Scum of the World

I could hear the cussing from inside the room and noted the awkward glances of nearby nurses and staff who turned to look and gawk. Even though I only sat a few feet outside the door, I ignored the increasingly loud litany of expletives and deliberately focused on the screen in front of me. He was my patient and I was doing my best to concentrate on his rapidly evolving list of medical problems, the electronic progress note already ballooning in front of me as I tried to prioritize multiple terminal conditions competing for attention. I scrolled through pages of old notes that were littered with repeating instances of phrases such as “lost to follow up,” “did not comply with therapy,” “uncooperative,” and the ever favored, “signed out against medical advice.” I paused and watched as a freshly berated specialist walked out of the room, sat down at a nearby computer, and dictated into his own note the word “belligerent.” The diction snob inside me was pleasantly surprised to hear a new and applicable word and so I inserted it into my note as well.

Last week my pastor asked me, “How do you keep from becoming cynical?” The question caught me off guard; it occurred in the context of a series of conversations on the struggles of caring for people in both spiritual as well as physical matters. My reply was somewhat flippant as I didn’t have a good response. The question was unintentionally pointed; Pastor Tom is a quick-witted man and one of the many reasons why I respect him so much is that even though he appreciates a dry and sardonic sense of humor, he intentionally suppresses it. By contrast, I relish in lengthy conversations about all things dark and cynical. In college I would rant about the evils of systems of poverty, child slave labor, sex trafficking. Nowadays I rant about urban violence, health disparities, child abuse, racism, Donald Trump. I am not shy about these views and justify vocalizing them as a mechanism for challenging injustice, but the genuine and curious nature of Pastor Tom’s question left me unexpectedly exposed to scrutiny. After all, what is justice and how does that apply in medicine? What is the root of cynicism and why are criticism and sarcasm so satisfying?

Continue reading “Scum of the World”

Scum of the World

Part 2: On Hope

After a brutal series of Christmas shifts in the ER, I had finally come home for the holidays. My mother and I were in the kitchen, talking like we used to. We had seen and loved the new Les Miserables film, and so I brought up an interesting question from an interview with Samantha Barks, who played Eponine:

Interviewer: I think aside from “I Dreamed a Dream”, “On My Own” is probably one of the most loved songs of the musical, and I think it’s fascinating that the two most recognized and loved are just the two most heartbreaking songs, so what does it say about us as an audience that the songs that we connect with are the most heartbreaking songs?

My mother was quiet as she thought about it. “I think,” she said, “that it is something we all share in common. We all suffer, and know what it means to lose a dream or to be disappointed. We all know how it feels.”

In those moments, I was reminded of how much of her life and our family history was filled with a tragedy not too different from that of Les Miserables. Half of our family tree was missing or unknown, scattered and wiped out during the Communist revolution in China. My grandparents’ histories were characterized by their flight from the war: watching massacres of schoolmates while hiding in the bushes, stepping on dead bodies to avoid landmines, being trafficked via hay carts and ships in order to seek refuge in Taiwan. My parents grew up in the grinding poverty of the rural villages there, their childhood overshadowed by the threat of imminent war, their education grimly driven by the hope of an opportunity to emigrate to the US so that they could form a family here… so that their future children — meaning I — could have a better life.

Without knowing my thoughts, my mother spoke again. “I really like that song from the carriage… where he has the little girl sleeping in his lap and realizes that everything is different now he has a child.” She paused. “You know, everything is different when there is a child. Your whole world changes.” Suddenly, I remembered a day from medical school that struck me the same way:

She wouldn’t stop crying, so I picked her up before realizing that the diaper was wet. The sun was setting and the room was dim and quiet, disturbed only by the peripheral noises of the hospital hallway and the sound of her distress. I gingerly held her up, setting her flat on the bed, and watched her arms wave from side to side as I puzzled over how to change my first diaper.

“Hey,” I whispered. “Stop crying.” She didn’t listen and I spent a few moments fumbling with the pacifier before sitting down in the rocking chair, swinging back and forth easily with the infant cradled in my arms. A plastic music box hanging on the edge of the crib’s stainless-steel safety bars began playing a lullaby. We rocked and swayed, rustling quietly in the dusky shadows of twilight. It was as if the hospital, that crazy world of light and noise and pain and angst, had rumbled off into the distance and lazily forgot to bother us for now.

