A BIG DECISION

I didn’t know I was poor until 1976. At the end of that school year students in the “California Scholarship Federation,” a club for students with GPA’s of 3.6 or higher, were treated to a day at Magic Mountain. I rode in a carpool with a friend who was a senior, and on the way home we stopped at a Denny’s with other students. While the others ate burgers or breakfast and sipped Coca Cola, I drank water and ate the onions someone didn’t want on their burger as I had no money.

Six months later I made the sophomore basketball team. The coach decided it would be a good idea for us all to wear dress shirts and ties on game days. I was not opposed to the idea, but I had a problem. I did not own a dress shirt or a tie. My typical school attire consisted of a pair of jeans and a white T-shirt. The coach was kind enough to give me a solid blue necktie but when it came to the shirt I was on my own. The only collared shirt I owned was a brown Pendleton I had been given for Christmas, and though I wore it with a tie for the first game it didn’t look very good. My mother must have said something to her much older boyfriend, because he took pity on me and the next week gave me a short-sleeved light blue dress shirt, which soon became my favorite.

Things changed when I began working during my junior year. I worked several days a week, sometimes more than thirty hours, but I could finally buy the things I wanted. My clothes and my outlook both improved. I continued working regularly for the next nine years, all through high school, community college, and ultimately the University of California, Irvine. Although I knew I was competing against students who did not work at all I never thought of myself as disadvantaged or viewed life as unfair. Until I decided I wanted to be a doctor.

As a product of an abusive home, I lacked self-esteem, and I wasn’t sure I had what it took to get in to medical school. My sense of self-doubt was so well developed that when I transferred to UCI to major in Biology, I felt compelled to promise my wife I would change majors if I did not have at least a 3.6 GPA at the end of my first year I would change majors. I did better than that, and when I submitted my applications two years later, I was in the top 3% of my class and had scored in the top 2.5% of the nation of the MCAT, the standardized admissions test. I thought I had made it.

I had, and I hadn’t. I had performed well enough to easily obtain admission into private medical schools in California such as USC, but when it came to the dramatically less expensive University of California schools I was found lacking. I was dismissed out of hand by UCSF, denied by UC Davis and UCSD after an interview, and put in the limbo of the “waiting lists” of UCI and UCLA. My deficiencies lie not in my grade average or test scores, but in something over which I had no control whatsoever, the amount of melanin in my skin. What I had overcome did not matter. No one cared that I had come from an abusive home or had worked my way through college. I was forced to sit and wait while much less qualified applicants were given spots ahead of me, forced to consider joining the military to pay for private tuition while the schools of my state granted admission to other people based on the spelling of the last name or the color of their skin. The most egregious example was when UCSF gave a spot to a fair-skinned female of Latin descent with a 3.0 GPA and test scores in the 40th percentile. I waited eight months to learn I did not have to force my wife to be a military bride. I did not receive an offer from UCI until six weeks before the first day of school, for UCLA the offer came five weeks later still.

I don’t think about the anguish of those days much, as everything worked out well for me in the end, but those memories came flooding back this morning when I read the news of the Supreme Court’s decision in Students For Fair Admissions v. Harvard. In clear, uncompromising terms, the majority of the court declared that admissions policies like the ones that nearly held me back thirty-seven years ago are unconstitutional.

Associate Justice Clarence Thomas, a man who happens to be black and who was abandoned by his father as a child and raised by his grandfather, ended his concurring opinion with these words-

“While I am painfully aware of the social and economic ravages which have befallen my race and all who suffer discrimination, I hold out enduring hope that this country will live up to its principles so clearly enunciated in the Declaration of Independence and the Constitution of the United States: that all men are created equal, are equal citizens, and must be treated equally before the law.”

Bart

PS: I never write about politics, as my politics do not define me, and my political beliefs are not all that important. This post was motivated not by politics but emotion. For the first time in memory the Supreme Court addressed something I had personally experienced. The post is not a comment on racism in America (I know it is still a part of our culture!). It is simply a story of something I experienced and how today’s decision impacted me.

We’re not that SPECIAL

The incredibles is one of the greatest movies of all time. I loved it the first time I saw it, so much so that we went back and saw it again the next day. It's one of those movies that gets better with age, and for me, it gets deeper too.

The movie’s villain uses gadgetry to do super human things, (and gain victory over true “Supers”) then declares his plan to use these fake superpowers to become famous and then sell those power giving gadgets to other people.

His ultimate goal is to diminish super heroes by making them common. He tells the Incredibles- “When everyone is super, no one will be!”

