FAT DOCTORS.

I can't concentrate anymore, there are too many faraway thoughts swimming in my head, and I'd rather not dwell on them or I might play Toccata in Dm on repeat. Mmm.. I shall write instead. Aren't you lucky, two posts in forty hours, during exam season. Actually, that's a tremendous achievement for normal periods. Fortuna te benedicit.

I came across this article trolling Medscape yesterday, 'Can Hospitals Say, 'Only Thin Doctors Can Work Here.' I laughed. It was almost as funny as the opthamologists are happiest doctors article. It's an interesting read, or listen; as it's a transcript of a vodcast, of a ethical analysis on the this Texan Hospital's latest policy.

Basically, the hospital is basing it's rationale on the idea that one cannot hold double standards. That is, one cannot tell a patient to keep fit and healthy if oneself is unfit and unhealthy, thus showing a hypocrisy in the physicians ideas. Hypocrisy is very much disdained in society for the lack of integrity that it shows a person has. Thought, typically hypocrisy is a moral dilemma. For example, it would be hypocritical for a parent to tell a child not to tell lies, then after that proceed to lie; whether or not in the presence of the child is irrelevant, the action itself destroys the parent's moral authority. While not a complete example, I am sure that you my dear can appreciate the situation. Within hypocrisy is the problem that whilst the moral teaching is correct, because the teaching authority does not follow the teaching, the innate sense of justice embedded in our souls spots the injustice immediately, and then the fallen human nature asks, 'if he, who is the supposed moral and righteous one does not follow his own teachings, why should we have to?'. After all, to be good and virtuous is a challenge that one strives for one's entire life. A life of sin is a life of laziness and easiness.

So thus, it begs the questions of whether being fat is immoral, and whether a fat doctor is morally capable of giving orders to his fat patients to be healthy and lose weight. Of course, ideally, everyone should be fit and healthy, and I emphasis that the definition of healthy does merely mean keeping one's weight within the boundaries of acceptable; it includes cardiovascular fitness, blood plasma levels of various nutrients, normal blood pressure, etc. Also, we do have a moral obligation to God and to society to take care of our bodies, for our body is to be the tabernacle of the Sacratissimum, and to contribute to society requires our good health. That said, a duty to the health of our souls is of much greater important to the Lord, and care for the soul will hopefully translate into care for the body through the virtues of moderation and temperance. Also, many would argue with regards to doctoring, it is a fairly sedentary job, so being unhealthy may not necessary cripple one's abilities to work. However, these points are not crucial in tho this question, and I merely them up to remind there is a duty to one's health. Yes, I am a really lousy writer.

So, returning to the moral question. I would argue that being fat is not necessarily immoral, save when it is caused out of conscious constant gluttony and sloth. While the hospital policy extends to all staff in the hospital, I shall only write with regards to doctors, since that is my area, however, I certain that the situation is similar for nurses as well. If one is familiar with the life of the junior doctor, one will know that the five years of medical school hardly provide much time for relaxation and personal time, in the latter part of school, studying is done on top of spending the entire day in the hospital, clerking patients or observing clinics or surgery. The years following graduation are similar; the studying never stops though now the doctor has the added responsibility of treating patients, and being on call. In Singapore, a call is 36hrs, and one has to do 6 a month. While the med student may clock off from the hospital on time, the doctors rarely ever do, there is always some patient that needs tending to, or some emergency to be looked into. Work begins early in the day, usually at six am, and doesn't end until six or seven (I might be exaggerating a little). Hence, there is actually little time that can be spent exercising, and often the temptation of eating a quick meal is strong. Who doesn't want to come home after a long day, grab a quick bite from a hawker centre of fast food joint and collapse on the couch? Also, there is the issue of smoking physicians, though most of them hide it from their patients. Hey, habits like that are hard to kick when you pick them up at 18. Hence, personal health sometimes takes a backseat to other pressing duties. However, this is not to let medical professionals of the hook, merely for you to appreciate the situation.

Anyway, being fat has nothing to do with being a good doctor. Doctors, of all people, know very intimately the effects and correlations to diseases linked to being fat. Furthermore, patients go to doctors to receive treatment and advice on how to cure their diseases, thus, what they are seeking is the doctor's knowledge, and medical skills. The doctors aren't personal trainers after all, they don't look after fitness, they look after health, though the two are related.

That said, it is a rather hilarious situation, considering, doctors are not exactly a commodity in excess in most parts of the world. Of course, the entire thing is a superficial ethical issue. Actually, the only reason that I am writing this is because I really hope this silliness does not become a trend worldwide. Well, actually, this is hope is more selfish that it seems, you see, I am about the size of a whale, and I really hope that I do not end up employable when I graduate in 5 years.

<--- david. That is humpback whale, by the way. I wanted to use a picture of a killer whale, because they are my favourite species, but they aren't really whales. I also thought of using a sperm whale picture, because most cartoons draw sperm whales, but alas, I am not so great as the magnificent sperm whale who fights epic battles with giant squid in the deep depths of the ocean, and from time to time butts heads with obsessed, self-glorified fishermen in submarines. So the humpback, a dumb, fat, gentle whale who makes annoying sounds. Sounds like me.