… I couldn’t recall the details, save the small fact that we were now responsible for her. We, meaning the hospital and the State of New Jersey, who were granted temporary custody as the parents were “currently indisposed of for the time being.” I thought about all the other rooms on the pediatric floor, each of which held two beds: one for the patient and one for the caretaker. Each room had its own guardian: an anxious mother or grandparent or cousin or other relative. Each room except this one.

I remembered the words of a nurse who stood by the bed at rounds, updating us on the baby’s condition. “She’s doing well,” the nurse reported, thoroughly distracted by the baby. The team continued talking about the details of custody and social work while the nurse remained preoccupied. She cooed at the baby. “Hey,” she said quietly, gently caressing the swaddling clothes: “It’s going to be a tough world out there.”

… And so we rocked, back and forth, and I thought and thought. Did she know how alone she was? What kind of person would she become? Who would rise up to defend her weakness, her frailty and vulnerability? If she met me in ten, twenty, thirty years from now, would she still let me hold her in my arms? Why couldn’t I adopt her? How different will it be on the day I hold my own child? Unfamiliar feelings of affection, of unknown protection and helplessness swilled around inside of me, centered but unfocused on this loose bundle of warmed clothing and weak, spastic movements. I didn’t know how to feel or how to respond. I still don’t.

I couldn’t wait to write this stuff down, mainly because I didn’t know what to do with all these ambiguous thoughts. I only held her for a few minutes and yet it’s taken me two days to articulate what I’ve been feeling. Who will love her? Who will dream good dreams for her at night? Who will give her the first cherry ice pop, the first kiss on her scraped knee? Who will keep her safe in this world of terrors?


“I have had this all my life, and I am going to get wid of it!”

“Rid of it,” her therapist corrected.

“W-right.” She turned her head to grin at us, and I couldn’t stop smiling. We were all lying on exercise mats in the therapy rooms because, as the therapist taught us, we could use “gwavity” to help roll those “r’s” better. I was sure she was one of the therapist’s favorite patients: diligent, focused, and with a personality composed entirely of laughter and light. In less than fifteen minutes, through listening to her “chawming pwonun-sheation,” I had already named her as a favorite. Few of my little patients were as mature, knowledgeable, and thrillingly articulate at the dignified age of seven.

And in that moment, I thought about the Newtown massacre and the fact that there must have been precious little difference between any of those children and this young girl who was now sprinkling glitter on a craft snowman, that even the best and brightest of us still live in that same world of terrors.


My mother spoke again. “My favorite song is that one Jean Valjean prays, about bringing him home… it is such a beautiful prayer. He says, ‘You can take, you can give… If I die, let me die; let him live… bring him home.’”

We talked some more, then she said this: “Life is filled with such suffering, you know. There is so much sorrow… but there are moments when God saves.”

That night, I went to my old bedroom and pulled a stack of journals off the bookcase. They were etched on eight, nine, ten years ago with an illegible scrawl that reflected the tired and stress-filled times they were written in. I leafed through the many yellowed pages of thought-scratch, reliving those moments of anxiety and worry. So many of them were desperate calls to God about things I no longer remember now, reflecting crisis after crisis that seem trivial and inconsequential now. I wanted to laugh at the little boy, his deep insecurities and obsession with doubt and suffering, and say, “You haven’t seen anything yet.”

But I didn’t because I realized that even I, the same boy a decade later, am still immersed in my own world of sorrows, conflicts, despair, and cynicism. In the New Year, like every year, we are hopeful that the old wounds of our past will heal, that we can assume a new and a fresh start, that the world will be a better and brighter place… if not for us, then at least for our children, the icons of innocence and hope. But this belies the experiences of our own sordid history as humanity and as individual humans. Is our redemption progressive? Does anything ever change? Are our cries for salvation heard?

