Another Week Ends

1) A head resident at Stanford University, aged 36, just found out he has inoperable […]

Ethan Richardson / 1.31.14

1) A head resident at Stanford University, aged 36, just found out he has inoperable lung cancer, and wrote about in the New York Times. In the recognition of his own (near) mortality, Dr. Paul Kalanithi talks about crossing the line from doctor to patient, and what that’s done to his perspective on the statistics of his condition. He knows that, as a doctor, what one must do is instill or summon hope in patients–tell them they’ve got a vague sense of possibility to go further, tell them what they need to focus on (their families, their own well-being) to obscure the bleak data.

Now on the receiving end of the x-ray, Kalanithi wanted the hard facts. But his doctor refused, not just because she found it unhelpful, but because she also simply couldn’t say. Kalanithi draws perfectly the picture of control a “sense of an ending” gives us, while here, the hope of a “day at a time” is the hardest–and yet most freeing–prognosis (ht CB).

For a few months, I’d suspected I had cancer. I had seen a lot of young patients with cancer. So I wasn’t taken aback. In fact, there was a certain relief. The next steps were clear: Prepare to die. Cry. Tell my wife that she should remarry, and refinance the mortgage. Write overdue letters to dear friends. Yes, there were lots of things I had meant to do in life, but sometimes this happens: Nothing could be more obvious when your day’s work includes treating head trauma and brain cancer.

071210_r16884_p465But on my first visit with my oncologist, she mentioned my going back to work someday. Wasn’t I a ghost? No. But then how long did I have? Silence.

Of course, she could not stop my intense reading. Poring over studies, I kept trying to find the one that would tell me when my number would be up. The large general studies said that between 70 and 80 percent of lung cancer patients would die within two years. They did not allow for much hope. But then again, most of those patients were older and heavy smokers. Where was the study of nonsmoking 36-year-old neurosurgeons? Maybe my youth and health mattered? Or maybe my disease was found so late, had spread so far, and I was already so far gone that I was worse off than those 65-year-old smokers.

…In a way, though, the certainty of death was easier than this uncertain life. Didn’t those in purgatory prefer to go to hell, and just be done with it? Was I supposed to be making funeral arrangements? Devoting myself to my wife, my parents, my brothers, my friends, my adorable niece? Writing the book I had always wanted to write? Or was I supposed to go back to negotiating my multiyear job offers?

The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day? My oncologist would say only: “I can’t tell you a time. You’ve got to find what matters most to you.”

I began to realize that coming face to face with my own mortality, in a sense, had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.


…What patients seek is not scientific knowledge doctors hide, but existential authenticity each must find on her own. Getting too deep into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.

I remember the moment when my overwhelming uneasiness yielded. Seven words from Samuel Beckett, a writer I’ve not even read that well, learned long ago as an undergraduate, began to repeat in my head, and the seemingly impassable sea of uncertainty parted: “I can’t go on. I’ll go on.” I took a step forward, repeating the phrase over and over: “I can’t go on. I’ll go on.” And then, at some point, I was through.

2) On a lighter note, the Onion’s streak continues with “6-Day Visit to Rural Village in Africa Completely Changes Woman’s Facebook Profile Picture.” And Gawker wins the award this week for most Onion-sounding news headline: “Black Person in Yoga Class Causes Profound Moral Crisis.” This realization was no joke for yoga-master Jen Caron (“Oh no,” indeed):

To bring you up to speed, if you’re just joining us: Jen Caron went to yoga class. Behind her in yoga class was someone new to yoga. That person, who was black and female, was not skilled at yoga. Their presence made Jen Caron painfully self-aware. And then came the true enlightenment

“I thought about how that must feel: to be a heavyset black woman entering for the first time a system that by all accounts seems unable to accommodate her body. What could I do to help her?”

