a recent experience at Dulles Airport.

He had dropped off a relative for a flight to Pakistan and while still in the drop off lanes, discovered that the flight had been cancelled. His relative was told that he might be able to catch a flight out of Dulles that same day. The relative then offered to drive there since he knew the way and took the keys from my friend.

Just then, an airport worker called the relative over, keys in hand, to tell him that they had reserved a seat on a flight leaving from Dulles in 40 minutes. Meanwhile, airport police came over and asked my friend to move his car. He told the police that his relative, who was nearby, had the keys. The police officer then issued a $40 ticket for this violation of departure lane protocol. The fact that the Airport Authority was the cause of the delay in moving the vehicle did not sway the officer.

Now, most Americans would be filled with indignation at this sort of injustice, but my friend, although intending to protest the ticket, is actually happy that the police officer carried out his duty. In his own country, a bribe would have been commonplace and justice arbitrary.

Political theory becomes concrete in these situations. In the United States, we take it for granted that the higher authority that we feel a sense of obedience to is essentially just. It is because of this that we obey rules even when there is no chance of getting caught breaking them. (Would you run a red light at a deserted intersection?) If we felt that enforcement of the rules was regularly unjust, how would that affect order in society? We don't have to look too far to see the answer.

Who Can You Trust Nowadays?

In the fall of 2008, one of our clients at the veterinary clinic was deported to Germany and had to leave without her three cats. Despite severe economic hardship, she wanted to reunite her family with the cats by boarding them at our clinic for the requisite month after vaccination, and then flying them to Frankfurt. This involved a lot of logistical issues and significant cost. We agreed to do this, but with strict guidelines as to payment deadlines. As time went on, her finances became more and more strapped, but we were already committed, so we ended up sending the cats to Germany with a large balance still on her account.

Emails were exchanged and gradually some payments came in. But the final installment kept getting delayed. It would have been easy for her to simply ignore the bill as we had little recourse to collections. Although I harbored no resentment, I had significant doubts that this veterinary bill would be paid, especially since there were many other important demands on her assets.

Today I went to Western Union down the street and collected a large final payment of her bill. While I was standing at the counter a woman came in close to hysterics to see if someone had turned in her handbag which was missing. She was in tears as the service desk clerk pulled out her bag and told her a young woman had turned it in. She pulled out $20 and was yearning to give it to this young woman, but she had already left the store and no one knew her identity. The owner of the purse then asked if there was a charity fund at the store, but the clerk just patted her hand and told her to keep the $20, saying "there are good people out there."

When I got back to the clinic, our manager told me that the $300 check that had bounced from one of our other clients had done so not because the client wrote us a bad check, but because her identity had been stolen, necessitating the closing of her accounts.

I think I'll give people the benefit of the doubt today.

Meekness

Several years ago at a homeschooling conference, a family friend presented definitions of the capital sins and cardinal and theological virtues that he had his children memorize as part of their coursework. I remember being impressed that his 10 year old could recite these definitions so well and decided that this would become part of my one day a week homeschooling time. Over time one definition has stood out as essential for healthy family life, that of meekness:

Meekness is a supernatural moral virtue by which we prevent and restrain anger, bear with one's neighbor in spite of his defects, and treat him with kindliness.

I point out to the children that heroic actions such as saving lives may be dramatic, but it is the way in which we treat each other that builds virtue on a daily basis. What I like about this definition is that it goes beyond just biting your tongue and demands a positive approach to loving others. Note that we aim to prevent anger. As St Francis de Sales says, we should, in our morning prayer, try to anticipate the temptations to sin that will present themselves. If we know that a sibling, child, or parent is likely to annoy us, we can prepare ourselves to respond in a loving way. In stead of fanning the flames of annoyance, we can douse them with an understanding comment, or at the least, self restraint.

Also, we do not deny that others have defects, but we do challenge ourselves to look beyond them to the good of the person. So often I need to reminded of this simple truth. If Christ could hold His arms open to us on the cross in spite of our defects, we should be able to draw on the graces that He pours out to do the same for those around us. Christ showed us that this wasn't easy (an understatement--it cost Him his life) but this demand He makes of us seems pretty reasonable compared to His sacrifice!

Science and Religion

I believe that there is a natural and a supernatural element to reality. Science can explain a great deal of natural phenomena, but not all--for instance, the existence of "dark matter" in the galaxy is assumed due to the nature of the orbits of stars, but by no means do we understand it, and stellar orbits within our galaxy are relatively easy to observe and measure. The origin of cellular life is equally a mystery despite our understanding of cellular structure and function. Maybe our understanding of these will improve in the future, but the point is that science sometimes cannot answer even basic questions about physical realities.

Good and evil are just as "real", (perhaps even more so) but you can only get so far in trying to explain them physiologically, psychologically, or through evolution. Assuming that you feel at least some responsibility for your actions and believe there is a degree of freedom in the choices you make, how else can we explain conscience and virtue? A supernatural explanation is the only satisfying one. But in allowing for the supernatural, we acknowledge something that does not rely on nature for its existence. Aquinas referred to this as a first cause. This cause encompasses the natural world as well, since without it, nature could not be.

So can we reconcile these two realities-the natural and supernatural, science and religion? Certainly! Our human experience demands that we do. But when we try to understand phenomena that have no convincing natural explanations (for example, the origin of the universe), shouldn't we allow for at least the possibility of supernatural ones? What we cannot reconcile is not religion and science, but religion and materialism. Allowing for only natural causes at the exclusion of the supernatural, or trying to limit the divine to the role of spectator in the physical universe closes our minds to the true splendor of the natural world.

PARTs of Prayer

I don't recall where this came from (probably the same wise gradeschool IHM nun who said my priorities should be God, Family, Work, and then Self), but I have found this valuable in structuring mental prayer:

PART stands for (in order of priority):

Adoration
Thanksgiving
Reparation (examination of conscience and contrition)
Petition

A great practical resource for fleshing this out is Introduction to the Devout Life by St Francis de Sales (my Confirmation Saint), particularly Part II. We are using this book as study material in Teams of Our Lady right now. St Francis not only understands the depths of God's Love, but how easy it is for us to get distracted from seeking it.