Art, and More

Art is defined by one video as the purposeful expression of human creative skill or imagination that makes the audience feel something. German author Johann Wolfgang von Goethe proposed three questions for one to characterize a creative work as art: 1) did it have a goal, 2) did it achieve that goal, and 3) was it worth pursuing? We’ve all been told by at least one lecturer in the halls of Chung Te that the practice of medicine is both an art and a science. Back in my second year of medical school, I caught myself rolling my eyes to the side and thinking at the back of my mind, “Ang mema.” I now realize that to think this way is to concede that the past three years of my life are complete futility. Is the practice of medicine therefore worth pursuing? If so, as a doctor-in-training, what is my goal in undergoing this long, lifetime endeavor?

During my undergraduate studies, I developed an interest in philosophy, particularly in existentialism. This school of thought is largely about how the human person thinks and perceives the world around them. Martin Heidegger was one well-known existentialist philosopher, and I was exposed to his ideas back in Philosophy 101. His work Being and Time (in German, Sein und Zeit) explored the ideas of what it meant to be. He discusses being in two senses of the word: a being, or an entity that exists, and be-ing, the act or the verb of existence.

Humans see the world around us in how we relate to the world, more than just by characteristics of objects around us. I can describe a stethoscope to be an object with three long hollow tubes protruding from a rubber center, with two of these tubes composed of metal and one tube made of flexible rubber. For a medical student, it is much easier to appreciate what I just described than it would be for an accountant or a law student. A medical student, because of their background and involvement in the medical field, can better understand what a stethoscope is and its purpose as a medical tool.

But other students have stethoscopes that are different from mine. My stethoscope is of a dark green hue tubing, with a bell-diaphragm unit that can spin on an axle to switch modes, and is of the Littman brand. On the other hand, there are other students who have stethoscopes with golden binaurals, bright neon-pink tubing, made by other manufacturers. And as such, because of all our differences, we would each have described the stethoscope differently.

And we differ in many more ways than by just what kind of stethoscope we own. We all vary in background, undergraduate course, high school, upbringing, nationality, gender, age, height, and even in the time we were born. We are all different in what Heidegger calls thrownness, as we all were thrown into the world. Each of us is created differently, with a different experience to bring to the plate, and a different set of experiences that made us who we are. This individuality, Heidegger says, is inauthentic when we base it too heavily on the routine of everyday life, when it is grounded upon a standard to please others or to live life according to the demands that others pile upon us. We are all beings bound by time, and ultimately we are all destined for nothingness. Eventually, all of us are going to leave this planet. Heidegger says that that it is therefore futile to try to live life in an attempt to please others, and that we should start living life determined by ourselves in order to live authentically.

Paul Ricoeur, a student of Heidegger’s, critiques this and offers another layer of thought in the work Oneself as Another. He says it is meaningless to live life on the sole basis of being bound by time. Life has meaning not because of the brevity of our time on earth, but despite it. If my pursuit to become a doctor is only because I am living for myself, then each day I struggle, complete with the entire coffee-study-repeat cycle, is meaningless. On the contrary, he says, our identity is the union of who we are and how we act in the context of the people around us.

The people around us are not just holograms that tickle our senses, but also selves by themselves. Each person we encounter is an Other—like me, a human with a background, a heritage and a history. A self, like me, with their own pains and passions. When we glance upon the face of the other, we don’t just see the outward manifestation of another human creature; we see a masterpiece bearing the signature of a master Artist. We see a being asking—no—demanding our pity, our mercy, crying out for our attention in words similar to the lyrics of the song This is Me. “I am brave. I am bruised. I am who I’m meant to be. This is me.” It is up to us, whether we choose to help them or to hurt them, the least of our brethren. But what we choose to do to them, we do to God himself.