The depth and the meaning in that line is amazing.

The villain was a normal boy who lacked the powers of his heroes but whose lifelong dream was to be recognized as “super.” When Mr. Incredible didn’t accept him as special, he made it his goal to ruin the few people in the world who were truly exceptional.

What an analogy for our culture today. No one is content with being normal or average. Everybody wants to be special, to be better than everybody else and recognized by the world, and they will do just about anything to achieve that status. This is borne out by recent surveys of high school students asked about their career aspirations. At the top of list of desired professions was: social media influencer.

You read that right, more than doctors, lawyers, nurses, school teachers, police officers, or firemen, young people of today simply want to be famous. They want to be special. Make the world a better place? Not interested. Make a difference in a child’s life? Whatever. Get a lot of likes and clicks? Sign me up!

These young people are headed for a rude awakening. It is impossible for everybody to famous, super, or special, and the truth is, very few people are. There are over 8 billion people on planet earth. And most of us just aren't that special, and by definition, half of us are below average. In the grand scheme of things, most of us don't make that much of a difference in the world.

This has been the way of things forever, but it seems this reality is unacceptable to many Americans, particularly those who are young. I have read a number of different explanations for this “gotta be special” mentality, from an addiction to “likes” on social media to the consequences of “everybody gets a trophy” participation awards to child centered parenting, but I wonder if something else is to blame. I wonder if it might be due to the rise of humanism in America. (Bear with me while I explain.)

In the not too distant past, America was a nation of near universally shared values. While rooted in Judeo-Christian traditions, these values spanned many different faiths. These values included such things as belief in family, truth telling, the value of hard work, integrity, keeping one’s word, traditional marriage, and kindness. Success, for most people, was measured by a person’s character. Moral values mattered so much that a wealthy person who lacked these virtues was often viewed as a failure.

To put it another way, being a good person made you special, and the recognition of your goodness by family, friends, and your faith community is what mattered. (Before the advent of social media the admiration of strangers was impossible.)

Nowadays I rarely, if ever, meet someone who as a strong sense of morality, much less anyone who aspires to be a good person. I probably shouldn’t be surprised by the fact that people in a microwave, fast food, instant gratification world feel this way. Being a noble person requires effort and takes work, typically over a long period of time.

Humanism is attractive because it offers a faster and easier path to praise. Being “true to yourself” has replaced “being a good person” as the highest form of praise, but it brings with it an unexpected problem.

When everyone is being “true to themselves”, being true to yourself isn’t special anymore. Unless the “self” you are being “true to” is dramatically different.

We see this desperation everywhere, in the extreme ways people alter their physical appearance, express their sexuality and self identify. The self worth created by such extremes will not last, as history as taught us yesterday’s fad will be tomorrow’s norm. (Old folks like me remember when tattoos and piercings were rare!)

The solution to the specialness dilemma is not flashy or popular, but it has endured through the ages. People who find their value in the eyes of God, the love of their family and in service to others will find a deep sense of wellbeing that transcends the temporary and provides something far greater than mere happiness or pleasure.

They will find joy.

- Bart

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Target-ing the Children

The mother was desperate. Seemingly out of the blue, her 14-year-old daughter had announced she was actually a boy and wanted to immediately begin the process of transitioning to meet her new gender identity. She had picked out a new name, and wanted to be referred to by male pronouns. Unsure of what to do and afraid she was losing her daughter, she turned to me for help. I had no choice but to say yes, as I had known the patient since birth and the mother for several years prior.

As much as I wanted to help and was willing to do so I was extremely nervous about the visit. The treatment of children with gender identity concerns has become a philosophical and political minefield and doctors who try to navigate the minefield do so at their peril. A single misstep can have devastating repercussions.

As a family physician who tries to “get it right” in every encounter and who regularly searches the medical literature to stay up to date with the current guidelines for diagnosing and treating my patients, I quickly learned that the treatment recommendations for patients who presented with gender dysphoria were different that those for any other condition I treat.

In the not-too-distant past gender dysphoria was an extremely rare condition. The incidence of males identifying as females was estimated to be somewhere between 1/10,000 and 1/30,000 individuals. Females identifying as males were an even rarer phenomenon, estimated to be from 1/30,000 to 1/100,000. Primary Care Physicians could expect to pass their entire careers without being asked to care for a single gender dysphoric patient. As the condition was so exceedingly rare the standard of care was to refer all gender dysphoric patients to a psychiatrist. The statistics I was taught, and which were unquestionably accepted, declared that 85% of adolescents with gender dysphoria, if left alone, would eventually identify with the sex they were assigned at birth.

