Sifting Ashes

The fallout from the ECUSA's General Convention continues. Diocese are requesting alternative oversight, Churches are in disarray. The various blogs are teeming with opinion couched as fact and facts questioned as sophistry. A simple country Anglican is left adrift. It should come as no suprise that the author of this particular site is of a conservative bent. Not conservative from a political standpoint as much as from a theological tradition.
The election of the PB-Elect has resulted in more knee-jerk reactions than a neurologist sees in a lifetime of exams. While cooler heads may prevail and the 'middle' reign triumphant, it is unlikely. And it should be unlikely. These are serious theological issues that cannot be brushed aside in the quest for peace and equanimity. The differences are as deep as bedrock and as solid.
My lay reading of theology from Gnosticism to Panentheism, humanist to orthodox have left me with definite beliefs and opinions. In this authors humble opinion, a Schism is inbound and there is little anyone on Earth can do to avert it.

In the Midst of a Whirlwind

The vast majority of the previous postings dealt with worldly matters that were quite important on that plane but pale in comparison to much more important subjects. While reading theology has always been a 'pastime' of mine, the recent events in the Episcopal Church (ECUSA) have brought casual reading to a new level. It is no underestimation to state that ECUSA is in a state of agitation that is almost, well, biblical. There are many in the fray that are absolutely assured of their correct position the theological spectrum. I too think that my stance is correct so don't assume that I am immune to the siren's song of righteousness. But one has to take a side if one is to continue to perform as an informed and thinking Christian. The middle of the road is where one gets hit by a fast moving vehicle.
Much of this may be inspired by Bishop N.T. Wright's writings. I started The New Testament and the People of God last month. It is quite a thoughtful tome and not for the casual reader. It is almost surely above my complete understanding but even a blind boar finds a truffle every now and then. Others have written erudite reviews of Bishop Wright and his work so there is no need for me to pen a rookie opinion. Suffice it to say that he is simply the clearest biblically honest apologetic that I have read since C.S.Lewis.
ECUSA could benefit greatly from Wright's input but it is unlikley that they will avail themselves of his scholarship. What is an American Anglican to do?

Quietly. Stunned.

N.T. Wright is an Anglican Bishop, theologian and author that has heretofore escaped my perusal. For the last twelve or so years it has been my practice to scour the bookstores' religious sections for Christian books with an orthodox (little O) view, those more in line with my beliefs. Mere Christianity was among the first and many other by C.S. Lewis as well as Chesterton followed. Our priest from down South recommended Newbegin as well as other classic Anglican authors. But it has been since the first book mentioned above that an author has, in my humble opinion, cut so quickly to the simplicity and complexity that is Christianity.
Wright's Simply Christian has done just that. Having just finished the 238 page book, it is as if a whole new world, previously contemplated but not perceived , is possible. No, he does not lay out some kind of 12-step guide to entering the Christian life; the joy and difficulty are lain out 'warts and all'. Bishop Wright instead describes the mystery and philosophy of the life that is at once awe-inspiring and desperately needed in this and every age. This is not an I'm-okay-you're-okay type of feel good book that would rocket it to the top of the NYT Non-fiction or Oprah's list. Were we more true to our true Judeo-Christian roots you would not be able to purchase it for it would be sold out. But that is not now. That being said, it is not a polemic against the left nor a prop for the right of the political spectrum. It's beauty is in the fact that it transcends this type of mundane sniping while remaining grounded in everyday life.
Bishop Wright examines how some are hit with a bolt out of the blue such as Paul on the road to Damascus. Others will take decades to grasp the true meaning of God and the Church. This book may well have taken years off of my search.

The Pause that Satisfies...

In the South, that is a phrase that I have often heard used to describe an R.C. and a Moon Pie. For some reason the same phrase came to mind when the letter confirming my successful completion of the Boards arrived last week. It would appear that having the date moved up was a blessing in disguise after all. Strangely, there is a small sense of anti-climax. This event has been built up in my psyche as the finish line in a very long race for years. While there surely exists a great sense of accomplishment....now what? People like me need a goal, an end point. While catching more fish this year is a worthy task, it is hardly in the same ballpark as the job just completed. At least not until I retire in twenty or so years. Perhaps my next task will be to come up with the next goal. It'll do for now.