It is here, he says, that we arrive at this realization: “I too am an Other.” We too are weak and vulnerable, with problems and struggles, in need of the same pity and mercy. Not one man is greater than his neighbor, but all men are created equally. All people are made in the same likeness, bearing the semblance of the same infinite Creator. This is a burden and a responsibility that is far greater than we ourselves are worthy of handling. The implication, when we acknowledge that our lives are not our own, is that we cannot live life by ourselves. And we then conclude, we should not live our lives for ourselves. We live for Him, and we live for others. It is then that we can live authentically, serving a cause greater than our own mere human existence.

Ricoeur then takes this into a more practical sense, introducing his well-known threefold mimesis, a three-step model of prefiguration, configuration, and refiguration. Mimesis is a word that means, “imitation”. As an artist will first examine a live model or recollect a distant memory even before the first drop of paint bleeds on to his plain, white canvas, our actions are prefigured. Prefigured by memories of people who impacted us, events that affected us, and the customs and cultures that shape the way we live. Even abstract art, though it may not represent any distinct object, is influenced by a thought, a feeling, or idea in the artist’s mind. These memories are far more than just “background noise” that we simply pass by in the hurriedness of regular routine. This is where “the face of the Other” comes in, as even if we may try so hard to ignore the Other-s around us, the Other-s are truly the ones who inspire us to think the way we do.

After this first step comes configuration, which Ricoeur likens to the thoughts of a person reading a narrative text. As the eyes of the reader graze through the grassy fields of letters and words, they are in the process of constructing a world of the text in their mind. Likewise, our own experiences cause us to form connections, associations, and neural networks, configuring our priorities, passions, and paradigms. These shape the way we think and how we view the world.

As we build our worldview, we the arrive at the final step of refiguration, or refiguring the world around us. When we act, speak, and live our lives, we share our worldview and perspective with those who live around us. Though our ideas are never completely our own, when we act based on these experiences, we then contribute to the ever-continuous process of rebuilding this world that we live in. We, acting by principle by how we understand the world around us, then come full circle and impact the lives of others, causing them to repeat the cycle again.

The concept of threefold mimesis has been applied in several fields and disciplines. It has found its way into the realms of popular culture, theology, art, and even neuroscience. (See Author’s Note.) Ricoeur invites us to engage with those around us through discourse, challenging us to see ourselves not as lone wolves but as characters in an overarching narrative. He wants us to understand that our individual actions is not futile dust in the wind. But after we reflect (configuration) upon the summation of our memories and experiences (prefiguration) it is inevitable that our response will impact our world in the long run (refiguration). Everything that we do exposes truths, changes perspectives, and shakes the foundations of society as we know it. It is just as every single hair on the brush of a skilled painter leaves a tiny but lasting smear of paint on the canvas of time.

What we do as medical students, and future doctors, will impact on the lives of those around us. It was last Sunday at church when a young woman approached me, greeting me as “Doc.” I was delighted to see the face of someone whom I had helped in a previous patient encounter. Though I was still a medical student, what I did back then when I took her history, gave her physical examination, and prescribed her management (under the guidance of the supervising physician) had a lasting impact on her. I was reminded once again of my “Why.” If I was able to touch her life while just a medical student, then how many more patients could I impact as a doctor in the future?

To cure sometimes, to relieve often, to comfort always.” This popular aphorism constitutes the three success indicators I will bear when I begin my practice as a doctor. And my goal, in the vein of the Great Healer himself, is to do the will of Him who sends me to heal. I believe these are goals worth pursuing. Only by Christ’s help, will I ever achieve these goals. More than an art, I believe that medicine is a mission.

That’s the whole story. Here now is my final conclusion:
Fear God and obey his commands, for this is everyone’s duty. God will judge us for everything we do,
including every secret thing, whether good or bad.

– Ecclesiastes 12:13-14, NLT

This article was originally written for, and will be published in SCOPE, the official student publication of the Ateneo School of Medicine and Public Health.

Bibliography

Changeux, J.-P., & Ricoeur, P. (2002). What Makes Us Think? A Neuroscientist and a Philosopher Argue about Ethics, Human Nature, and the Brain. (M. DeBevoise, Trans.) Princeton, New Jersey: Princeton University Press.

