A Christian Physician's Thoughts on Bruce Jenner

This last week seems to have been “Transgender Week” on television. NBC News devoted lengthy segments of its nightly broadcasts to stories about parents who had determined their young children to be transgender and were raising them as such. ABC aired a 2 hour interview with Bruce Jenner in which he declared he was a woman and would be living as one for the rest of his life. In each of the stories, embracing one’s transgender reality was portrayed as brave and courageous and as the right thing to do. As a Christian Physician I was left wondering how I would respond to a patient or a parent in a similar circumstance. What would be the right thing to say?

As I ponder the question I am struck by how society’s definition of the “right” thing to say has evolved over time. In the not too distant past individuals who identified as transgender were considered to have a psychiatric condition that warranted treatment. Homosexuality was similarly considered to be a disorder at one time. What changed? Many assume that it was advances in scientific understanding of sexuality and gender identity that led to the change, that with increased understanding came more widespread acceptance.

The truth is that there have not been any major scientific breakthroughs in the area, that no genes have been isolated nor hormonal alterations identified. While it is possible that such discoveries may be forthcoming the increased acceptance of the medical and scientific communities has not been a result of traditional research. The reasons for the change in perception are primarily cultural and arise from a change in how society defines normal behavior.

Our nation was founded by people who were, at least in the large majority, religious in a Christian sense. Our founding document, the Declaration of Independence, made it clear that the fundamental rights of men were a gift of God. We were “endowed by our Creator with certain inalienable rights, among them life, liberty and the pursuit of happiness.” As rights came from God so did the definition of what was right and what was wrong. Moral law was established by God, not defined by men.

Over time the emphasis drifted away from the Creator who gives rights and more to the rights that are given. Life, liberty and the pursuit of happiness continue to be sacrosanct, but their definitions have become individualized. Happiness is now defined not as a result of doing what is right in the eyes of God but in doing what is right in the eyes of the individual. Liberty is no longer defined as the freedom to do right but as the freedom to do as one pleases. Autonomy is everything.

With this evolution of thought comes the rejection of a universal moral law. Right and wrong behavior are determined, whenever feasible, as what is felt to be right or wrong by the individual actor at a particular moment in time. Behaviors that were unquestionably wrong become first tolerated, then accepted, then embraced and then ultimately defended against those who would disagree.

In the realm of sexuality this cultural evolution can be seen in our views toward premarital and extramarital sex, abortion, homosexuality and same sex marriage. Societal attitudes toward the transgendered are similarly evolving. Attitudes toward the polyamorous are in the early stages of gaining societal acceptance. In every one of these cases scientific “validation” has followed the cultural change, not preceded it.

This is how it must be in such things, for biology can never prove morality. While saying “I was born this way” requires others to give careful consideration to the feelings of another and to proceed with caution in responding, it is not proof of goodness or rightness. There are many conditions with which people are born that are considered unacceptable and in need of correction. Medical conditions such as cystic fibrosis and sickle-cell anemia, and mental conditions such as schizophrenia and alcoholism are not considered acceptable simply because the patient was “born that way.” If pedophilia is one day discovered to be genetic it will not be instantly considered acceptable and appropriate. Science can never prove morality and goodness.

The recognition that moral values, not scientific facts, determine societal responses to sexuality is crucial in determining how we respond to the Bruce Jenners of the world. As a Christian physician, if I am asked by a parent how they should respond to a child who they thought was transgendered my response would be different from other physicians, for my moral viewpoint is different. I would have to preface my response by addressing the basis for any response the parent could make.

I would say that how we respond is based on what we believe. The Christian worldview is that right and wrong are not determined by our feelings but by God. It is true that everyone has feelings and desires, many which they are born with and cannot change. It is also true that everyone has a choice as to which feelings they embrace and follow and which feelings they do not. The Christian view is that when we follow those feelings which are good in God’s eyes we will experience blessing, in the next life if not in this one. If the parent embraces this viewpoint they will need to get professional help in responding to their child in such a way that allows them to accept the reality of their feelings and what that means for their future, in helping their child determine God’s plan for their life and how they can live with the feelings and desires given them at birth.

The secular worldview is that right and wrong are not absolute and that our understanding of morality evolves over time. Many in our culture have concluded that multiple forms of sexual identity and desire are acceptable and good. From this perspective parents would be more apt to encourage the child to "follow their heart." I would also encourage parents who embrace this perspective to get professional help in responding to their child in such a way that allows them to accept the reality of their feelings and what that means for their future, in helping their child recognize which feelings are enduring and should be embraced and which are temporary and need not be followed.

