Caveat Emptor: The Real Condition of Medical Care in America

Kristina's been sick, and we've gotten an inside look at some of the ugly inefficiency and dysfunction inherent to the medical establishment in America: An initial incorrect diagnosis that's caused irreparable harm, foot-dragging insurance companies, a primary care physician who is as new to this condition as we are, nurses who think they're smarter than doctors, a specialist who's tried scare tactics and manipulation to get us to do something that wasn't medically necessary, and another specialist -- maybe the only one we trust -- who's four hours away. Tonight we learned that the hospital screwed up the last procedure they did on Kristina, rendering its results useless, and wasting the last ten precious days.

I'm furious, of course. And if you know me, you'll also know that I've been doing a lot of thinking about our medical system. One thing almost everyone agrees upon is that the U.S. healthcare system is dysfunctional. We have a great number of dedicated, skilled medical professionals. We also have a few bad ones. And while the good vastly outnumber the bad, the system within which they all work is broken.

Patients and their families are increasingly left to fend for themselves in a profit-driven, increasingly competitive business. Patient care isn't the driver in this business. Money is. We're fortunate, in that Kristina has health insurance and an advocate who makes up with tenacity what he lacks in skill.

But what happens to the poor, or to those with no close-at-hand advocates? The poor are largely uninsured to begin with, so their financial prospects are dire from the outset of any serious medical issue. They're also largely not as well-educated and well-resourced as we are. They may not recognize poor care when they see it, and they may have a difficult time leveraging the all too frequently encountered reticent and embittered lower-level providers to their advantage.

There are no easy answers to these problems. Most of you won't ever have to deal with the kinds of cascading failures we've seen in the last five weeks. But don't let the fact that you haven't fool you into thinking our medical system's dysfunctions mustn't be addressed sooner, rather than later.


"Social"... Really?

I post this knowing full well that some who read this may misinterpret my motive. I won't lie and tell you that Kristina's health problems weren't grist for the mill. But let me assure you that this is not some passive-aggressive dig at specific people whom I feel to be lax in their engagement in my family's ordeals. We're getting loved on a lot. Probably by more people than we realize, if the truth be told.

Now that the sure-to-be-ignored disclaimer is out of the way…

Over the last few weeks, I began to notice a marked difference in the number and quality of interactions on one so-called social network compared to another. And I realized some of these networks really aren't social. They're branding engines, broadcast networks. But — at least in my experience — they're not social.

I'm not naming any names, and I'm not calling anyone out. My data is more anecdotal than scientific. But the fact is that I've had more and better interactions with total strangers on one network in the last two weeks than I have had with people on another who live in the same area code.

I bet that happens a lot. In fact, I bet I've been guilty of it myself.

Now it's time for some brutal honesty:

  • If your feed is so full that you don't actually interact with the people there, it's too full.
  • If your life is so busy that you don't have time to engage with others, you're too busy.

I think it's Bob Goff who says — and I'll have to paraphrase — that life happens at the margins of your calendar. If you don't leave some room at the edges, you can't really tap in and get rowdy.

Tomorrow's Thursday. Bob usually encourages folks to find something to quit on Thursdays, to make a little room for love to go and do something.

Think about it.


the truth of art and science, inseparable

There are two kinds of truth: the truth that lights the way and the truth that warms the heart. The first of these is science, and the second is art. Neither is independent of the other or more important than the other. Without art science would be as useless as a pair of high forceps in the hands of a plumber. Without science art would become a crude mess of folklore and emotional quackery. The truth of art keeps science from becoming inhuman, and the truth of science keeps art from becoming ridiculous.

"Great Thought" (19 February 1938), published in The Notebooks of Raymond Chandler (1976)

I'm sure someone will note that Mr. Chandler missed the kind of truth that starts with a capital T, the kind embodied in the Word made flesh — and they'll be right to do so — but mostly I don't want to miss the lower-case-tee truth of what he says here.


give. quietly.

Lots more folks are talking these days about justice, giving, service, missional living. That's a good thing, in my book. I'm grateful for the power of the networks we wield in service of our King, and for the increasing number of people whose hearts are breaking for the things that break His.

There's this, though:

“Be careful not to practice your righteousness in front of others to be seen by them. If you do, you will have no reward from your Father in heaven. So when you give to the needy, do not announce it with trumpets, as the hypocrites do in the synagogues and on the streets, to be honored by others. Truly I tell you, they have received their reward in full. But when you give to the needy, do not let your left hand know what your right hand is doing, so that your giving may be in secret. Then your Father, who sees what is done in secret, will reward you."

- Matthew 6:1-4 (NIV)

Jesus wasn't worried about His platform. He told the demons He cast out not to reveal who He is.

We the dreamers, we the world-changers, we need to look carefully, humbly, into the dark places of our hearts. We need to ask the King we serve to root out of us any of that Pharisaical nonsense we find so appalling in others.

And there's this:

"And let us consider how we may spur one another on toward love and good deeds…"

- Hebrews 10:24 (NIV)

Give. Quietly.