Heidegger, M. (1996). Being and Time: A translation of Sein und Zeit. (J. Stambaugh, Trans.) State University of New York.

Messmer, J. (Director). (2017). What makes something art? [Motion Picture]. Canada: YouTube. Retrieved from https://www.youtube.com/watch?v=vV2cc_fFgmA

Ricoeur, P. (1984). Time and Narrative. (K. B. McLaughlin, & D. Pellauer, Trans.) Chicago: University of Chicago Press.

Ricoeur, P. (1992). Oneself as Another. (K. Blamey, Trans.) Chicago: University of Chicago Press.

Turnau, T. (2015). Ricoeur’s Theory of Narrative as a Theory of Popular Cultural Religion. Retrieved June 15, 2018, from Faith-Popular Culture-Imagination: http://www.turnau.cz/node/31

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A Life Undeserved

If only academic problems were the only problems plaguing me. If that were the case, life in medical school would be so much easier. It’s true, and I always knew it was, that following God’s calling for my life would be no walk in the park. But I never expected it to be this bad.

It is as they say, that the race would be riddled with entanglements. Distractions. Things that trip you and make it so difficult to get back up again. When you finally do, what is left of your energy and motivation is but just a few drops of oil dribbling down to the bottom of a steaming gas tank. And instead of running the race, you end up shuffling. Crawling even. Desperately wondering how you’re going to reach the end with your heart shattered into a thousand pieces.

Sometimes the things that trip you aren’t necessarily evil. It’s not always sin. A lot of times, it’s a gift that God himself gives you. Something good, like an opportunity, favor in the eyes of men, a dear friend, or even a childhood dream. Something that draws you to thank him for each and every day.

And when all is perfect, and you feel that nothing can go wrong, there’s a plot twist, and God takes it away from you. And in an instant, your whole world shatters, and walking the road to the kingdom becomes just a little bit harder. A little bit lonelier.

I am currently reading the book of I Samuel, I saw the faith of David when he went up to King Saul and said that he would challenge Goliath, saying that because God helped him kill the wild animals who threatened his sheep, he would be able to slay the giant who threatened God’s people.

And I’m torn inside. On one hand, I’m thinking, “Wow, what amazing faith, this David has.” I knew how he would swear by the name of God to defeat the Philistine who threatened Israel and become a powerful and mighty king.

On the other hand, I’m thinking, “He has something terrible coming up.” I’m thinking of his entire affair with Bathsheba, his inborn child, the rebellion of his son, and the rape of his daughter. I’m thinking of how even a righteous man, in an instant, can have his entire horizon to warp into obscurity.

But then I stop and think. Could there ever be anyone righteous enough to deserve God’s blessings? Is there any one man who can dare go up to God and make a demand by his own merit? There is truly none. I am a child of God and a follower of Christ, but even then, I can never demand that from him. Even if I have plans and dreams, it is God who ultimately determines what happens in my life.

Even Jesus Christ himself, a man wholly righteous and One with God the Father, did not get what he wanted. He could have been a great earthly king, ruler of many kingdoms, and respected and honored by all men. But in obedience and humility, he conceded to His Father’s will, giving himself up to death on a wooden cross. Because of His obedience, He was glorified. And because of His sacrifice, I am set free from death’s power. I am destined for an eternity in the Father’s embrace. An embrace undeserved.

By this truth alone, I am thankful. By that, I am humbled. I realize now that even my wildest dreams, I do not deserve. Fame, acceptance, glory, I deserve none of that. All the blessings I have in my life are undeserved. Yet, in God’s love for me through Jesus Christ, I am accepted as His son and destined for a wonderful life lived serving Him. A life filled with blessing, promise, and wonders I could never dream of. A life undeserved.