As our societal evolution has progressed to the point of aggressively defending individual moral choices against those who disagree (in some cases to the point of punishing those who do not embrace majority thought), Christians need to be especially careful in how we respond to these situations. It seems to me that the best initial response is to say that while many may disagree, we are of the opinion that right and wrong are determined by God and not by men and that not all feelings need to be followed.

-          Bart

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A Lesson I Learned in Prison

"You're a doctor?” The prisoner’s smile was large and his laughter was deep. “You ain’t no doctor!” He had met doctors before and in his judgment my personality and demeanor were totally inconsistent with the medical profession. He didn't know  me well as our interactions were limited to softball games twice a month. I was part of a church team that had been playing games against the prison team for several years so we didn't see each other often.

Our teams were polar opposites. The prison players were large and muscular men, most of whom were of Hispanic or Black descent, almost all of who were significantly tattooed. We were on the pale, scrawny and inkless end of the athletic spectrum. We had very little in common in our daily lives but found common ground on the softball field.

I was the youngest player on the team. When we first started going to the prison I was just 22 years-old. I was not comfortable back then with starting deep conversations with older men I hardly knew so I related to the prison players the only way I could. Like any self-respecting athlete, I starting talking trash. I soon realized I had unwittingly opened a door to better conversation. My joking insults showed that I viewed them as people, not as targets for conversion. Laughter became a bridge.

For the following 7 years of play I continued to joke and have fun with the inmates. I didn’t talk much about myself so they were not aware that I was attending medical school. The last game I played was the Saturday after I graduated, just before I moved away to start my residency training. Realizing I would never see these men again I intentionally said my good-byes to the prison players between innings. Many shared the one inmate's assessment, I was not like any doctor they had known. To them I was too young and too much of a jokester.

Looking back I see the inmates' amazement as a compliment. The response was not due to a perceived lack of  intelligence or ability, it was because they knew me to be genuine, fun-loving and approachable. As I consider it, I think their perception is something to strive for. It was and is a good thing to be viewed by others first  for who we are and how we treat others, not by our education and profession. A valuable lesson I learned in prison!

 - Bart

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Plenty of Sex but no Purpose

He wanted to be checked for STD’s. Alcohol inspired unprotected intercourse with a complete stranger in a foreign country had resulted in an unpleasant burning sensation with urination. He was educated enough to know that this was a sign of a possible infection and that he needed to be tested. He was educated, but that had not kept him from an extremely risky act. I was curious as to what his decision making process was, wondered what the values were that guided his life and how could have been so foolish.

As we talked I learned that he was like many young men I have seen over the years. He didn’t have a well-developed system of values, hadn’t spent much time thinking about why he did what he did. He lived his life in the moment, doing whatever felt right or good at the time.

This approach to life had brought him to a place where he was not only infected with a sexually transmitted disease, he was also unemployed and unsure of what he wanted to do in life. His life resume included a college degree from a respectable university, a fair number of jobs and a large number of sexual partners but it did not include a sense of purpose or direction. He talked about jobs he thought he might like, industries he might want to work in and the lifestyle to which he aspired, focusing on pleasure and finances. What he did not talk about were the things that truly matter in life such as personal character and lasting relationships.

I asked him if he had ever considered pursuing something different, if instead of focusing on the things he wanted to do perhaps considering the type of person he wanted to be. He hadn't. I asked him if he wanted to be married someday. He said he did, so I said, “Think of the type of woman you would want to marry someday, then think of the type of man that woman would want, then try to be that kind of man!” The thought that a quality woman might not be attracted to him was clearly novel to him!

It was also clear that he had not spent any time considering his character and personal development. He hadn't even considered it. As we talked I realized that he had never been mentored or parented, had never had a relationship with a mature and moral man who had the ability to model a truly successful life. Absent such influence there really was no way that he could be any different than he was. I realized he was the unavoidable end product of modern American culture. He was motivated to consume, to experience and to have. Delayed gratification, sacrificial love and personal growth were alien concepts.

My time with him made me realize the terrible mistake parents make when we emphasize achievement and experience over character and growth. We are so obsessed with our children having successful careers that we forget to train them in successful relationships. We have forgotten to teach them that doing well means doing right. That this is no longer a value is evident by parental response to report cards. Almost no one cares about the citizenship grades anymore. It is all about the “A”.

