The Problem of Prayer

"Those who believe they believe in God but without passion in the heart, without anguish of mind, without uncertainty, without doubt, and even at times without despair, believe only in the idea of God, and not in God himself." -Madeleine L'Engle


I was just enjoying Anali's blog and her post mentioning Dionne Warwick's song, "I Say a Little Prayer for You." Lately prayer's been coming up a lot; a personal ramble seems in order.

A few days ago I came across Dr. Sid Schwab's brilliant post about a family who had chosen prayer as the sole intervention for their child with neuroblastoma, after one arduous course of conventional medicine after another had failed.

I can understand why people would feel totally exhausted in the effort to fight a ruthless cancer. I took care of a 5-year-old with rhabdomyosarcoma my first year out of medical school, and that experience completely destroyed my faith--at least for a time. She was only five but looked like a hundred and five - emaciated, her skull and skeletal form detectable beneath her greyish skin, barely any wisps of hair on her head, miserable beyond description, unrecognizable when compared to the photograph of her at her hospital bedside, showing a healthy, smiling, fair-haired little girl, all sweetness and promise.

Her x-ray was unrecognizable too. We doctors get used to seeing certain things on an x-ray - large black spaces outlining the lungs, heart in the middle of the chest cocked just so, ghostly traces of familiar internal structures all in their proper places and configurations. Looking at her x-ray was like looking at a jumbled mess of alien, unfamiliar objects, which of course it was. Piles and piles of tumor had ravaged her on the inside, taking over every nook and cranny and claiming them as their own. There was barely anything identifiable to be seen.

The girl died after weeks, perhaps months, of indescribable suffering. If I'm ever asked to be on a jury for a "pain and suffering" case, I'm going to have to explain, "Well, guys, just so you know what my idea of 'pain and suffering' is, ever hear about rhabdomyosarcoma?" Five years old, lung spaces so obliterated by cancer that she could barely breathe. Five years old, body wracked with pain from head to foot, then untimely death. Hopeless.

My own daughter was five years old at the time - exuberant, full of laughter and life, pleasingly plump, sunny and bright. Naturally, I had a lot of questions. At the time my conclusion was that no one was listening; we were fundamentally alone, and after our lives ended, we turned into dust, our consciousness, "spiritual" growth, memories, and identity completely snuffed out into oblivion. But if you were to ask me today if I pray, the answer is, actually I do.

Dr. Schwab was able to articulate questions about intercessory prayer that so many people, believers and non-believers alike, ask, especially in the face of extreme hardship or tragedy. I've put a link to the full post on my sidebar, but here are the passages that I found so eloquent and so powerful:


I must also say this: there's something perverse to the point of revulsion in the idea of a god that will heal the girl if enough people pray for her. What sort of god is that? To believe that, you must believe he deliberately made her ill, is putting her through enormous pain and suffering, with the express plan to make it all better only if enough people tell him how great he is; and to keep it up unto her death if they don't. If that sort of god is out there, we're in big, big, BIG trouble. If people survive an illness because of prayer, does that mean that god has rejected those that didn't pray? If you pray for cure and don't get it, and if you believe that praying can lead to cure, then mustn't you accept that God heard your prayers and said no? If so, are you going to hell? But if you say either outcome is God's will, then what's the value of the prayer in the first place? In this case, it seems, it's only to make the girl feel guilty and unworthy. How sad. Since the whole idea is so internally inconsistent, give the poor kid a break.

Does this family's god need reminders; does he have DADD? Or is he waiting for them to hit a magic number of people praying? A certain quantum of prayer-units that must be achieved? Does he give credit for getting close, maybe knock off a little pain when they hit 80%, or is it all or nothing? In praying to him -- and if, as the article says, people around the child see God at work in all his glory -- shouldn't they be thanking him for their daughter's misery rather than asking for a change of plans? Shouldn't they be delighted with the whole thing? If He's perfect, how can you add to that by praying? Or expect a change? I simply don't get it.

And what of children who have no one to pray for them? If prayer works, what's going on with those kids? Does this prayer-tabulating yet perfect god not care about them? Or isn't he paying attention? Has he deliberately set them up...?