The Envelope Please....

Well, today is the day. The letters with the Board results are mailed out this morning. Okay Caesar, is the thumb up or down? I REALLY don't want to go into the arena again. Despite the early indications, actually seeing the answer in black and white under the appropriate letterhead is the only way that my blood pressure will begin normalizing.
I could use some good news after the events of yesterday. Due to factors beyond my control, I resigned my commision on Tuesday. My civilian practice has lost a partner and there will no longer be sufficient time to participate in the Air Guard. My remaining partners would be severely affected if a call-up occurred and it is simply not fair to place them in that position. It is as if a very important part of me has been removed. There is a sense of nakedness without my military ID card. For the last eight years it has never been farther than my back pocket. Sounds juvenile but I really don't know how else to explain it. There is no real upside to having a military obligation in civilain life. There are no special clubs or perks. We are just a group of people willing to submit to a higher authority in order to help our country and fellow man. And lest ye read too much into this, it ain't religion. Bush and Rumsfeld are not new members of the Trinity, at least in my eyes. While my Christianity is held near to my heart and to my intellect, it remains something else altogether. And the topic of a whole other post. When called to the Desert I went for the same reason that millions have gone over the past 2000 years....my friends and comrades needed me. When called to Katrina, I went because I had a unique skill that was needed in my former hometown. Those Guardsmen and women that were with me inspired me to be a better man than I would be in the usual 'civilian' world. Its about being part of something bigger than oneself. No, one may not personally believe in a war or in the way that relief is being carried out but you are an intelligent individual who can put a personal face on the ordered action and make it better than it would have been without you there. All of us did and we and the nation are better for it. The fact that my name will no longer be on the roster to be called to assist has left a hole in my heart and my soul.

There I was...

So there I was.......
So begins so many aviation stories, especially among the military fighter comunity. While mine may not be nearly as exciting in the retelling, it is nonetheless a personal bombshell. Let's let the story play out.
So there I was, sitting at my desk in the office. My partners and I affectionately call this the 'penalty box' aka clinic. Yes, we surgeons like surgery and it should thus not come as a striking revelation that non-operative professional pursuits are granted perjoritive monikers. Don't even ask what administrative meetings are termed. There was, however, to be a silver lining viewable to the patient. The phone rang in from the front desk stating that a certain Dr. X desired a moment of my time. Given the seniority of this particular personage my attention was suddenly focused like Copernicus at the telescope. He was not in the habit of calling for advice, referrals, idle chat or, for that matter, anything at all. In fact, recent memory does not recall his voice on my handset. I was suddenly experiencing a feeling not remembered since walking steel 14 floors above the sands of Gulf Shores, Alabama, building condos. In an effort to keep this rated G, let's just say that there was a combination of nausea, giddyness, terror and an indescribable tingling in the nether regions.
With the pleasantries out of the way, I set about trying to glean the exact purpose of this unexpected communication. Initially all thrusts were parried as if I were at swords with a Musketeer. This man was in every loop that now mattered to me. If anyone knew my fate as relates to the recent 'quiz', it was he. The official results are not due for 6 days and they are attached around the nape of a lion cub with mama lying at her side. Any attempt to view said results before the official date are met with deadly force. Was I being tortured or teased? I was more than willing to be toyed with, I had already been brought to heel in a most auspicious way. This was no great stretch.
And then suddenly the he let it slip.....your scores were fine...you passed . Yes, there were bells ringing and angels singing. You must understand, I have invested 20 years of my life in this pursuit. Imagine being in the arena with the Emperor's hand perched shakily between life and death. I had just received a thumbs-up. A grant of professional life with a huge mantle of responsibility. You have been approved by the ultimate powers that be but are now expected to shoulder a heavy mantle of responsibility and tradition. Time itself ceased to flow. While the hands are spinning now, their rate remains slower than yesterday. I look back on those who have passed this same trail and realize that my feet rest on the shoulders of the proverbial giants. I am thankful to those who took the time to train me and all those who put up with me. My family has been patient beyond belief. My gratitude knows no bounds. I think I'll just let this percolate through my consciousness a bit.