Henri Nouwen writes about this in his last book, Can You Drink the Cup?, scripted during his final years as minister at l’Arche Daybreak, a community of those with intellectual disabilities:

There is Tracy, completely paralyzed, but with a bright mind, always struggling to find ways to express her feelings and thoughts. There is Susanne, not only mentally disabled but also regularly battered by inner voices that she cannot control. There is Loretta, whose disability causes her to feel unwanted by family and friends and whose search for affection and affirmation throws her into moments of deep despair and depression. There are David, Francis, Patrick, Janice, Carol, Gordie, George, Patsy… each of them with a cup full of sorrow…

And for me things are not very different. After ten years of living with people with mental disabilities and their assistants, I have become deeply aware of my own sorrow-filled heart. There was a time when I said: “Next year I will finally have it together,” or “When I grow more mature these moments of inner darkness will go,” or “Age will diminish my emotional needs.” But now I know that my sorrows are mine and will not leave me. In fact I know they are very old and very deep sorrows, and that no amount of positive thinking or optimism will make them less. The adolescent struggle to find someone to love me is still there; unfulfilled needs for affirmation as a young adult remain alive in me. The deaths of my mother and many family members and friends during my later years cause me continual grief. Beyond all that, I experience deep sorrow that I have not become who I wanted to be, and that the God to whom I have prayed so much has not given me what I have most desired…

Whose cup is this? It is our cup, the cup of human suffering. For each of us our sorrows are deeply personal. For all of us our sorrows, too, are universal… Jesus, the man of sorrows, and we, the people of sorrow, hang there between heaven and earth, crying out, “God, our God, why have you forsaken us?”…

In his immense loneliness, he fell on his face and cried out: “My Father, if it is possible, let this cup pass me by” (Matthew 26:39). Jesus couldn’t face it. Too much pain to hold, too much suffering to embrace, too much agony to live through. He didn’t feel he could drink that cup filled to the brim with sorrows.

Why then could he still say yes? I can’t fully answer that question, except to say that beyond all the abandonment experienced in body and mind Jesus still had a spiritual bond with the one he called Abba. He possessed a trust beyond betrayal, a surrender beyond despair, a love beyond all fears. This intimacy beyond all human intimacies made it possible for Jesus to allow the request to let the cup pass him by become a prayer directed to the one who had called him “My Beloved.” Notwithstanding his anguish, that bond of love had not been broken. It couldn’t be felt in the body, nor thought through in the mind. But it was there, beyond all feelings and thoughts, and it maintained the communion underneath all disruptions. It was that spiritual sinew, that intimate communion with his Father, that made him hold on to the cup and pray: “My Father, let it be as you, not I, would have it” (Matthew 26:39).

Jesus didn’t throw the cup away in despair. No, he kept it in his hands, willing to drink it to the dregs. This was not a show of willpower, staunch determination, or great heroism. This was a deep spiritual yes to Abba, the lover of his wounded heart…

Our culture tends towards an inflexible sense of optimism and humanism. We are convinced that true joy and human actualization must come through the eradication of pain, suffering, and sorrow. It comes as little surprise then that we hide away the sick and suffering in hospitals and mental institutions and ghettoes, or that conversations about suffering are branded as cynical and faux pas (unless they revolve around the trivial). It is only logical that our perspective on hope is sentimental and, when brutally challenged by events like Newtown or other corruptions of innocence, easily susceptible to cynicism and despair.

In the person of Jesus Christ, whose entrance into the world was humble and threatened by scandal and violence, we are reminded that hope must be divine. It must derive itself from the external, the invisible, and the eternal if it is to pose any help to our intractable, superficial, and fickle humanity. It cannot be the mere absence or abolition of suffering; it must engage it, overcome it, transform it. It does not begin from a position of strength or intimidation; it starts with weakness so that it might express itself in desire and, through satisfaction, bring joy. It has no grounding in idealism, theory, or abstraction; it instead comes from the closeness, the sweetness, and the affection of Jesus Christ, the incarnation of all we hope for and desire.

It is this recognition of Christ’s presence in the hardness of life that brings us liberty and enables us to hope freely and challenge the darkness of cynicism, unburdened by the restrictions of sentimentality and its incongruity with reality. We can live and thrive in the darkest corners of the hospitals, nursing homes, mental institutions, funeral homes, labor camps, and ghettoes simply because Jesus says he lives and thrives there as well.

“Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.

“Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you?  When did we see you sick or in prison and go to visit you?’