The most recent research study I know of, the STEP trial, showed that prayer makes no difference to the outcome of coronary bypass surgery. In fact, people who were prayed for and knew it experienced a significantly higher incidence of complications than those who either were not prayed for or were not sure they were being prayed for. The study had no control group (people who were not prayed for and knew they were not being prayed for). The "prayer" consisted of Christian prayer groups, who were told the date of surgery and the patient's first name and last initial, asking God for "a successful surgery with a quick, healthy recovery and no complications," twice a day for two weeks, starting on the eve of surgery.

Already I have a problem with this - not with the results, but with the underlying presumptions. One time my son wanted to ask God to prevent rain as the storm clouds were already gathering overhead. I told him this was not the right way to pray - asking for something so self-serving, and also asking for something not to happen when it was already beginning to happen. Even Jesus prefaced a desperate petition with "If it is possible..." Asking for over 1200 patients to recover quickly without complications from cardiac surgery is asking the impossible, especially when many of them were having the surgery BECAUSE they already had conditions which were the first step in developing those complications - previous heart attacks, high blood pressure, diabetes, lung disease, and the like. I think there's something inherently disrespectful and counter-productive in turning prayer, which is not merely an act but a way of relating, into what amounts to a GAME. Let's see if God will play - will he help out 50% of the time? 55%?

Like Dr. Schwab, I reject the notion of a Vending-Machine God. My husband said it well when we were talking about this: a prayer life is so much more about a relationship than about asking for things. Prayer is an intimate expression of longing, faith, hope, and love. If we do have spirit beyond our conglomeration of cells and molecular reactions, prayer, being a spiritual form of engagement, has real gifts for us. C.S. Lewis pointed out that prayer is not for transforming God but for transforming ourselves. I think we can pour out our longings and our pain in prayer, and we can even ask for help, but I also think if God is the parent that so many believe God is, this parent has to let us live our own lives freely, without interfering every time we have trouble. I believe help is possible, but using prayer solely or primarily as a means of acquiring fixes is missing the point and misusing the act.

I used to get mad at God for the suffering of children - sick children, abuse victims, the impoverished. Then someone pointed out to me, "What do you want God to do, make everything perfect? You're looking for the Christ who healed lepers and gave sight to the blind. He's not here." How startling it was to me to hear such simple, familiar, yet eye-opening words as if I'd never heard them before. Even the scriptures ask, "Why do you seek the living one among the dead? He is not here." I think Jesus lived out the example of what a loving God would want: when you see suffering, try to heal it. It's not what we're meant for, not "God's will."

We're the eyes and hands now. We have our work cut out for us.

The Purity Ring Thing

For the last couple of days I have been following news items about Lydia Playfoot, a British teen who lost a court battle for the right to wear her "purity ring" in school. I came upon the story quite by chance; I was on call overnight yesterday, and our hospital's default welcome page happens to be msn.com, which featured the story prominently in its news section.

Today I feel like opining rather than story-telling.

In my opinion, it takes great courage for an adolescent to stand up sincerely and vocally for her beliefs when those beliefs are not shared by the majority of her peers (or for that matter, the adults in her society). Any young person who tries to do good and encourages people, by word and example, to respect of self and others, should be applauded.

Some people have criticized Lydia for "making such a big deal" out of a little ring, saying that she can still speak out about abstinence with or without an article of jewelry on her finger. I agree with the latter statement, but I also know that symbols can be exceedingly powerful, and the ring may in fact be a very big deal for her, regardless of anyone else's opinion of it.

Whatever one's personal view of fornication may be, from a medical and psychological standpoint the following, in my opinion, may be reasonably inferred:

-if every single person waited till marriage to participate in sexual intercourse, the rates of sexually transmitted diseases and unwanted / unplanned pregnancies would likely be vastly reduced;

-if every single person waited till marriage to participate in sexual intercourse, the emotional pain, confusion, or disappointment often associated with dating relationships would likely be mitigated.

