Miss America isn't the Problem, America is

This last week the press was abuzz with the news that the Miss America pageant was no longer going to be a beauty contest. The pageant announced it was doing away with both the swimsuit and evening gown portions of the competition.  Gretchen Carlson, the Chairman of the Board of Directors made it clear that women who wished to compete for the title of Miss America would no longer be scored on their appearance. “We’re not going to judge you on your appearance because we are interested in what makes you you," Carlson said.

The move was hailed as part of the positive cultural change brought about by the #metoo movement, the widespread uprising against the harassment and abuse of women. Ms. Carlson referenced this when she said, “Miss America is proud to evolve as an organization and join this empowerment movement.” Commentators called the changes long overdue, with the Dallas News going so far as to say, “As long as Miss America requires contestants to look good in an evening gown while strutting in high-heeled dress shoes, it’s unlikely women in the United States will achieve gender equity.”

The reports were characterized by a sense of celebration, recognition of a positive societal evolution. There was a sense that the days of women being objectified were numbered, that women were now going to define for themselves feminine ideals. Miss America was showing the way, first by getting rid of misogynistic leaders and filling the organization's board with female leaders, and now by making sure that contestants would not be subjected to body shaming or leering audiences.

The changes in Miss America dominated the news this week were significant, but were not the most important story impacting the rights of women in America. The biggest news came from a minimally reported public opinion poll. The Gallup organization this week announced survey results that should give pause to all who think our nation is making progress in its attitudes about women.

Gallup asked respondents a simple question, “Is pornography morally acceptable?” The findings were devastating. 67% of men between the ages of 18-49 and 43% of all respondents said, “Yes.” This was not “yes” to bikinis or “yes” to nudity of the type seen in Game of Thrones. This was not “Yes” to the Sports Illustrated swimsuit edition or airbrushed poses for Playboy. This is “yes” to explicit sex acts, the most degrading material possible.

It is important to note that the question was not about legality, Gallup did not ask about what should be allowable or tolerated in a free society. They specifically used the word "moral." Morality refers to the rightness of a thing, or to put it another way, to the absence of wrongness in a thing. We have reached the point where two-thirds of young to middle-aged men believe there is nothing at all wrong with them gaining pleasure by watching women perform sexual acts with other men.

What does it say about a nation that celebrates banning modest swimwear on television while at  the same time finds it acceptable to broadcast graphic sexual acts over the internet for everyone to see?

It says that America has no sense of morality at all. 

Can a Christian be Anxious?

Words are dangerous things. As with a knife in the hands of a surgeon or the grasp of an assassin, whether they heal or harm depends on the manner in which they are wielded. The words of Scripture are no different in this regard. Divinely inspired and intended to further the purposes of the Loving God, when used incorrectly they can wound the soul.

In my experience, some of the most dangerous words in the Bible can be found in Paul’s letter to the church at Philippi-

“Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God.”

Written to encourage believers to focus their hope on God and his eternal purposes, they are at times transformed into a cudgel of discouragement, ignorantly wielded in a manner that bruises the hearts and minds of emotionally struggling Christians. “Do not be anxious,” wrongly elevated to the status of commandment, becomes a measure of faithfulness such that the presence of anxiety is interpreted as a sign of mistrust in God, spiritual immaturity and sin.

For Christians stricken with anxiety disorder, these words can be devastating. Feelings of guilt and inadequacy, already the daily companions of anxiety sufferers, grow in power and intensity at the implication that one’s feelings of anxiousness are a sinful choice.

I have been on both the giving and receiving end of these misspoken words. In the formative years of my Christian faith I attended a church with a Pentecostal bent, a place where faith was more emotional than intellectual, a place where hurting people were “encouraged” to simply “let go and let God.” Prayers for the struggling often included asking God to help them “trust God more” or to be “set free” from sin. I joined in these prayers, ignorant of the impact of my words.

My perspective changed a little over 10 years ago. I was preparing to enter an exam room one day when I felt a sense of dread come over me. Uneasiness and fear took hold. For no reason at all I felt as if something bad was about to happen. These feelings were soon joined by pressure in my chest, lightheadedness and a sense of detachment. My mind began to race and I felt as if my emotions were about to spin out of control.

“What is happening to me?” I thought. I answered my own question as quickly as I had asked it. “I am having a panic attack!”

The intellectual awareness of what was happening gave me the strength to stall the downward spiral. I was able to calm myself partially, enough to allow myself to call my wife and ask her to bring some medication from home. I had the presence of mind to tell my staff what was going on, and to ask them to reschedule some of my patients. It took a while, but with great effort and the calming presence of my wife I was able to finish my work day.

In the weeks that followed additional attacks came. I found myself in fear of the next attack and what it would do to me. I developed other fears as well, including intense self-doubt in personal and professional interactions. With the fears came increased irritability as I struggled to regain a sense of control over my life and thoughts. I saw a doctor, and with the help of counseling and medications learned to deal with a new reality.

I have not been the same since. While debilitating moments of panic have been rare, fear and anxious feelings now greet me every morning. Their voices are quieter some days than others, at times easily drowned out by the clamor of the day, but they are always present. Countless hours in prayer and Bible study have made one thing certain. Telling myself, or being told by others, “Don’t be anxious”, does not help.