Fear & Loathing in Houston

Well that was fun. Last week found me in Houston for a 3-day prep course that was well worth the time and money. Anyone who sits for their orals without taking the course is either brilliant (and should already have passed them) or they do not possess sufficient situational awareness to get out of the rain.
The exam took place on Thursday. While it will not likely cause me PTSD (unless I flagged it), it was still a gut wrenching experience that hopefully will not need repeating. While most of the questions were straightforward, it was the complex cloaked in simplicity that trips one up. There you are, being grilled by the leaders of the specialty who in former lives must have been professional poker players. You give a brilliant answer.....nothing. You make a rookie mistake....nothing. There is no way to know, at the end of the day, whether you were outstanding or completely out-of-bounds. It will make the next two weeks partially sleepless while the results are being tallied.

Post Traumatic Stress

It's been difficult to get into the rut of studying again. Perhaps the fact that the reference is to a rut bodes poorly. That is not necessarily a positive portrayal. One of my partners believes it to be a form of PTSD. All of us who do this for a living have spent many years of our lives alone with books for more days than we can count; perhaps for more days than we have spent with our spouses. We were the types that would pride ourselves on being the first one at the library in the morning and the last one to be kicked out that evening. We were the ultramarathoners of the studying world.
But that was then. While not afraid to work long hours and to give up sleep and time with the family to get the job done well, studying is simply a different skill set. Reading up on a real case is one thing, going back to college and med school studying is another.
I can spend hours reading the latest Le Carre novel or treatises on theology. But picking up the medical texts and perusing that which I have known and read before is as appealing as a root canal. Being dragged through town by my tongue sounds more appealing.
Well, enough of the pity party. Rereading this is painful. This guy sounds like an introspective idiot. Just get over it! You have a job to do....do it. All right, I will.

Deep Brain Stimulation

Polishing up on the minutiae that is a part of this profession can be both stimulating and tedious. Stimulating to reaquaint oneself with the interesting rarities of disease and the beautiful anatomy that is the human nervous system. Tedious because much of that information is so rarely used and therefore difficult to store away for immediate retrieval. When one of those rare diseases present, one has ready access to volumes covering every possible aspect of the specific disorder. That coupled with a good residency in which one was exposed to all of the once-in-a-lifetime problems should be more than enough for one to make sound diagnoses and recommendations. But the Boards are not such a real world assessment. Or maybe they are.

When one talks to those who have both passed and failed the Boards, many different views are reported. Many say it is absolutely fair. Others disagree. Some relate sheer terror. It is likely that keeping one's head is at least as important as the knowledge base possessed. After all, you cannot even sit for the Oral Boards until you have been forged in the furnace of residency and passed a written test that can be equally as daunting. So no problem, right?

The fact that a general neurosurgeon sees just that, a general representation of surgical neurology is comforting. It gives one a broad knowledge base from which to start. Many 'super-specialists' only see a thin, albeit deep, slice of pathology. It would be petrifying to prepare for the oral boards if one had spent the last 3-4 years treating only a selected subset of neurologic pathology. However, because there are so many disease processes that are rarer than honest thieves, even a community neurosurgeon who treats a broad swath of neurologic 'badness' never sees it all again once out of training. And it is only by constant practice that one becomes facile enough to prove oneself before the group of very intelligent men and women sitting across the table.

All of that being said, reviewing my specialty is gratifying and humbling at once. Its been a while since I have reviewed DBS (deep brain stimulation). Its one of those surgical procedures mainly performed in tertiary medical centers but also a subject about which an examinee needs conversant. Then again, this whole process is a form of DBS in which this surgeon is also the patient.

Good News?

The notification came today that my Oral Boards have been moved up from November to this May. It rather brings things into perspective and definitely focuses things a bit. More than anything else, it feels as if medical school has reconvened with me as the only student and the most important exam is only a few weeks away. To say that the sheer volume of information is staggering would be akin to standing in the face of a tidal wave and describing it as humid. Well, to be fair this is not furthering my journey to mental serenity so I had better go unroll the firehose and begin imbibing.