When I went to review the current guidelines on the subject, I discovered that everything had changed, and had changed over a very short period of time. In a Pew survey conducted in 2022, 1.6% of adults and 2% of people under the age of 30 identified as transgender. If we add in those who consider themselves “non-binary”, the incidence increases to 5%. To put it another way, the incidence of gender dysphoria has increased by a factor of somewhere between 60,000% to 500,000%. My personal experience reflects this. From the day I started practice in 1993 until 2020, I did not encounter a single transgender individual. Since then, I have encountered 4 transgender patients in my practice and 2 within my own family.

When I read these numbers, a single question jumped to the front of my brain. “What happened?”

If the incidence of any other condition of disease had increased by such an amount an epidemic would have been declared and millions of dollars spent searching out the cause. When I read the available medical data on the subject, I discovered the world of academic medicine was remarkably uninterested in explaining or understanding the reasons for the dramatic change. Every article I found simply declared transgenderism as “normal” and something to be affirmed in every patient.

Given the lack of scientific evidence to support the medical establishment’s recommendations about gender dysphoria and my understanding of the mental and emotional history of the 14-year-old girl I was about to see, I did not feel comfortable affirming her new identity. I knew she battled depression and struggled in school, I knew she was the child of divorce, and I knew her parents loathed each other. It seemed to me she was struggling with a multitude of issues in her life and had somehow mistakenly decided her gender was the root of her problems.

While I had read the guidelines calling for “gender affirming care” for young people in such circumstances, the lack of serious investigation into the trans epidemic led me to question the wisdom of affirming her declaration of maleness. While I knew “experts” in the field often called for name and pronoun changes, puberty blockers, testosterone injections, breast binders and even mastectomies, I was worried these things would result in irreversible changes. I was also aware of the consequences I could face if I didn’t use her new pronouns and support her new identity. I had read about doctors and mental health practitioners who had their reputations destroyed on social media and review platforms such as Yelp for “misgendering” or “deadnaming” a patient. There was so much at stake.

When the day of her appointment with me arrived I was nervous, and I entered the exam room with a significant amount fear and trepidation, as I was taking an approach that would place me at neither end of the gender ideology spectrum. Instead of challenging her sexual identity and saying she was mistaken or affirming her identity and working to help her mother accept it, I would encourage her to work on other aspects of her life before addressing such a momentous issue.

I encouraged her to consider how difficult it was for any parent to process a child’s new gender identity and encouraged her to give her mother grace and as she worked through feelings. Her mom would almost certainly use female proteins and the name she had been given at birth, and not necessarily because her mom was not supportive of her feelings.

As there were very few treatments she could pursue without her mother’s support, I encouraged her to work with a therapist to become as emotionally healthy as she could. “Your parents will be much more likely to support your thoughts and feelings when they know you are coming from a healthy place,” I told her. I suggested she work on her depression, on being a better friend and daughter, and doing better in her schoolwork. “You will be a better, happier person by working on these things, regardless of your gender identity,” I said.

I don’t know if it was because of the therapeutic relationship I had achieved over the years, the simple truth in my words, or the fact I did not argue with her about her gender identity or try to talk her out of it, (I told her several times I was not questioning the validity of her feelings in any way), but she accepted my recommendations readily.

A year passed before I received an update on how she was doing, though I thought of her often. Her mother came to see me for an unrelated issue and doing the visit joyfully told me, “You will never guess what happened. Last weak Suzy came to me and said, ‘Mom I was so stupid last year. I’m not a boy.’ Can you believe it?”

After the mother left the office, I found myself wondering how the outcome might have been different if her daughter had seen a different provider, a doctor who has accepted the new recommendations on how to treat children who present with gender dysphoria without pausing to critically assess the shaky foundation on which these recommendations have been build.

Finally, I grieve over the failure of my profession to stand against the tide of political opinion and protect children, especially young women, against what has become an assault on womanhood. This attack takes many forms, from television shows and movies that deny basic biology, to misled educators who seek to teach our children to question that which is normal and accept that which is not, to massive corporations and retailers who propagate falsehoods about gender in the pursuit of profits.

As a Family Physician who cares for families, this issue has been heavy on my heart for a long time. I have resisted the urge to write about it for fear my words could be misconstrued or taken out of context. After reading about recent controversy with Target marketing trans clothing to young children, I decided to write this post from a very personal perspective. I am motivated by a simple question. If Family Doctors to not speak out in defense of our children, who will?

