God's Economy in Medicine
When he arrived at the other side in the region of the Gerasenes, two demon-possessed men were coming from the tomb: to meet him. They were so violent that no one would pass that way. “What do you want with us, Son of God? they shouted. Have you come here to torture us before the appointed time?”
He said to them, “GO!” So they came out and went into the pigs, and the whole herd rushed down the steep bank into the lake and died in the water. Those tending the pigs ran off, went into the town and reported all this, including what had happened to the demon-possessed men. Then the whole town went out to meet fesus. And when they saw him, they pleaded with him to leave their region.
Jesus is the one who gives us value as people. He is the one who calls us to himself. He is the one who loves us when we are still sinners. He is the one who came to make himself nothing on our behalf, and then to die as well. Because Jesus has infinite value - as God - his sacrifice for us (in which we are identified through baptism) gives us value. Jesus is the shepherd who leaves the 99 sheep to search for the one who is lost - because that one lost sheep is valuable.
This account in Matthew is about value. Those two demon-possessed men were of great value to Jesus. Did he know when he set out that they were there, on the other side of the Lake? Certainly. Could he have chosen to journey to his destination via another route? Certainly. Did Jesus choose to pass that way so that he would meet them and have an opportunity to heal them? Probably. (I am of the firm belief that what appear to be distractions or coincidences in Jesus’ ministry were instead close to the core of his ministry: the bleeding woman, the death of Lazarus. the woman at the well, the thief hanging on the cross next to him.) I believe that these two demon-possessed men were of great value to Jesus, that they - as much as I - were the reason he came to earth, that he desires them in heaven eternally with him because he loves them. This is not the economy of our world.
What does the economy of this world look like? This world values people based on their money, their potential, their physical beauty, their accomplishments, and the power they hold. Our world—and our society, in particular—values Donald Trump, multimillionaire; Kobe Bryant, basketball Star; George Bush, former President of the United States; Jennifer Lopez, movie star and singer. In the medical world, we also honor those who have made “significant contributions” to the advancement of science: Jonas Salk, who invented the oral polio vaccine; Janet Rowling, who discovered the Philadelphia chromosome; Warson, Crick and Franklin, who discovered the double helix. We honor the department heads, the deans, the workaholic doctors who have a paper published each month and grind Ph.D.s through their labs.
In this world’s economy, two demon-possessed men who were “so violent that no one could pass that way, were worth very little. People like these are all around us: the schizophrenic veteran on Haldol to control his violent behavior; the woman who had post-partum psychosis and lost custody of her three children because she tried to drown them; the foster child who bounces from family to family because he persists in fighting and starting fires. I saw several of them in my clinic this very week: the forty-eight year old woman addicted to codeine who came in demanding Demerol for pain; the Mexican immigrant who has no insurance and who can no longer work because his diabetes has cost him his eyesight; the woman abused by her husband for so long she hasn’t the will to leave and comes in only when she needs stitches.
So let’s talk money for a minute: what is a herd of pigs worth? I have it on good authority from a Kansas hog farmer that right now, hogs are high. He said a herd of hogs is anywhere from about 150 to 1000 hogs. (The Mark 5 account of this healing puts the herd size at 2000.) Minus the 10-15% of the herd that is held back for breeding next year’s herd, those that are sold can go for $32,000 (for 150) up to about $400,000 (for 2000.) Add in the future value of that 10—15% lost to breed future herds, and you have a significant loss—plus all the feed, land, and labor that went into caring for those hogs. You can buy a top-notch, private medical education—plus student loan interest—for the price of a medium-sized herd of pigs.
So there was Jesus, seemingly “just passing by,” when he was accosted by two violent men possessed by demons. Does he run away? Does he zap those two worthless men with his magic, powerful God—finger and turn them into dust (or at least stun them until he can get by, unnoticed?) Does he have his nurse or front-desk tell them he can’t see them today, could they please schedule an appointment for a week from Thursday or actually, he doesn't take uninsured patients?
No. Jesus healed the men. Not only did he heal them, but he demonstrated concretely to their community exactly how much they were worth to him - or perhaps, what was their minimum value, since then the Lamb of God also went to slaughter for them. Those two demon-possessed men - unemployed, homeless, abandoned (and probably uninsured) - were worth as much as a medical education, or the average US orthopedic surgeon’s annual income. No wonder those people were upset. No wonder they pleaded with Jesus to leave their region.