3) The Atlantic’s Derek Thompson contributed “The Case Against Performance Reviews” this week, an in-depth history and review of the ways we think we like to measure our growth for the sake of improvement. Turns out, even when we think we want to be evaluated–to find those areas of growth–or to find our bosses have nothing negative to say at all–we really don’t to be evaluated:

It’s bad enough that annual evaluations are outdated. It’s problematic that they’re susceptible to a plague of biases. It’s worse that they tend to be pathetic motivators. But the coup de grace is that they’re not even good at identifying the thing they’re meant to identify: performance.

Research from Corporate Executive Board found that two-thirds of employees receiving the highest scores in a typical performance management system “are not actually the organization’s highest performers,” Jena McGregor reported for the Washington Post. Nearly 90 percent of companies surveyed said they have or hope to make changes to their evaluation process in the next year.

It’s worth asking whether a process so flawed is worth saving.


And on the other side of the spectrum, kids in New Zealand are learning the value of roughhousing again. In place of the helicopter era in which kids have been “wrapped in cotton wool,” this New Zealand school wants to allow kids to fall down and get muddy again (ht TB):

AUT professor of public health Grant Schofield, who worked on the research project, said there are too many rules in modern playgrounds. “The great paradox of cotton-woolling children is it’s more dangerous in the long-run.”

Society’s obsession with protecting children ignores the benefits of risk-taking, he said…The research project morphed into something bigger when plans to upgrade playgrounds were stopped due to over-zealous safety regulations and costly play equipment. “There was so many ridiculous health and safety regulations and the kids thought the static structures of playgrounds were boring.”

4) Over at First Things, Lutheran James R. Rogers talks about the Evangelical church’s general trend towards Calvinism over Lutheranism. Besides citing the parallel mindsets Calvinism offers current or post-Evangelicals (i.e. Calvin had a systematic theology, Luther did not; the Westminster Short Catechism provides an easier entry point for a Bible-savvy Evangelical than Luther’s basic Short Catechism, etc), Rogers finishes his point in reference to the meaning of “sola fide” in the Lutheran tradition, and how it emphasizes a passivity Evangelicals don’t tend to have in their background (he references academic Phillip Cary):


I have heard Evangelicals worry whether the faith they have is “true” or “authentic” faith, or whether they are deceiving themselves. I have even heard some worry about being lost by having a passing doubt at the moment of their death. Salvation in this view can be assured only by a sustained act of will to believe. The burden of having to sustain this act of will can be nerve-wracking.

In contrast, Luther’s “sola fide” for Cary is grounded not in the believer’s internal act of will, but in the work of Christ applied to “me” in baptism. Cary characterizes Luther’s syllogism this way:

Major premise: Christ told me, “I baptize you in the name of the Father, Son and Holy Spirit.”
Minor premise: Christ never lies but only tells the truth.
Conclusion: I am baptized (i.e., I have new life in Christ).

Cary observes that the “difference is subtle but makes a huge logical difference in the outcome.” First, Christ’s promise is spoken to me in baptism. It is “Christ who speaks the baptismal formula” through the mouth of the pastor (or the lay baptizer in the case of emergency). These words are spoken to “me in particular.” (As in absolution, Christ speaks through the pastor, saying, “I forgive you, the person to whom I am now speaking.”)

Cary’s essays are worth reading in their entirety. The crucial shift is that, for the Lutherans, justification derives from Christ’s faithfulness—his trustworthiness—rather than from an act of mental will. This affects Lutheran preaching and Lutheran piety.

Also, an intriguing article at Aeon by Christopher Harding, asking the question, “Is Christian Meditation a Contradiction?”

5) Regardless of your Super Bowl plans or biases, there are plenty of amazing pre-game analyses out there, the most concise of which is “Game Change” by the New Yorker’s Amy Davidson, who goes into swift detail about the whole Richard Sherman thing, as well as the future of the League’s popularity, given the recent concussion-A.L.S.-brain damage settlement, and the sport’s growing reputation as “barbaric,” something even Richard Sherman admitted about his line of work.

And then, if you really want to go deep, there’s Grantland’s “Official Super Bowl Preview.”

And Stephen Colbert’s Superb-Owl Coverage.



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