As far as I can tell, most things that are considered "wrong" within certain faith systems involve hurting oneself or one another. I believe most religions that have what, by most modern American standards, might be considered "conservative" norms regarding sexual morality probably have people's best interests at heart. Simply put, we're supposed to take care of ourselves and avoid hurting each other. Thus mocking, disdaining, or categorically criticizing these norms, without giving their underlying foundation of care for the human person its proper respect, is, in my opinion, an uneducated, arrogant, intemperate act.

That said...

I think a private school is well within its rights to prescribe a dress code for its students and can, at its discretion, in light of a regulation against jewelry that applies to all students, ask that students refrain from wearing symbols of their beliefs that are not strictly required by their belief systems. I believe it wrong, however, for a school to favor certain articles over others - cross necklaces ok, but bracelets not, head scarves ok, but gowns not, etc.

I am also a little wary of the exaltation of the word and concept of "purity." By implication people whose behavior has failed to meet certain standards can be considered "impure," tainted, sullied, stained, dirty, inferior...you get the idea. This mode of discourse equates a person's worth with his or her "purity" - already a fallacious equation - and predisposes to a great deal of judgment that, in theistic belief systems, should supposedly be left to God.

There are belief systems in which even the merest physical contact with "contaminated" objects and individuals elicits more aversion than a scrub nurse's horror of a medical student accidentally touching a sterile drape. But I like Jesus's take on purity politics: it's not what touches you from the outside that makes you impure, but rather what's in you that defiles you (Mark 7:15). It's all about what's going on deep down - you may act morally, but are you really moral in there, in your mind and heart? Haven't I smiled at people but resented them or disparaged them in my mind? Well, yeah, and shame on me; isn't that about as impure as it gets?

Jesus also said "blessed are the pure in heart." This isn't to say he thought we could all casually copulate with anyone just because we were "good on the inside" and felt like it. On the contrary, he said people should keep not only their hands etc. off each other's spouses, but also their very thoughts. He wasn't stupid. He knew it was normal for the mind to wonder and wander...but he taught active rather than passive morality: work to curb selfish impulses; make acts of love, and a life of love, a conscious, continuous choice, starting with what's inside of you and proceeding accordingly.

What I would love to see in our world of many beliefs and belief systems is this: virgins who don't look down on unmarried non-virgins, and non-virgins who don't look down on virgins. I would love to see a world, in fact, that's cleansed of any kind of "looking down," that's spiritually wearing a ring inscribed with Luke 6:37 - Do Not Judge. That would be a purer world indeed, one in which the "lions" and the "lambs" really could lie down beside each other free of all domination and fear.

On Seeing and Being Seen: a meditation on the social psychology of medical intervention

I thought Bill Clinton's graduation advice to make sure you really see the person next to you was good.

I thought the failure of people to notice Joshua Bell playing at the Lafayette Metro Station was bad.

But there's worse.

What's worse is people NOTICING something notable, but ignoring it.

And worst of all is when failure to see, or act on, a noticeable crisis costs a life. It was one of this week's buzz stories in the O.R.: the death of Edith Rodriguez.

Edith Isabel Rodriguez went to the E.R. at Martin Luther King, Jr. Hospital in L.A. - also known as King-Harbor and formerly known as King/Drew - doubled over with abdominal pain. According to the Associated Press, "It was at least her third visit to Martin Luther King Jr.-Harbor Hospital in as many days. 'You have already been seen, and there is nothing we can do,' a nurse told her.”

This kind of situation can put any doctor or nurse in a tough spot. A patient presenting with a history like this is usually either afflicted with an ill-defined medical problem, sometimes chronically, often more than one, and typically difficult to relieve completely, OR...the patient is in SERIOUS TROUBLE.

Jonathan Larson, composer of the famous Pulitzer Prize and Tony Award-winning musical Rent, got sent home when more than one emergency department failed to diagnose the cause of his chest pain and nausea: aortic dissection, which killed him the day before Rent opened.

Sometimes it can be a tough call, but I think when someone goes from abdominal pain to vomiting blood, it's usually a clue that something really BAD might be going on, depending on the nature of the vomitus and the amount of blood present, and I have to wonder what the thought process was in that emergency department. I admit I don't know all the details, and hindsight after someone codes and dies is certainly 20/20, so I am in no way trying to point the finger here. I'm just wondering, like everyone else, what happened, and how could it have happened?