Bart

PS: There a few sources I have found quite helpful-

Irreversible Damage, by Abigail Shrier

When Harry Became Sally, by Ryan Anderson

Easter: Yes or No?

Easter is a big deal to me. As our kids have grown and gotten married and with the loss of my mother-in-law, family Easter lunches have faded away (a source of annual sadness), but the importance of the day remains. I do not exaggerate when I say that almost everything I hope for, every aspiration for which I strive, and even the values that guide my practice, have the meaning of Easter as their source.

While I was walking my dogs this morning before church, I found myself reflecting on the holiday and wondering how I could communicate Easter’s significance to my friends who do not share my faith. Most non-Christians are at least marginally aware of Easter’ standing as a religious holiday, and I suspect the majority have heard someone say it is the day Christians celebrate the resurrection of Jesus. Despite this passing knowledge, it has been my experience that the essentialness of the day escapes them. (It has been my experience that the essentialness of the day is lost upon many who profess the Christian faith as well.)

The first observation to enter my mind was that Easter is the only “Yes or No” holiday. I say this because the central claim of Easter, that two thousand years ago a man named Jesus was executed and then rose from the dead, is one that people either believe or reject. They either respond to the resurrection claims by saying, “Yes, he did” or “No, he didn’t.” (I am sure there are some who might say “I don’t know if that is true,” but in my experience these folks are usually leaning one way or the other.)

The implications of the Easter claim that Jesus rose from the dead are profound. If he did, he is unlike all other prophets or religious teachers. He becomes more than just a man, he becomes the Son of God. (One could say that the resurrection is in itself an argument for the existence of God). The Apostle Paul, in his letter to Roman Christians wrote that Jesus was “declared to be the Son of God in power… by his resurrection from the dead. To put it another way, if Jesus rose from the dead, all of his teachings and assertions are proven true and we would be fools if we did not follow them.

If Easter’s claim is false, it is profoundly important in another way. If Jesus is still dead, every Christian religion is a waste of time. Every dollar spent on the church, bibles, missionaries, and seminary training is a dollar wasted. Every minute spent on prayer, bible study and church attendance is a waste of time. If he is not risen, there is nothing special about Jesus’ teachings, and he was nothing more than a mentally ill man with grandiose claims. The Apostle Paul understood this, in one of his letters writing, “if Christ has not been raised, your faith is worthless.”

I was in my early twenties when I first recognized the importance of being able to answer questions about the resurrection. Though I had heard and read the gospel accounts dozens of times, I had never explored the available historical evidence. I was a little trepidatious at the outset and wondered what I would do if I found the evidence lacking! To my great relief, what I learned strengthened my faith and deepened my commitment. I feel confident each Easter when I say, “He is risen, indeed!”

I know this post is not very entertaining and some may consider it too preachy, but it is Easter! These were the thoughts going through my mind this morning and I thought I would share them. If you are interested in reading about the historical arguments in support of the resurrection, you will find links to articles at the bottom of this post.

Bart

One final note to my patients who read this-

My commitment to loving and serving each and every person who walks through my door is based on my faith, not yours. There never has been, nor will there ever be, a time when my faith prevents me from giving you my best!

Bart

references:

https://www.desiringgod.org/articles/historical-evidence-for-the-resurrection

https://www.amazon.com/Son-Rises-Historical-Evidence-Resurrection/dp/1579104649

https://www.christianitytoday.com/ct/2020/april-web-only/justin-bass-bedrock-christianity-resurrection-appearances.html

https://ca.thegospelcoalition.org/article/10-concise-pieces-of-evidence-for-the-resurrection/

Falling in Love with Tennessee

He was the salesman from whom I ordered all the medical supplies for my office, the only medical supply salesman I ever did business with. Our relationship was purely business related at the start, with our conversations centered on the products he sold and I used and our only non-business remarks limited to the occasional, “How’s your family?” and “Just fine, thank you.”

He came by the office every few months to check in, and as our conversations were limited I did not know him well. I knew he was from Tennessee, primarily because he gifted me salt water taffy from Gatlinburg each Christmas and spoke with an accent. I knew he was a man of faith because of conversations around the holidays, and I knew he was honest and reliable, which is one of the reasons I continued our business relationship.