“The King will reply, ‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.’” — Jesus (Matthew 25)

For you did not receive a spirit that makes you a slave again to fear, but you received the Spirit of sonship. And by him we cry, “Abba, Father.”  The Spirit himself testifies with our spirit that we are God’s children.  Now if we are children, then we are heirs—heirs of God and co-heirs with Christ, if indeed we share in his sufferings in order that we may also share in his glory. — Romans 8

I want to know Christ and the power of his resurrection and the fellowship of sharing in his sufferings, becoming like him in his death, and so, somehow, to attain to the resurrection from the dead. — Philippians 3

Genocide, massacre, poverty, disappointment, crucifixion, famine, nakedness, death, or sword; together with Christ, with the fellowship of suffering and the drinking of its cup to its dregs, we shall have our overcoming. Somehow, we shall attain.

Happy New Year.

Part 2: On Hope

Part 1: On Cynicism

I originally wrote the following passage for a Good Friday reflection in 2007, unknowingly done one week before the Virginia Tech shooting. The intent in re-posting here is not to lessen the tragedy of what has just occurred in Connecticut, but to speak truth about how little has changed five years later. Kyrie eleison.

The statistic is that roughly 18,000 children die each day from hunger and malnutrition alone. This does not include those who die from preventable diseases like rotavirus (which causes severe diarrhea and kills approximately 600,000 children a year even though it is vaccinatable, preventable, and treatable) and cholera, or the treatable ones like malaria, tuberculosis, and HIV. This does not include the children who are caught in the genocide of Sudan, or the vicious military crossfire of civil conflicts as in Iraq and Afghanistan, or those whose limbs have been blown off by landmines designed to look like toys, or those who have been conscripted into military service in Uganda or the Congo. It does not include those who are pressed into the sex trafficking industry, like the 100,000 or so children in Cambodia. It does not include those who die alone, cold, and friendless in the streets of Calcutta or New York City or those who are shot to death in the gang fights of Newark. It does not include the upper-middle class teenager or celebrity that died from a drug overdose or drunk driving or any other death we might consider as a tragic consequence of wealth.

Some people have called me cynical for saying these things. They say that I am being bitter or despondent or a sourpuss and that it’s just “not natural” to look at the world that way. But the frightening truth is that it is natural because it gives us a piercingly accurate look at our human nature… perhaps more accurate than we would like to admit.

Cynicism has an interesting origin. It came from a group of Greek philosophers whose purpose in life was the pursuit of virtue. They took their calling so seriously that the ancient cynics neglected personal hygiene and scorned the norms of society, often congregating in the streets to insult and condemn those who were pretentious, self-important, materialistic, or evil. One ancient cynic described himself in this way: “I am Diogenes the dog: I nuzzle the kind, bark at the greedy, and bite scoundrels.”

We live in a society that is so cynical that it has become a form of entertainment. Stephen Colbert’s deadpan comedic style won him four Emmys. The television shows South Park and The Family Guy continue on air despite their numerous offensive vulgarities because of the huge audience demand for their acidic wit and social commentary. Modern cynics have exchanged the pursuit of virtue and bad personal hygiene for something a little more practical: biting sarcasm, an unshakeable belief in human selfishness, and a tired frustration with our collective inability to change.

When I was in college, a friend of mine started a humanitarian organization that dealt with a lot of the darker issues of poverty and war that I mentioned earlier. One day we decided to show a documentary on the genocide in Sudan in the student campus center. We reserved the main television and when I arrived to plug in the tape, I was relieved to see that the only thing people were watching were a few clips on SportsCenter from the previous night’s games. But when I changed the channel and announced what we were showing, a student angrily got up and stormed off, saying, “Who cares about all this stuff? This stuff happens all the time!” He did not use the word “stuff.”

And he was right. This stuff happens all the time, and our media saturated society is sick of hearing about it. We are tired of counting bodies in Iraq. We are tired of CIA leaks and government scandals. We are tired of empty campaign promises and embezzled funds. We are tired of FEMA and mismanaged bureaucracy in the Gulf Coast. We are tired of hurricanes and earthquakes and falling stock market prices. We are tired of HIV, AIDSTB, and other acronymed diseases. We are tired of starving children and anorexic celebrities. We are tired of school shootings and inner city crime. We are tired of debating evolution in schools and abortion in the courts. We are tired of HMOs and insurance companies and a broken healthcare system. We are tired of divorces in our homes and grappling for grades in our schools. We are tired of griping bosses and sniping co-workers. We are tired of searching for someone who will like us for who we are and not who we pretend to be. We are tired of hypocrisy and judgment in the church from whom we had expected to receive grace. We are tired of the disappointments that happen all the time.