Edith Rodriguez's story has by now been publicized widely in the media. The articles I saw were on MSN and the L.A. Times, but I was struck most by the CNN video on glumbert.com. It relates how Ms. Rodriguez lay on the floor vomiting blood, and somehow got help from NO ONE except a couple of individuals who tried to call 911 for an ambulance to take her to ANOTHER hospital. From the video and the articles I read, I've reconstructed part of the transcript of these calls here:

First call, 1:43 a.m.:
Caller: My wife is dying and the nurses don't want to help her.
Dispatcher: Okay, what do you mean she’s dying? What’s wrong with her?
Caller: She’s vomiting blood
Dispatcher: Okay, and why aren’t they helping her?
Caller: They’re watching her...uh...they're watching her there, and they’re just not doing anything. They’re just watching her.

Second call, from a different person, 1:51 a.m.:
Dispatcher: What’s your emergency?
Caller: It’s a lady on the ground here at the emergency room at Martin Luther King.
Dispatcher: Well, what do you want me to do for you, ma’am?
Caller: Send an ambulance out here to take her somewhere where she can get medical help.
Dispatcher: Okay, you’re at the hospital, ma’am, you have to contact them.
Caller: They have a problem, they won’t help her.
Dispatcher: Well, you know, they’re the medical professionals, okay? You’re already at the hospital. This line is for emergency purposes only. 911 is used for emergency purposes only.
Caller: This IS an emergency!
Dispatcher: It’s not an emergency. It is NOT an emergency, ma’am.
Caller: It is!
Dispatcher: It is not an emergency.
Caller: You have to see how they’re treating her.
Dispatcher: Okay, well, that’s not a criminal thing. You understand what I’m saying? We handle-
Caller: Excuse me, if this woman all out dies, what you mean there ain’t a criminal thing?

The call did not end well. The dispatcher insisted again that the situation was not an emergency and offered the caller a business number if she was displeased with what was going on. Just before 2 a.m. the caller said, "May God strike you too for acting the way you just acted." The dispatcher's reply: "No. Negative ma'am, you're the one." He has since received "written counseling" for the way he handled the call.

Edith Rodriguez was pronounced dead at 2:17 a.m.

Zev Yaroslavsky, LA County Supervisor, was flabbergasted at the security video of the incident. He said it was even worse than the audio tapes. “Not one person out of a couple of dozen, including citizens and staff and doctors and nurses…[They] didn’t lift a finger to help her. They just ignored her. Even the janitors who were cleaning up the vomit from around the woman who was on the floor did a very elegant job of cleaning up the vomit but didn’t do a thing to help her. It was just indescribable.”

With her writhing on the floor in pain, vomiting blood, and her loved ones begging for help, how could someone NOT have assessed the need for some intervention? If nothing else, isn't that what emergency departments DO?

Now, I know about the Bystander Effect. I've heard of Darley and Latané's social psychology experiments demonstrating the failure of people to help others in a crisis if other people are also present. I've read about the terrifying case of Kitty Genovese, who was stabbed, raped, and killed over the course of half an hour even though 38 witnesses heard her desperate cries. I've even been a cautious bystander myself.

When I was walking back to my hotel from dinner with an anesthesiologist friend of mine (we were in D.C. about to take our oral boards, actually), we noticed a pair of human legs protruding from the bottom of the potted plant decorating the entrance of her hotel. We came upon a man passed out on the sidewalk, his head and neck cocked to a rather concerning angle. There was already someone palpating the carotid for a pulse (correctly, we observed), and we didn't want to contribute to a "too many cooks spoil the soup" situation, so we lingered in case our help was needed but stood quietly in the background. I did go into the lobby and try to get the hotel management to bring out any first aid or medical equipment they might have had, but they just stared at me blankly and said 911 had already been called. I insisted that someone go and retrieve the stuff anyway, and one of the employees went, but I didn't see him again. Anyway, the paramedics arrived and packed the guy up, and my friend and I saw that they needed no interference from us. But I should hope we would both have asserted ourselves immediately if the situation had really called for it.