This is not the way we raised our children and built our home. I was blessed with spiritual heritage that taught me perspective and what matters in life. Lisa and I worked hard to teach our children that what mattered most was not the job you did but the character you had. We made sure our children understood that success is not about the things you own. It is about the people you love and serve.

My son illustrates the chasm between our Christian values and the valueless choices of the young patient. Nate is about the same age as the young man who came to my office and their lives are dramatically different, a difference derived from their upbringing. My son has been married for over 2 years to the only girl he ever dated. He loves her dearly, sacrificially and completely. He is a man of faith and family who is in church every Sunday, who calls his mom several times a week and who carves out time for family on a regular basis. Out of a desire to build a life with and for his wife he has applied himself in his work and studies. He values honesty, justice and relationships. He has a clear sense of the type of man he wants to be and he is working on becoming that man. Values matter to him.

My conversation with the young patient was relatively short but is my hope and prayer that our brief interaction will help him look at life in a different way. It is not too late for him, or for any of us, to change our approach. If he realizes that who we are is more important than what we do he may find the sense of purpose and direction he has been lacking, as well as the sense of fulfillment and happiness he desires.

- Bart

After the Oscars, Recognizing the Real Winners

Normal people don't win Academy Awards. Normal people don't get nominated or get to attend the ceremony. Most normal people go through life without recognition or honor. They wake up each day and go about their business, doing what they need to do and have to do, playing their part in the theater of life in the roles they have been assigned. Mothers and fathers, craftsmen and laborers, managers and employees, all are essential and few are recognized. Watching the Oscars caused me to stop for a moment and consider some of those in my life whose performances in the last year have been truly remarkable. Here are some of my award winners for the last year-

Best Doctor in a Starring Role- Ehab Mady, a specialist in Vascular Medicine. Over and over again he has made the difficult diagnosis and gone the extra mile, providing stellar service and amazing care, even when payment wasn’t guaranteed. He is truly a life saver. .

Best Pastor in a Supporting Role- John Coulombe, the hardest working pastor I know. As the primary pastor to the senior adults in a church of thousands he is always in demand, performing funerals and comforting the grieving, organizing events and developing ministries. He speaks several times a month, tirelessly advocates for the church to be truly intergenerational and still finds the time to be a source of encouragement to me. He never seeks the limelight but his light shines.

Best Produce- Mr. W,  Patient who runs his own construction company while battling chronic and severe pain from a severely damaged ankle, prostate cancer and a heart condition. In his extra time he leads a Bible study, and he never complains. Each time I see him he manages to encourage me. 

Best Director- Peter Mackler, the Executive Director for Government Relations for Memorial Care. He puts in long hours and countless miles, traveling to Washington DC and Sacramento advocating on behalf of doctors and patients, most of whom will never know how hard he has worked for them. I have seen in him action and benefited from his counsel.

Best Special Effects- The Parents in my practice with special needs children who juggle work schedules, school conferences, and doctor’s appointments, the spouses holding the family together while their husbands and wives battle serious illness, the countless people who each day put one foot in front of the other and simply get it done. They challenge and inspire me.

As I consider all of these people I am reminded that the true stars in this life are not the ones up on the screen, behind the podium or on a stage. The true stars are more likely to be in the audience or behind the scenes.

- Bart

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4 Rules for True Friendship

Sometimes it is hard to know who your friends really are. You think someone has your back and then when circumstances get tough, they disappear. Who do you trust? Who are your true friends? A better question- what qualities define true friendship? Here is a short list-

1- A true friend runs to your side when times get hard. "A friend loves at all times, and a brother is born for adversity,” is how it is described in Proverbs 17. When the going gets tough, great friends don't even wait for you to call. They come.

2- Friends tell you what you need to hear, not what you want to hear. “Wounds from a friend can be trusted,” says the proverb, and it is true. Years ago a colleague called me at home and told me that my aggressive attitude was offending some of the other doctors. He encouraged me that a softer approach would serve me better. He was right and in correcting me he showed he was a friend.

3- True friends are committed to the friendship. Neither time nor circumstances should diminish the bond, which is why the Proverb says we should not forsake our friend or the friend of our father. I think of Daryl, a friend of 40 years. We have laughed together, played together and prayed together,even hurt one another, but we have never quit.

4- True friends know when to keep their mouth shut. “Gossip separates close friends.” says Proverbs 16:28, and boy does it. The writer expounds on the principle in the next chapter saying “He who covers over an offense promotes love.” Close friends know how to hurt us. True friends protect us.

What kind of friend are you? I know I can do better!

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