Our relationship changed a few years after I moved my practice into its current home in a converted home on Beach Blvd. He dropped by the office one day for a sales call just as I was finishing up my work for the morning. We exchanged greetings, and I then surprised him by asking if I could buy him lunch. He laughed and said it was the first time a doctor had ever offered to buy him anything, but he readily accepted. That lunch was the beginning of our close friendship. We went out to lunch nearly every other month, trading responsibility for the check each time. It wasn’t too long after that first lunch that he invited me to stay at his cabin in the Smoky Mountains.

“We gotta get you y’all out to the cabin. You need to go to Tennessee. Y’all will love it,” He would tell me, repeating the invitation almost every time I saw him. I conveyed the invitation to my wife, and Lisa responded in the fashion I have come to realize is typical for people from Southern California.

“Why would we want to go to Tennessee? What would we do there?” she said.

After a few years of politely declining his invitations, in 2007 I told Lisa we might as well go, as Jim’s vacation cabin was near the national park and the lodging would be his treat. Our first trip to Tennessee was in June of that year and we enjoyed it so much we traded our timeshare week and went back the following summer. We loved the beauty of the park and the frequent wildlife sightings (especially black bears!), our visits to Dollywood, and the kindness of the people. We loved the ability to create a different vacation each morning, choosing whether we want to spend the day exploring nature, floating down a river, visiting a historical site, going to a theme park, or sitting on the porch. A surprising highlight of our second trip was a visit to a cemetery in Maryville (pronounced Mare-ville, as if there is no “y”). Lisa had begun doing genealogy, and to her surprise discovered she had ancestors from the region, some of whom had been buried just 45 minutes away. There was something incredibly moving about standing on the exact spot your ancestors had stood generations earlier.

We told ourselves we would return to the area soon, but life got in the way. Our son started college and became engaged, then got married in 2012, and family vacations became harder to organize and pull off. The one thing that didn’t change was Jim, who continued to invite us to return. When he retired in 2017, I told Lisa I wanted to return to the Smokies, in no small part because it meant I would be able to visit my friend, who had moved back to the area in which he had grown up. Jim had often raved about the beauty of the Smokies in autumn, so we booked a trip for October 2018 so we could see the fall colors.

That year was an incredibly stressful one for me, as I had become the chairman of the ethics committee at Hoag Hospital and as a result was responsible for performing every end-of-life consult. When October rolled around I was physically, emotionally, and spiritually drained. That week in Tennessee restored my soul. Not only were the colorful leaves spectacular, Dollywood was hosting a southern gospel music festival! All over the park, from open to close, Christian artists were singing songs of the faith. At the end of the week I told Lisa, “This is the most healing, restorative vacation of my life. I want to come back here every year at this time!”

When we got back to the cabin that night I started looking on Zillow, curious to see how much a vacation cabin would cost. I talked to Jim and learned how much rental income he was able to generate on VRBO. Lisa and I talked about it, and it seemed like it might be a worthwhile investment. Even if we didn’t turn much of a profit there was a pretty good chance we could cover the costs of upkeep and maintenance. In addition, though it was a sad and morbid thought, I knew Lisa’s mother, who was on hospice at the time, would likely leave her an inheritance that could help pay for a cabin.

We signed on with a realtor soon thereafter, and began reviewing cabin listings in earnest. When we saw one that seemed promising the realtor would visit the property and take us on a video tour. I limited my search to properties of at least two bedrooms, hoping to find a place large enough for our whole family to be able to visit together. Two weeks before Christmas I accidentally stumbled across a cabin that seemed perfect. Although it was over 2200 square feet, it was listed as a one bedroom! I had forgotten to limit the search to 2 BR or more, and it popped up right away. I was so excited I woke Lisa up to tell her about it. (She did not share my excitement at that moment!) I flew out to Tennessee the following week for a one-day trip, and after seeing the property and taking Lisa on a Facetime tour of it, we made an offer. When I landed back home in Orange County, I learned our offer had been accepted. Escrow closed in January, three days after my mother-in-law passed away. Lisa and I often say, “Mom bought the cabin for us.”

The cabin has been my place of refuge ever since, in ways I never could have imagined. A year after buying the cabin I came down with a painful nerve disease that beats me down on a daily basis. Our cabin in the Smokies is a place where I can rest, a place where the beauty of God’s creation restores my soul and gives me the strength I need to go on.

The cabin has been an unexpected blessing in other ways as well. Two of Lisa’s adult nieces and one of her cousins have fallen in love with the Smokies as well, staying at the cabin her mother bought for us. The cabin has forged a bond between us and kept us connected in ways we know would make mom happy.