What option is there left for us? We aren’t revolutionaries; we know the world too well to expect it to change. We aren’t saints; we know ourselves too well to expect change there either. The only truth we are sure of is a humanity and an identity that is so disgustingly and predictably selfish that we might as well poke fun at it. We’ll do anything except hope for change, because hope requires vulnerability. Hope demands that we have an expectation that can be disappointed and unfulfilled. Hope means that we must be certain of something we cannot see, that we must trust in something we do not understand.

This is a frightening prospect for a cynic.

This is a frightening prospect for me.

I would much rather describe the world than have hope for it. There is nothing to fear from a description: nothing to be surprised or disappointed by. And so I will stand here and tell you that 18,000 children die each day from hunger, that you can’t trust anyone else or even yourself which means that you certainly should never trust a politician, that you can’t get something for nothing, that you can’t find a good church or even good people these days, that justice is a joke and peace is a sham, that everything is broken, and that nothing is sacred or perfect or even mildly decent.

As a cynic, I can tell you what the world is, but I cannot tell you what to do with it.

Again, I do not say these things to lessen the tragedy of what occurred in Connecticut. What I mean to say is that we are very good at overestimating our capacity for human empathy, kindness, and sorrow. We are very good at the self-pacification of conscience, at seeking out the path of least resistance required to change. We will pat each other on the back and say, “What a cruel world! What can be done in the face of so much evil?” We will congratulate ourselves on feeling sufficiently badly after expressing what we believe to be a fair and credible amount of grief. Once we have done this enough, have made significant acts of penance and efforts towards change, and are satisfied with their futility, we will move on and say, in the words of K. Vonnegut’s Tralfamadorians, “So it goes.”

It is tempting to offer consolation and imagine that we are better people, stronger people now. We desperately want something to hope for as we look forward to the cathartic ending that Hollywood promises: that the triumph of the human spirit or engineered systems or political goodwill shall redeem an otherwise pessimistic view of our human nature. But these proposals offer no answer as to why 18,000 children die daily from hunger, a malady with no bullet to blame or act of malice to fault.

There are two fears we are driven by, and what the cynic rightfully does is challenge our collective fear of truth. We lack the will — politically, socially, economically, personally — to pursue justice and to stare at the face of hard questions in order to ask why certain things are a certain way. Why does God permit evil? Why do we permit evil? What is the moral justification to use violence to restrain violence? Why are we so bent on self-preservation that we are so permissive towards injury to the other? Why do we cry over the slaughter of innocents in a school yet shrug in hardened indifference when shootings take place on my street corner here in the inner city? Or in Syria? Or when they starve to death in North Korea? Why, when the topic of abortion arises, do we roll our eyes and say, “Not this tired old argument again”?

What we fear most is the revelation that we are not as compassionate as we think. We do not believe children or life to be as sacred as we proclaim, and that is the truth we are most afraid of. As a physician, as a pediatrician, I see this every day. In the name of “quality of life”, we not only permit but encourage the abortion of children. Pregnancy for “those poor mothers, those teenage girls” is no longer something to be supported or even celebrated, but has deteriorated into becoming just another sexually transmitted disease… one that can be “treated”. But we will not do the hard thing, which is to speak out against the sexual flexibility of a culture that persistently prepares these young girls as prey in dress, action, and relational expectations. We will not speak against the industries that enslave our young men to pornography, to drug and alcohol addiction, to gang violence, to video games, or even to childhood obesity! We will not speak against the things that are unhealthy because we are not willing to sacrifice the freedom to love and indulge in our vices.

Even in writing this, I struggle with understanding my own voice and position. Am I being too generic? Am I being too conservatively minded? Am I being too “political”? Or am I being too silent? Too self-satisfied? Too smug and proud? As a cynic, I end in a place of paralysis because of my second fear: the fear of hope. But that is a discussion for a later time. For now, we look to Christ, in whom there is the absolution of all things. Kyrie eleison.

Who shall separate us from the love of Christ? Shall tribulation, or distress, or persecution, or famine, or nakedness, or danger, or sword?  As it is written,

“For your sake we are being killed all the day long;
 we are regarded as sheep to be slaughtered.”

No, in all these things we are more than conquerors through him who loved us. For I am sure that neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord. — Romans 8

Part 1: On Cynicism