What bothers me about the Edith Rodriguez case is that I could easily have been one of the bystanders in that hospital lobby and contributed to her death, although I can't say for sure what my reaction would have been without knowing all the details of the actual situation. We all want to think we would have been the different ones, the types who would have said "no" to the authority figure in the Milgram experiment and refused to apply the electric shocks to the subject, the types who would have called for help in Darley and Latané's experiment when the stranger started seizing. We all imagine we would have bent down in concern toward Edith Rodriguez and at least tried to figure out what was going on, if not offer actual assistance. I think I would have done this, I hope I would have...but I also think deep down we all know that it's easy for ANYONE to be swept into the middle of an inert crowd and stay there dumbly looking on.

Edith Rodriguez's brother, Eddie Sanchez, made this poignant comment on the glumbert video: “You go there to get help, and nothing happens, like…You get ignored like if you’re nobody.” How many times have I failed to SEE my patients, or unwittingly treated them as if they were "nobody?" I cringe to think that I may have done the very same, albeit without the fatal consequences. Or, even if I paid adequate attention to a patient, what if I made the wrong judgment about how to manage the patient's problem, out of a reluctance to admit, "Yes, we have a disaster, and it's right in front of our eyes?"

I pray every day for the ability and courage to make the right calls. A couple of weeks ago our friend who's a flight attendant was describing a flight during which a passenger was found doubled-over in his seat. She announced the need for a physician and said it took a long time for one to come forward. I understand that - the daunting sense of responsibility often competes with the desire to serve and relieve suffering. As it turns out, the physician who did examine the man also told our friend that the captain had to land the plane immediately because the man was in acute heart failure. I think that was a very brave doctor in there. That's a heck of a call to make, diverting a flight filled with passengers to save one life on the suspicion of a life-threatening condition NOT confirmed by the technological aids we get so used to relying on in hospitals. I spiritually bow my forehead to the ground in respect and admiration and pray I never have to make a call like that. Although, what's worse - being wrong about the heart failure, and causing an inconvenience, or being right but lacking the confidence to make the move, thus costing a life? I guess the answer's pretty unambiguous.

I've alluded to the training we got in our medical simulator during residency. I am not allowed to comment specifically on our training scenarios or on people's actions within them, but I think I can make some general remarks on the experience. While the medical aspects of those scenarios were useful, I think a key element in teaching crisis management of any kind is a rehearsal and discussion of group behavioral dynamics. We did bring up and discuss issues like those raised by the Edith Rodriguez story. What makes us blind to another's needs? What makes us ignore data that's right in front of us, or help that's offered? How can we best structure a group's interactions so that efforts to provide help are focused and organized?

One take-home message I valued was that there should always be an "event manager" - one who's NOT involved in DOING tasks, but rather is WATCHING everything that's going on, processing it, and determining what steps are needed next. But of course, in the real world, this role separation is difficult, and often it's not possible to delegate. Or, people are reluctant to step forward to claim the role.

My heart goes out to Edith Rodriguez's loved ones. We in the medical profession failed them, egregiously. The only personal offering I can make at this point is a commitment not to rest smugly in the position of critic and judge, thinking, "Well, I would have seen her there, and I would have done something. I'm not blind." Sure I am. Or can be. And it makes me think twice about an old, familiar New Testament quote from a blunt, rather ticked-off Jesus:

Jesus said, "If you were blind, you would not be guilty of sin; but since you say, 'We see,' your sin remains." (John 9:41)

All I can honestly say is I would LIKE to think I would have treated the situation differently. But I cannot say that I would surely have been immune to group blindness or inertia. I think we need to learn to acknowledge our blind spots and make a promise to all patients, "We don't always see well, but we will always work to see better. Always."

God on the Brain; the Brain on God

When I was little I wanted to be St. Bernadette. One of my prized possessions was a worn, newsprint comic book depicting her short life - her impoverished childhood in Lourdes, her visions, her illnesses. The visions, of course, were what captivated me. To see a supernatural person, someone from heaven - wouldn't that have been the most amazing thing ever? I remember trying to find vision-friendly spots in our garden - a grotto-shaped pile of rock, a hospitable arrangement of brambles. Similarly I would look for arrangements of tree branches or hedges that might make good portals to magical worlds like Narnia. Needless to say, I never had any visions, and when I was reminded that sainthood often involved suffering greatly for one's faith, I got over it.