What does this mean to us: physicians, soon-to-be physicians, and our families? Most of us go into medicine “to help people.” But if we are honest with ourselves, we also are people who crave work that makes us important and gives us prestige. None of us can deny that we see the financial security offered We may not be trying to “get rich,” but if we are honest with ourselves, we will realize that we already are.
Yet each of the people you encounter is worth more than you can imagine. Each one is a precious lamb whom Jesus will go out to bring home, through you if you will go. And each one is worth everything you have - he is worth your entire education, she is worth a year (or several years) of your future salary... and you, as the lowliest medical student or the biggest of big-shot attendings, are no more (or less) valuable than the most repulsive, pathetic patient you can imagine.
How can this be so? Or - how can we believe and live as though we believe - this is so? First, this is not a battle to fight. The only way to learn this lesson is through prayer. Hear the word of the Lord from Romans 12:1-2:
I appeal to you therefore, brothers and sisters, by the mercies of God, to present your bodies as a living sacrifice, holy and acceptable to God, which is your spiritual worship. Do not be conformed to this world, but he transformed by the renewing of your minds, so that you may discern what is the will of God - what is good and acceptable and perfect.
We are so shaped and molded by the economy of this world that we often cannot even see those whom God is calling us to honor. Is it the unit clerk on the general medicine floor, or the scrub tech on L&D? Is it our children and spouses, who never see us because we are working 80 to 100 hours a week, and when we are home, we are exhausted, grumpy, or studying? Is it the depressed guy across the hall you dread talking to because he goes on and on?
Don't get me wrong. I do not have it all figured out. But I am here to testify that as continue to pray that he will transform me by the renewing of my mind, he changes me. Ten years ago, I was a medical student at the University of Chicago. I went to the best schools because I could. I was deciding between Cardiology and Family Practice. I applied to the best residencies; my husband was doing an M.D./Ph.D., and I anticipated his placement in a highly sought-after academic position. Then those in our faith community urged us to pray for God’s will: his good, pleasing and perfect will. And he changed our minds.
Seeing the value God places on people has had two major effects on my life.
First, I am able to see the value in my children, husband and family - which means I don’t work all the time. God will provide the money we need; we don’t drive new cars, we don’t live in a big house, we don’t take expensive vacations or buy a lot of clothes: being with my family is infinitely more valuable than all these things. Seeing the value in the people in my life has made the time I spend with them a priority. My husband works part-time right now, and when he begins his fellowship, I will work part-time to be with our children. But because I can see beyond the lies the world tells us - “you need more money,” “everyone has a reason to drive a BMW” “a diamond is forever” - I don’t need things to have value.
Secondly, the people who come to me as patients have incredible value.
The value of my work is not found in my paycheck, or how much I save for retirement, or how prestigious my specialty or position is. The value of my work is in praying with a patient who shares with me the pain of an abortion, the fear of deportation, or the horror of cancer. On a good day, I can see the most noncompliant, depressed, addicted woman inmy office as a blessing, sent to me by Christ. And I can go home to my family and play and be a mother to my sons. At night, I can get on my knees and thank God for allowing me to serve his people who are of countless value simply because he loves them. And I thank him that he loves me in that same way.
Maybe God is calling you to go into Pediatrics and to work in the inner city. Maybe he will tell you to be an ophthalmologist who spends two months a year in rural Mexico. Maybe he wants you to work exclusively with stroke victims, or abused children, or adults with developmental delays. Maybe he will call you to work a reduced schedule to be with your family more. Maybe he will call you to live off half your salary and give the other half to support missionaries.
When he calls us, when we begin to see those around us with his eyes, with the value he has imbued them, how can we hold onto that change when we are constantly surrounded by the world and its economy?
First, keep on meeting together, as many of you are doing. Test all the advice your colleagues give you. Does it agree with Scripture? Test all the role models who are set up for you in your training. Do they resemble Christ? Avoid the TV; every Lexus ad is designed to get us thinking what we deserve, what we “need”—when what we really need is not a herd of pigs, but the grace of God. Make sure you are in a community of believers—preferably one outside of the medical world, as well—who can see beyond the trappings of medicine and money to what is important. Ask them to hold you accountable on your journey. And pray, pray, pray.
I appeal to you therefore, brothers and sisters, by the mercies of God, to present your bodies as a living sacrifice, holy and acceptable to God, which is your spiritual worship. Do not be conformed to this world, but he transformed by the renewing of your minds, so that you may discern what is the will of God - what is good and acceptable and perfect. (Romans 12:1-2)
Ann E. Dominguez, M.D., be contacted at ann_ dominguez [at] hotmail [dot] com.