It does not help, because the words of Paul (and Jesus in the Sermon on the Mount), were not meant to be used in this fashion. New Testament teaching about anxiety is never directed at the generalized sense of unease associated with a serotonin imbalance, it is directed at the human tendency to obsess and focus on earthly needs in a way that is contrary to a life of faith.

When Paul wrote to the church at Philippi, he was in prison, awaiting a possible death sentence. The church was being persecuted and many believers were suffering for their faith. It would have been easy for them to out of fear turn away from God. To these people, in these circumstances, Paul said, “Do not be anxious… but make your requests known to God.” Similarly, in the sermon on the mount Jesus reminded people not to focus on material needs, but to instead trust in God’s eternal purposes.

Paul was not saying that all anxiety was sin, or that Christians should never be anxious. He was acknowledging the danger that in focusing on the sufferings of this present life Christians can become discouraged. He therefore reminded them of the alternative, to focus on God and his promises.

I do not believe feelings of anxiety are a measure of anyone’s faith. Faith is displayed not in the absence of doubt or fear, but in the choice to trust God and his purposes in their presence. I do not say to myself, “Stop being anxious and trust God.” I instead say, “Yes, you are anxious, trust God anyway.”

These words do not take my anxious feelings away, but they do put the feelings in context. I am reminded that I will not be anxious forever. Eternity awaits, free from both emotional and physical pain. In that hope I find hope, peace, confidence and strength. I also find, strangely, a sustaining sense of joy.

Bart

While the focus of this post has been on Christian perceptions of anxiety it is worth noting that bad counsel is not limited to people of faith. Patients often tell me about family and friends not understanding their struggles, of being told that there is no reason for them to be anxious. I typically smile as I point out that this is why it is called an anxiety disorder. Normal people worry for a reason, people with anxiety disorder are often anxious for no reason at all. 

All patients with anxiety, regardless of faith, should be encouraged to get help. Counseling, in particular Cognitive Behavioral Therapy, is extremely beneficial. Medications, especially selective serotonin reuptake inhibitors, can also be tremendously helpful tools.

Failure is not an Option, it is a Certainty

It wasn’t supposed to end this way.

The CT scan of his lungs was supposed to be normal. Joe did not have any symptoms of cancer, no shortness of breath or unexplained weight loss. He was completely healthy. Nevertheless, new guidelines for lung cancer screening had just been announced and although he felt fine he fell within the screening parameters. I followed those guidelines and ordered a lung scan.

The results were a surprise. He had a mass in his lungs that was unquestionably cancerous in appearance. The news was bad but there was cause for hope. The scan seemed to have done its job and caught the cancer in time. The tumor appeared to be of an operable size and there was no evidence of spread. I was confident that Joe would be okay.

The surgeon shared my optimism and scheduled a resection of the tumor for the following week. The patient was upbeat, grateful that his cancer had been discovered early. He was nearing retirement and was looking forward to many more years with his family confident that our early diagnosis was going to give him those years. He felt so healthy that the day before the procedure he spent time with his grandson shooting baskets in his driveway.

We were all proven wrong. The surgery did not go well. The tumor was much larger than expected and was wrapped around one of the bronchi. Simple removal was impossible. The planned wedge resection gave way to a resection of the entire upper lobe of his lung. It was going to be a difficult recovery.

It was worse than difficult. Each day seemed to bring a new complication. We learned that his years of smoking had taken a much greater than expected toll on his lungs. He had more COPD than his tests had suggested, and the lungs he had left struggled to meet the oxygen demands of his body. The stress of the surgery led to Acute Respiratory Distress Syndrome, a life-threatening condition that causes lungs to get stiff and hard to inflate, as well as fluid to seep into the areas where oxygen is exchanged. We could not get him off of the breathing machine. Less than a week after shooting baskets with his grandson, he was dying.

Multiple specialists were called, all of them excellent, all of whom did everything they could to halt the downward spiral. They all failed. After about a week it was clear that he would not survive. Filled with sadness I came to the hospital to deliver the news to his shell-shocked wife. Together we made the decision to remove life support and let him go. We had done our best, but we had lost.

It is a sad reality of life that doing our best does not guarantee success. Excellence does not always result in good outcomes. This is not always easy to accept. We live in a results-based society that celebrates the motto from Apollo 13- “Failure is not an option.”

The truth is that failure happens, even to the best of us. Good doctors lose patients, good drivers get in car accidents, and good parents have kids that go astray. Those of us who understand this can resist the temptation to judge others based on things they cannot control, and take comfort in knowing that God judges us not on external results, but on the heart that only he can see.

- Bart

Dogs, Squirrels, and a Wasted Life

Sadie on Squirrel Guard Duty

My dog is obsessed with squirrels. I realize all dogs are, but she has taken things to a different level. She has dialed her squirrel intensity up to 11. Her walks are less about exercise and more about squirrel hunting. Her eyes continuously scan the environment looking for the flicking tail or bounding scamper of her prey. So intent is she that she remembers the location of every previous squirrel sighting so she can return to it on following days. As she approaches the sites of previous encounters her body tenses and quivers and she strains against her leash, muscles taut, ready to launch into the chase should the animal reappear.