As an adult I didn't have too hard a time letting go of some of my childhood "magical thinking" (I've happily clung to some of it - like the thought, "If I get all my resuscitation drugs ready, maybe I won't need to use them.") In high school we had a required course in scripture during which we were encouraged, as our church teaches, to undertake a contextual rather than an insistently literal interpretation of the Bible. Rather than objecting to or resisting this, as many of my classmates did, I found this approach emancipating and, in fact, spiritually enriching, opening up more truths and insights for me than I would have gleaned otherwise.

I wasn't bothered, either, when neuroscientists began to study religious experience and connected religious visions with temporal lobe epilepsy. By then I had spent time as a medical student in psych wards and, though the various disorders of the DSM-IV and the way we seem to be at the mercy of our neurotransmitters made me really question the nature of human will, I didn't necessarily connect sanity with validity. Some of the most psychotic people I saw spoke uncanny truths and had remarkable insights that the "rational" caregivers, supposedly more connected with "objective reality," didn't have.

A few months ago when our church was planning a retreat for young people who were about to get confirmed in our faith, one of the suggested activities was a "Saint Buffet": a time and space set aside for story-telling and visual exhibits about people's favorite moral heroes and heroines. During the discussion of which saintly people we might highlight, I remember saying, "Can we not do Joan of Arc?"

"Why not?" one of my team-mates asked.

"Um, because she was crazy?" I replied, hoping she would hear my tone as affectionate and not disrespectful. Then, fearing that the other folks in the group who didn't know me well, and didn't realize the deep love I had for our faith and many of its elements, might not realize I was NOT trying to be irreverent, I dug myself deeper by saying, "Don't get me wrong, she was an amazing person, but she was psychotic. Or, she had temporal lobe seizures." Thankfully, people seemed willing to chalk this up to me having to interpret everything through the lens of modern medicine, and no one ejected me from the retreat-planning team.

Bishop Stephen Sykes of the University of Durham said during a BBC program, "There is a very interesting dispute at the moment about whether one can have a talent for religion and whether that is something like a musical talent which some people have and some people don't have." This relates to other issues I've often wondered about - the issue of talent in general, and creativity, and their origins / sources / relations to experience and learning. I've often heard that faith is a gift. There may now be scientific proof of that, in the observations regarding our temporal lobes and the other parts of the brain that interact to produce/interpret spiritual experiences. I do think many of the traditional saints, and people who have had profound mystical experiences, had/have highly active, perhaps unusually active, temporal lobes. Some people seem to have temporal lobes that are innately (i.e., genetically?) more "receptive" to religious experience than others'.

As someone who has to interfere with the brain a little bit every day - chemically reduce anxiety, promote indifference to painful stimuli, induce lack of consciousness, and even cause some amnesia - I am acutely aware of how neurotransmitters can be manipulated. I do it for a living! And yes, I did hear about the Johns Hopkins study that found that the psilocybin in psychedelic shrooms can act on brain receptors, induce mystical experiences, and produce positive changes in the study subjects. Clearly the brain is the gateway to human perception and thus has a great deal to do with what we consider spiritual experience. As many pieces in the emerging field of "neurotheology" have pointed out, our spirituality, in large part, is in our heads.

The thing is, I just don't mind. It wouldn't make sense for the brain NOT to show these responses. Also, I've gotten to the point, I think, where I don't feel I have to be RIGHT about everything I believe. There are some truths that lie beyond human belief, and whatever science reveals should only enrich my understanding, not destroy it.

By now neurotheology has its prominent names - Drs. Vilayanur Ramachandran, Michael Persinger, Andrew Newberg, and Matthew Alper, to name a few. Some scientists interpret the growing data about the neurobiological basis for spirituality as suggestive of God being a human construct, with the " 'God' part of the brain" being a genetically-enabled product of evolution which helps self-aware creatures cope with the knowledge of their own mortality - the fruit of Eden's tree. It's the old chicken-and-egg conundrum: did God create the brain, or did the brain create God? Some people of faith argue that God, being a smart one, would obviously create a neurobiological substrate for divine revelation - a natural, physical way for humans to perceive and interpret a relationship with the divine.