Call others to serve. Humbly.

Hold these commands in holy tension with me. It will require us to rest in grace.


The Bride of Christ as Hot Mess

Douglas Wilson, bringin' the heat.

...we need to come to grips with the fact that in North America, the bride of Christ is a hot mess.


...if the Spirit didn't actually do anything, then our systematic theologies are nothing but printed kits for organizing smoke.

*shifts uncomfortably in seat*

In the meantime, we do not need for the bishop to process up the central aisle, like the biggest crow in the gutter. We do not need another message from Doctrine Man, with ten rivets in each subpoint. We do not need the worship leader to take us through yet one more orgasmic chord progression. We don't need a doctrine of responsible stewardship and sustainability that worries more about how many times we flush than how many babies we kill. We do not need any more cardboard cut-out celebrity pastors, grinning at us, as smug as all dammit. In short, we don't need any more of what we currently have. A.W. Tozer once cuttingly observed that if revival means more of what we have now, we most emphatically do not need a revival.



out of the hinterlands

One often finds in epic literature the hero who must trek through wilderness on his way to conquest and glory. Jason. Ulysses. Bilbo, Frodo and Sam*. When they set out on their journeys, none of them knew what besides adventure lay ahead. The wilds of their respective worlds were nothing more than incidental obstacles.


“Who are you? Give us an answer to take back to those who sent us. What do you say about yourself?”

John replied in the words of Isaiah the prophet, “I am the voice of one calling in the wilderness, ‘Make straight the way for the Lord.’”

John the Baptist, paraphrasing Isaiah


I read these words as a sophomore in college and I knew—in that soul-deep kind of knowing—that in them I would find who God made me to be. It was that knowledge that drove me to seek understanding on a spiritual walkabout of my own.

My own wanderings in the hinterlands were not, I think, a banishment for sin, like the ancient Hebrews experienced. Neither do I think I was sent out to be tempted like the Christ. I set off—much like those men and hobbits did—with a spring in my step, uncertain of my own ability, but rightly knowing it takes courage to plumb the depths of the soul in search of God. I was undoubtedly immature and naïve. It all seemed so romantic at the time.

Now I’m just tired. I’m ready to walk out of the wilderness and into a season of rest. And so it was with Joshua and the Israelites, the weeping prophet Jeremiah, and all the heroes of our favorite epic literature.


“I wish I was at home in my nice home by the fire, with the kettle just beginning to sing!” It was not the last time that he wished that!

-  Bilbo Baggins in The Hobbit, J.R.R. Tolkien


I was thinking about all of this yesterday when I realized something: I have misunderstood the purpose of wilderness wandering. My wandering has not been any more incidental than it was for the great heroes of literature. They found no rest when they walked out of the wilderness. They were weary, battered, hungry and cold…and they were in for the fight of their lives.



What makes each of these characters heroes is that they each saw their journey through to the end. And so shall I. The author and perfecter of our faith finished writing this story a long time ago, and He is relentless in His desire to see each character in it through to the very end. The best stories never end quite like we expect them to do, and I am certain that this story we're now in is the best of them all.




* I feel certain that some of you just spewed a bit of coffee or lunch on your iDevice. The Lord of The Rings may not yet rank in the pantheon, but I think in time we will find Tolkien's magnum opus there alongside the great Greeks. Also, I hope you will grant license to the one who humbly finds the meaning of his own story in the stories of these great heroes of old.


reflecting on buried talents

If you've followed me for any length of time, you know that I've been wrestling for a long time with discovering my vocation. I've bounced all over the place, grasping at one idea after another, all of them ultimately dead ends.

I still don't know what my niche in God's Kingdom work is, but for the first time I'm able to admit that I've been looking in the wrong places for the answer. All of the half-cocked shots and aborted missions have been my ideas, rooted in immaturity.

I won't go into autobiographical detail about how I came to be where I am. This process goes back longer than just about anyone who reads this has known me. The takeaway is that God has been at work under and behind and through and above my immaturity. He has used a long season in the wilderness to bring me to an understanding of my own selfishness, my own laziness and fear. He has faithully lead me closer to Himself by allowing me to fail, by blocking the way forward I've chosen for myself.

The conviction has been growing in me that it is time for me to engage my talents in greater measure with the work of the Kingdom. Last night at Mosaic, Schatzman was teaching from Matthew 13. While Mark was talking about the parable of the pearl, God was hammering home to me His point from the parable of the talents (Matthew 25.14-30, below; see also, Luke 19.12-27).

Parable of the Talents

14 “For it is just like a man about to go on a journey, who called his own slaves and entrusted his possessions to them.

15 “To one he gave five talents, to another, two, and to another, one, each according to his own ability; and he went on his journey.

16 “Immediately the one who had received the five talents went and traded with them, and gained five more talents.

17 “In the same manner the one who had received the two talents gained two more.

18 “But he who received the one talent went away, and dug a hole in the ground and hid his master’s money.

19 “Now after a long time the master of those slaves came and settled accounts with them.