The process of endochondrial ossification

The process of endochrondrial ossification is usually described in a rather violent fashion. If one changed the words a bit, that would be the full scale invasion of a great civilisation by another one.

1. The cartilage is invaded by blood vessels right in the middle to form the primary ossification centre. (read base of attack)

2. Chondrocytes undergo modifications to form longitudinal columns.

3. These then deteriorate. (Torture of the locals, followed by execution)

4. Osteoblasts then enter cartilage. (like tanks signifying hostile take over. Osteoblast does sound like the name a of futuristic tank from Red Alert, doesn't it?)

5. Diaphysis starts from the centre. (A diaphysis is essentially the long shaft of the bone, the expansion of the conquered territories)

6. Ossification begins from the centre, as osteoblasts move lengthwise up and down the shaft. The Cartilage continues to grow outward. (As though a desperate attempt to escape the vicious osteoblasts)

7. Epiphyseal plates around on the ends. Meanwhile, osteoblast catches up with cartilage. (and guns them down. Well, turns them into bone).

8. Epiphyseal plates ossify.

The city has fallen.

Sirach 38

‘The real difficulty which confronts everybody, and which especially confronts doctors, is that the extraordinary position of man in the physical universe makes it practically impossible to treat him in either one direction or the other in a purely physical way. Man is an exception, whatever else he is. If he is not the image of God, then he is a disease of the dust. If it is not true that a divine being fell, then we can only say that one of the animals went entirely off its head.’ – GK Chesterton

I should be sleeping but I shall write this before it leaves me. A friend gave me this lovely going away card. In it, she pasted a lovely letter, the prayer of St luke for physicians and this excerpt from Ecclesiasticus (Sirach). I shall reprint it here:

Medicine and Illness
Sirach 38

1 Honour the physician for the need thou hast of him: for the most High hath created him.
2 For all healing is from God, and he shall receive gifts of the king.
3 The skill of the physician shall lift up his head, and in the sight of great men he shall be praised.
4 The most High hath created medicines out of the earth, and a wise man will not abhor them.
5 Was not bitter water made sweet with wood?
6 The virtue of these things is come to the knowledge of men, and the meet High hath given knowledge to men, that he may be honoured in his wonders.
7 By these he shall cure and shall allay their pains, and of these the apothecary shall make sweet confections, and shall make up ointments of health, and of his works there shall be no end.
8 For the peace of God is over all the face of the earth.
9 My son, in thy sickness neglect not thyself, but pray to the Lord, and he shall heal thee.
10 Turn away from sin and order thy hands aright, and cleanse thy heart from all offence.
11 Give a sweet savour, and a memorial of fine flour, and make a fat offering, and then give place to the physician.
12 For the Lord created him: and let him not depart from thee, for his works are necessary.
13 For there is a time when thou must fall into their hands:
14 And they shall beseech the Lord, that he would prosper what they give for ease and remedy, for their conversation.
15 He that sinneth in the sight of his Maker, shall fall into the hands of the physician.

The remainder of the verses, 16-39, deal with mourning the dead and how people’s crafts contribute towards building the city and it is through their work that they make God happy. Of course, the ones I have reprinted here are the ones that shall interest me tonight.

The Work of God.
Sirach writes, ‘For all healing is from God’. When I read this passage, I’m reminded of the great humility with which I shall need to carry out my future responsibilities as a doctor. Without the Almighty, from whom all healing comes, would my work be in vain and most fruitless. It is so important that a doctor should remember this in his daily duties. How disheartening it is for all those physicians who do not place their faith in the one who provides them with their abilities, and does not give Him credit. How great is the mercy of God that he still works his healing powers through them.

Moreover, this is a particular vocation that ‘the most High hath created’. God is so great that he has, in the wake of the illness and disease, a consequence of original sin, created the vocation of physician to aid man. ‘[F]or his works are necessary’, Sirach instructs the reader. What a great privileged it is, to have a job created by God for the necessity of mankind. How great is God that he shall allow me to partake in his wondrous works! He has created me for this job, this vocation, and has deigned to use me so that He can heal illnesses and wounds, and through me let his mighty works be shown. He is the primary agent and how blessed am I that I should partake as the secondary agent.

God provides for the tasks he has ordained
I find great solace and comfort in the knowledge that God provides for the tasks He puts one through. Medical school is long and very stressful. There is a tremendous amount of knowledge to be learnt, assimilated and memorised. One practically has to learn to speak in a different language, whereby acronyms can replace nouns, adjectives and verbs. Once school is the done, the learning continues forever and work is stressful (‘of his works there shall be no end’). Work puts one continually at the forefront of health risks. A mistake could result in a malpractice suit and the suspension of one’s license or even jail time. Yet, this is the job that God himself has created, we cannot fail in it, certainly and especially if we stand by him, and if He wills it. Sirach says, ‘The virtue of these things is come to the knowledge of men, and the meet High hath given knowledge to men, that he may be honoured in his wonders.’ Which is a great comfort for me as a student. I, for one, am not particularly intelligent, as this rather clumsy amateur exegesis inadvertently reveals. Thus, I am rather relieved that I shall not have to memorise everything alone. Not to mention, all the tools of the trade does he provide, for ‘The most High hath created medicines out of the earth’. Hurray for divine providence!