What would be really neat is if both were right and true somehow.

My understanding of neurobiology, rudimentary as it is, goes something like this: the brain is "hard-wired" to learn, all experience counts as learning, and learning creates changes in the cellular architecture, gene expression, and electrochemical interactions in the brain. Everything we experience changes our brains from moment to moment, and sometimes cumulatively those changes can be significant. Reading a book, hearing an oboe concerto that moves me, being hurt by an ex-boyfriend, playing cards with my family, practicing tendus repeatedly at the ballet barre, internalizing grammar rules in a new language, smelling roasted peanuts while walking down a Manhattan sidewalk, these all make their mark in our minds, and therefore on our bodies, because our brains are, after all, body. The idea that they are separate is illusory.

And maybe we have some evidence. Dr. Andrew Newberg's work with SPECT scans of people from various religious traditions in deep meditation showed not only increased blood flow to the temporal lobes but also decreased flow to those areas in the parietal lobes that were related to our perception of time and spatial orientation. This finding may explain what those who meditate often describe as an experience of "loss of self," a liberation from the limits of space, time, and individual personality, or a mystical union with a greater reality. I wonder if the perfusion changes were a cause or an effect? In any case, these studies lend support to the fallacious nature of thinking of mind and body as separate. Mind IS body.

This is why I love the story in Chapter 5 of the Gospel of Mark, where Jesus heals a woman of a chronic hemorrhage. I love the juxtaposition of medicine and faith in this chapter, and the way the healer, Christ, felt a transformation in his own body - the healing power draining from it, into the woman - while at the same time the woman felt the transformation in the depths of her body as the flow of blood dried up completely, all because she reached out and made a very physical, hopeful connection by touching the hem of Jesus' clothes. Both healer and healed were physically and emotionally changed by the healing. I love this story so much I wrote a poem about it. (I know -what a dork. Or, as someone who loves me a lot says, what a super-duper-dork!)

Now I gotta go to bed and give my temporal and frontal lobes a little rest.

If you don't like your D, don't go to C; or, The Gift of Imperfection

Today I had my fourth oboe lesson. I have been having trouble descending down the C scale. I'm fine till I get to E, then D, then C...I have trouble there, whether it's crooking my pinky finger just right to hit the low C, or getting the appropriate tone if I do hit it, or sometimes getting any sound at all. Kyoko gave me some pointers on where to position my finger and also how to rest my lips around the reed to make a fuller, rounder, more open sound in the low registers. "You have to have that full sound already at D," she advised. "If you don't like your D, your C will not be good either." So I worked on getting that whole, round tone before moving on. This will take some practice. She did say despite my struggles, "Don't worry, you actually have a nice, warm sound. Don't get stuck."

After she scraped at my reeds a little, things got better. "It's not you, it's your reeds!" she joked good-naturedly. We had a good laugh at my horror of blaming equipment rather than myself for bad form. As a doctor I can't ever say, "Sorry I didn't pick up that Grade III aortic MURMUR there, but it was a bad stethoscope," or, "Well, I couldn't get the airway and the patient DIED because my laryngoscope was broken."

Plus, I've heard my teacher play my "bad" reeds, and you know something - a really good oboist can get a good sound out of a "bad" reed. But I understand her point - as a student I probably need a good reed to achieve a good tone consistently, at least until all the mouth muscles and lumbricals get in better shape. "You so want to be a swan," she commiserated, noting my love of the oboe parts in Swan Lake, "but with oboe you have to be willing to be a duck first. I was a duck for years."

The great thing about all this is I can LAUGH about it. Hear me quack. We spend half my lessons in stitches over my playing. For someone who's been a perfectionist all her life, for whom patience has never been a virtue, whose psychological self-flagellating capacity rivals that of St. Augustine, this relaxed attitude to imperfection - in fact, to being really BAD at something - is a HUGE deal. It feels great. Maybe that's why I feel so comfortable blogging about all this and have the audacity to name myself an "anesthesioboist." My definition of success is true peace with oneself, and I'm so at peace with my own imperfection at the oboe that I feel I've already succeeded, in a way.