Lately her squirrel problem has become our problem. There seems to be a somnambulatory one that likes to traverse our back fence in the middle of the night. Our sleep is often interrupted by the sound of our dogs jumping to their feet, sprinting down the hall, and bursting through the doggy door in response to the sound of the squirrel invader.

Things have escalated. We are now at SquirrelCon 4. It seems that this squirrely night walker has now taken up residence in our neighbor’s yard. As far as Sadie is concerned this is an evil that cannot stand. She is perpetually on the lookout for it, spending hours on guard duty staring through a crack in the fence. She will not rest until her furry enemy enters its final rest. The squirrel’s death is now her primary reason for living.

As I watched her watching the fence this morning I laughed at the absurdity of her doggy behavior. The squirrel was impossibly out of her reach. There was nothing she could do to get to it, yet she gave it all of her attention.

This behavior is funny in a dog, but it is tragic for people. Looking at her I thought about the hours, days and years I have similarly wasted focusing on things that were unobtainable and out of reach. I thought of the time I spent wishing my father would realize disowning me was a mistake and hoping my mom would become sober. I recalled patient behavior I could not change, professional recognition I could not gain, and relationship problems I could not solve. I had so many thoughts about so many things I couldn’t change.  It seems that wasted attention is not merely a canine problem.

What is sad about futile attention is that it always has a cost. When we focus on the unobtainable we turn away from blessings that are within our reach. Time spent trying to change patients who were set in their ways is time I could have spent helping others who would have benefitted from my attention. Hours of thinking and planning on how I could get people to appreciate me are hours I could have spent in quality moments with the family and friends who already loved me and appreciated me.

How much better would all of our lives be if we learned this lesson. It is time to focus on the good we can do, the love we can share and the lives we can touch, and not on those things beyond our reach.

It is time to be smarter than my dog.

Bart

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Naked in College

Letitia Chai giving her thesis presentation at Cornell. from Facebook

There’s an old saying about how one can overcome anxiety when speaking in public, “Imagine your audience in their underwear.” I speak in public often but have never resorted to this tactic (perhaps because most of my presentations are done in church and such thoughts would be inappropriate.) This last week a student at Cornell University went the opposite direction. She gave her thesis presentation wearing only her underwear and asked the audience to join her.

The story is that Letitia Chai, the aforementioned student, was about to give a practice presentation of her thesis in the class “Acting in Public: Performance in Everyday Life”. As she was preparing to deliver her talk the professor commented on her attire (she was wearing very short cut-off denim shorts) and asked if that was what she was planning on wearing for her final presentation. The question did not go over well.

Ms. Chai was taken aback and offended at the perceived criticism of her appearance. She took particular umbrage at her teacher’s suggestion that her appearance was making a statement that might detract from the points Ms. Chai was trying to make. Ms. Chai stormed out of the class. A few minutes later she returned to the room and took her spot in front of the class, wearing only her bra and underwear. She later wrote how proud she was that she had stood up for “every person who has been asked to change how they look to make other people feel comfortable.”

Her story resonates with me for I had a similar conversation with a female medical student a few years ago. The student, by far one of the best I have ever taught, showed up to the office in a tight fitting blue cotton t-shirt along with white denim pants and a matching blue belt. The outfit was undeniably “cute” but it looked like something a young college student would wear on a date. It was not what would I considered professional attire. I pointed this out to her.

“You are a young woman,” I told her, “and you are asking people to trust you with their lives. Look the part.” I told her it would be easier for people to take her seriously if she was dressed seriously and that when she came to my office to see my patients I wanted her to dress as if she was interviewing for a professional position.

To her credit she received the feedback in the spirit is was given. Each day thereafter she wore either a dress or slacks and blouse. She oozed professionalism and carried herself with class. While nothing about her knowledge or skill set had changed, the perception others had of her did. It was a growth experience for her.

Over the years I have had similar conversations with other students, employees and even my children. My message is always the same. Like it our not, what we wear sends a message. Our jobs get easier when the message sent by our appearance aligns with what we hope to communicate. If we want people to think we are professional, we should dress professionally. As a physician I want to do everything I can to convince people I know what I am talking about, I do not want to give them any reason to dismiss what I say. Unlike Ms. Chai, I intentionally change my look in order to make other people feel comfortable. I do this because they are more important than I am.

This is true in every area of my life. When I give advice to a patient, it is the patient’s understanding that matters. When I deliver a sermon in church, the intent is for the audience to receive what I am saying. When I am called to the hospital to meet with a family about end of life care, it is important they believe I am an expert in the ethical issues we discuss. In each of these settings I choose my wardrobe carefully. I always where a dress shirt and tie in the office, always wear a collared shirt in church and always wear a conservative suit when I meet with families. Communication is never easy; there is no reason to make it more difficult by dressing inappropriately.

It appears this is a life lesson Ms. Chai has yet to learn. 

- Bart

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