20 “The one who had received the five talents came up and brought five more talents, saying, ‘Master, you entrusted five talents to me. See, I have gained five more talents.’

21 “His master said to him, ‘Well done, good and faithful slave. You were faithful with a few things, I will put you in charge of many things; enter into the joy of your master.’

22 “Also the one who had received the two talents came up and said, ‘Master, you entrusted two talents to me. See, I have gained two more talents.’

23 “His master said to him, ‘Well done, good and faithful slave. You were faithful with a few things, I will put you in charge of many things; enter into the joy of your master.’

24 “And the one also who had received the one talent came up and said, ‘Master, I knew you to be a hard man, reaping where you did not sow and gathering where you scattered no seed.

25 ‘And I was afraid, and went away and hid your talent in the ground. See, you have what is yours.’

26 “But his master answered and said to him, ‘You wicked, lazy slave, you knew that I reap where I did not sow and gather where I scattered no seed.

27 ‘Then you ought to have put my money in the bank, and on my arrival I would have received my money back with interest.

28 ‘Therefore take away the talent from him, and give it to the one who has the ten talents.’

29 “For to everyone who has, more shall be given, and he will have an abundance; but from the one who does not have, even what he does have shall be taken away.

30 “Throw out the worthless slave into the outer darkness; in that place there will be weeping and gnashing of teeth.

It's really hard to read this and see myself in it. In my brokenness and immaturity, I've chosen not to use the best part of the gifts He gave me. I can't say that it was because I knew Him "to be a hard man"…but I can't say it wasn't, either.

And right now, it doesn't matter why I buried the talents He gave me to invest (or as in the parallel passage in Luke, covered them with a handkerchief). What matters is what I do next.


literary gumbo

I've been reading a lot lately, and have collected a few quotes I've been meaning to share. It's messy and disorganized to lump them all together. There's no thread running through them that is immediately apparent to me. But I feel like I need to clear out my mental queue, so here you go:



…their resentment and anger exhibited their own bigotry: they looked down their nose at people who looked down their nose at people!

Tim Keller, Ministries of Mercy

I'm ashamed to say I'm just now beginning to see this particular sin of pride in my own life. If I deem someone to be inadequately pious in practice, I'm likely to start hucking stones at them. No wonder I have such a hard time getting through to people.

I've tweeted quotes from MoM several times. It's more practical than inspirational, so it's taken me several months to wade through. I appreciate the effort Keller takes to show the Scriptural case for undertaking ministries of mercy in the church; he loses me, though, when he gets into the nuts and bolts at the end of the book. Since the book was published in the mid-80's, I'd be curious to hear if Keller's perspective on any of those methods has changed.

Reading the book did help me realize something about my theology, though:

Mercy ministries are the mode and the means for both the Great Commandment and the Great Commission.

To be clear, those are not Keller's words but mine. They make up an as yet unchallenged and unsupported bit of personal theology, as evidenced by my actions, and may not be all that well-written to boot. I may yet decide they're not Scriptural. The idea, though, has certainly been foundational to the way I've seen the world. It's also been a point on which I've been known to be quite judgmental, as the first Keller quote reveals.

All five of my readers are welcome to comment if inclined.




Latin, "Christ, the only King", behind the title page in The Seven Storey Mountain, by Thomas Merton. This may very well get worked into my next tattoo.



On the last day of January 1915, under the sign of the Water Bearer, in a year of a great war, and down in the shadow of some French mountains on the borders of Spain, I came into the world. Free by nature, in the image of God, I was nevertheless the prisoner of my own violence and my own selfishness, in the image of the world into which I was born. That world was the picture of Hell, full of men like myself, loving God and yet hating Him; born to love Him, living instead in fear and hopeless self-contradictory hungers.

Merton, ibid.

The opening lines of Seven Storey Mountain. One of the best literary openings I've read, I think. Meaty. Captivating.



The devil is no fool. He can get people feeling about heaven the way they ought to feel about hell. He can make them fear the means of grace the way they do not fear sin. And he does so, not by light but by obscurity, not by realities but by shadows, not by clarity and substance but by dreams and the creatures of psychosis. And men are so poor in intellect that a few cold chills down their spine will be enough to keep them from ever finding the truth out about anything.

Merton, ibid.

Merton's been talking in a sort of detached way about the deep-seated fear of Catholicism held by his grandfather who raised him. Then this. Right to the heart of the matter. Just my kind of thing. Look no further than our current political process to see this worked out before your very eyes.

I've just started it, but I think I can recommend Merton's "autobiography of faith" to those of you who haven't read it. Thanks again, Matt, for suggesting it.



Only sin
And glory,
And not yet,


Numquam Oblivisce

Our Lady of Empassioned Unity ascended
From the ash and rubble of the Towers of Babel.
Resplendent, bloated from feasting on the fortunes
Of reasonable folk, eleven years gone by now,
She need not pursue them.
A certain devotion brings them to her Temple,
neverforget on their lips as they finger
The prayer beads of their forgotten prosperity.