Oboe is helping me with my spiritual homework. Here's what I mean. I think "the meaning of life" is to learn how to be more loving and more complete each day, but I also believe that under that umbrella-meaning, each person has little "homework assignments" to work on. I think some of mine are to learn about human worth - what defines it, and how to honor it; to learn patience; and to learn enough humility to accept imperfection (my own as well as others'), and also to forgive and let go when imperfection causes me pain. I have other homework assignments, but these seem to be the recurring themes, I think because I am a slow learner. I try, I fail, I try, I fail - "I'm all... 'this is hard!' " as the speech-impediment girl on Will & Grace said. Oboe helps me slow down and work on learning these lessons.

So if I'm playing badly because I haven't developed sound technique or muscle strength yet, so be it. I'll just keep working. If the reed really is at fault, ok then. We'll scrape it and try again. Patience, patience, patience. No need to fixate on blaming something.

I believe, like so many self-help books and gurus have expressed one way or the other, that assigning blame is one of the most immature and unproductive human tendencies (speaking as someone who has succumbed to it many times). People seem to NEED to point to someone who's at fault, and also NEED for themselves NOT to be found faulty, as if imperfection were the end of the world (again, guilty).

I had a very recent experience of this latter phenomenon when I pointed out an instance of unequal treatment to someone, and that person bent over backwards trying to find outside explanations for the event rather than taking responsibility for it, however unintentional it may have been, as if admitting a mistake or a failing or an imperfection were going to destroy some precious, unblemished identity. But people are intrinsically precious; if we could all really, truly believe that, no matter what, then dealing with our own imperfections and mistakes, and those of others, would be so much easier. We wouldn't be wound so tight. (This was actually what my NPR essay was about.)

I think Jesus was probably one of the most relaxed people on earth. Heal on the sabbath? Sure, why not. Hug a leper? Absolutely. Tell a person caught in adultery that she wasn't condemned? No problem. I think one of the reason's he wasn't wound so tight is because of what HIS faith was made of. He KNEW people were pearls of great price - all of them. "You are the light of the world," he said. I think this "good news," in fact the whole point of his life and the reason he was willing to enter fully into our human experience, was to help us learn this about OURSELVES.

So many of his teachings are precisely about the worth of each human being. No, don't sit in the place of honor, because EVERYONE has dignity and value. Wash each other's feet. Trust like a child, live simply, be generous. If someone asks you to walk with him a mile, go for two. Do not judge (if only people would take THAT one literally more often). Don't lord it over others. Don't just love when it's easy - love when you don't feel like it either. "Be perfect as your father in heaven is perfect." (Matthew 5:48)

But wait, isn't this post about imperfection? What happened to, embrace your own imperfection?

In the koine Greek of the New Testament, as I understand it, the word translated as "perfect," teleios, implies not sinlessness or faultlessness but completeness. Being whole (whole, holy, same root, I think), fully integrated, without missing parts, mature, having no need for external honors or affirmations. If you believe every person is precious, including YOU, then there's nothing to be afraid of or envious of, not a movie star's beauty, not a businessman's wealth, not an academic's accolades or publications, none of that. You're already worth the world. You can be at peace. You can also stop thinking, or needing to think, that you're "all that," more deserving than others, superior to others. I repeat: you can be at peace.

I remember recently hearing an ad on the radio for a summer program for high school students being offered by a well-known Ivy League university. It was inviting young people with talent, vision, "leadership," etc. to apply. I had to roll my eyes. If EVERY child were a leader, where would all his or her followers come from? Why is "talent" so important? If our children were "average," would I love them less than if they were prodigies? DUH, of course not. This is why I love the movie Little Miss Sunshine so much; the idea that life is a beauty contest in our society, but SHOULDN'T be, is so true and so humorously rendered in the film. I'll be thrilled if our kids grow up to be loving, kind, happy, hard-working people with good judgment and integrity. Integrated, whole, holy, teleioi. For all their imperfections, I already think they're pretty perfect.