Treat not just the body, but the soul as well.
A wise Jesuit by the name of Fr Hilario heard that I was going to medical school and quickly reminded me of the nature of my future work. He said in a patient, fatherly tone, ‘A doctor is both a healer of body and soul.’ and then went on to regale me with a tale of how a Hindu doctor used to visit a sick patient every day and asked how she was, and how she felt so much better after each visit. It wasn’t that he actually did anything, but his presence comforted her soul and that brought about some healing. The entire story reminds me of two things. The first, corny as it is, is the age old adage that a doctor ‘cures sometimes, relieves often and comforts always.’

The second, is far more delightful, is of my patron saint, the first modern doctor to be canonized, St Giuseppe Moscati. He once told an intern,

‘Remember that you have to deal not only with the bodies but also with the moaning souls coming to you. How many suffering people you will more easily soothe by advising and going straight to their souls, instead of giving cool prescriptions to be given to the chemist! Be joyful because great will be your reward; but you will have to set a good example of your elevation to God.’

St Guiseppe was greatly concerned with the state of his patients’ souls and viewed the sacraments as the ‘first medicine’, often encouraging his patients who would be undergoing major surgery to receive them, especially that of communion and confession. He couldn’t have been more right. Confession truly brings healing both to our souls and to ourselves, and communion, which is the very gift of Christ himself, fills us full of supernatural grace from God!

I bring this up because it ties in largely with what Sirach has written.

‘My son, in thy sickness neglect not thyself, but pray to the Lord, and he shall heal thee.
Turn away from sin and order thy hands aright, and cleanse thy heart from all offence.’

Sickness and disease, like death, are consequences of original sin. When the soul is in the state of mortal sin and is turned away from God, the body too suffers from this disconnexion. Mortal sin ruins and kills the soul by removing the connexion we have with God and destroy our humanity, which is the image of God. Consider the effects of Post Abortion Syndrome and how it affects both men and women and ruins their lives. Perhaps listen to a few of the stories from the Silent No More campaign.

His grace, the late Archbishop Fulton Sheen actually predicted this phenomenon back in the seventies when Roe V. Wade came about. He actually understood how sin corrupts the body and the need for confession. You can watch that here.

Of course, with the aggressive militant secularity of modern culture, public displays of religiosity are looked down on and attacked. We live a society that persecutes us for merely wearing a symbol of our faith on our person. I just read about a nurse who was given a desk job for refusing to take off her crucifix, a crucifix she had worn for thirty-one years without complaint from anyone in the hospital. Therefore, looking after patient’s souls will become a difficult task, however there are still ways about it. I read recently of a physician who hired people to pray for the intentions of his staff, himself and for his patients.

It is more than necessary nowadays that we center our lives in prayer and on Christ, for he will give us the strength to persevere and be good Christians. He will give us the necessary spiritual armour to face the day and the strength to carry our cross. Which brings me to the next point.

Personify Christ.
I should note that Haydock says that the verse, ‘Was not bitter water made sweet with wood?’ is an allusion to Moses, striking the rock and making the bitter water sweet. It is upon this same staff was mounted the bronze serpent that healed all those afflicted from those fatal snakebites. That same serpent on a stick is the symbol Ascelpius’ staff, the usual symbol of western medicine. Ascelpius is the greek god of medicine. That symbol of the bronze serpent foreshadows Christ. It is interesting to see this foreshadowing throughout history. Many theologists talk about how the Truth is written throughout time and space, in the very fabric of Cosmos itself.

Sirah too describes this, ‘He that sinneth in the sight of his Maker, shall fall into the hands of the physician.’ The physician is none other than Christ, God himself, who has come into the world to heal it from sin through his suffering and death on the cross. St Thomas Aquinas references this in his prayer in preparation for communion, where he goes ‘sick to the physician of life’. Christ himself uses the analogy in the gospels of Ss Matthew and Mark when he speaks to the pharisees, ‘They that are well have no need for a physician, but they that are sick. For I came not to call the just, but the sinners.’, Mk 2:17

In this nifty allusion, it not only foreshadows the coming of Christ, his role as the physician of life, but also our role to personify Christ for others. While all Christians are called to be Christ for others (and also to see Christ in others, since Christ may come in veil of the lowliest and ugliest that frightens us), the doctor has a special role, he personifies the healing powers of Christ, he personifies Christ the healer. Again, I say, what a great privilege that is to share in this wonderful plan of God, and co-healers with Christ.

To end of, perhaps I can take you to this tongue-in-cheek writing about the Christ, the polymath specialist.