God does everything for a reason. And when my life is shaken up, I can see now that it’s only so He can bless me more. When I remember again that He died and rose from the dead to bless me with freedom and eternity, I am reminded that I have been blessed with something that can never be taken away from me: a part in God’s loving plan. And with this renewed sense of identity, I get back twofold whatever was lost: more opportunities to serve Him, favor in the eyes of God, more chances to love, and more creative ways to dream.

It is through my identity in Christ, that I am being continually transformed into a new creation. And with this transformation is the hope that I may become more like him.

Seeing my problems now from His eyes, it’s almost like they were never there at all. He has given me a renewed sense of purpose, and a renewed perspective on my life.

A life undeserved.

On Antibiotic Resistance

Why would I need a prescription, if I wanted to buy antibiotics? I’ll try to answer your questions in this blog entry.

You might have the question, “Why do I need a prescription if I want to buy antibiotics?”

There’s actually a broad history to this. In essence, i’s all about antibiotic resistance, but I was thinking you’d appreciate it more if there was more detail on why prescriptions are necessary.

There’s a TLDR at the end if you’d like to check it out. 🙂

HISTORY
The classic antibiotic penicillin was developed long ago as a remedy to bacterial infection. It’s a beta-lactam antibiotic, meaning it ruins the bacteria’s cell wall which makes it easier to kill. Penicillin was hailed as a “miracle drug”, and it was often used for bacterial infections. However, because it was rampantly used, bacteria also began developing resistance to the drug.

SCIENCE
In a lot of cases, antibiotics are not necessary for patients’ treatment. Doctors avoid prescribing due to factors like allergies and side effects. (Look up Steven Johnson Syndrome, it’s scary.) And when antibiotics are necessary, there is an entire plethora of antibiotics that can be prescribed. Each antibiotic targets a certain type of bacteria/fungus/virus. Medical students spend at least two years studying drugs in the classroom setting, and even more after that, just so they can find out which drugs are appropriate for particular diseases. In addition, data is continually updated as per which species develop resistance for certain antibiotics, so doctors in turn update the way they give prescriptions with the emergence of new research.

How do bacteria develop resistance? Well, bacteria multiply in a way far different from humans and animals. Instead of just copulation, bacteria make clones of themselves and make copies of themselves at exponential rates. This is an advantage for them because it makes it much faster for them to grow their population and transfer their genes.

In addition to their core DNA, they also have another kind of DNA that’s called plasmids, which allows them to exchange new information with each other. For example, if just one individual bacteria mutates in such a way that it becomes resistant to a certain drug, it can easily transfer its newfound genes to other bacteria.

Because of these mechanisms, entire populations of bacteria can become resistant to certain drugs in a short matter of time. Self-medication of antibiotics, stopping your antibiotics prematurely, or over-dosage of your antibiotics can contribute to the process of developing antibiotic resistance.

Drugs like Amoxicillin and Coamoxiclav (which itself is a combination of amoxicillin and clavulanic acid) are given as if a bacteria is no longer susceptible to certain drugs (such as methicillin resistant Staphylococcus aureus bacteria), or if a patient has allergies to first line drugs. Giving these prematurely is like sending a blueprint of a weapon of mass destruction behind enemy lines, giving them a strategic advantage in the overall war.

PRACTICAL TIPS
Self-prescribing antibiotics (a.k.a., buying antibiotics without a prescription) is not advisable because just giving the wrong/unnecessary antibiotic can strengthen your bacteria and will make your body more susceptible to systemic (widespread) infection. Things can get worse if these bacteria spread to other people, as these have the potential to create entire pandemics, wiping out great portions of the earth’s population.

Stopping antibiotics prematurely will give your bacteria a “strategic advantage” when their populations are still not completely wiped out, and will help them to strengthen their arms using what remains of the antibiotic in your system.

Finally, over-dosage of antibiotics can result in development of resistance in other bacteria, making a patient worse off than he was when he first consulted.

TLDR?
In a nutshell, there’s a whole host of things that doctors consider when prescribing antibiotics: the bacteria in question, condition of the patient, the potency of the drug, the duration of dosage, and possible side effects. You can trust your doctor that he will give you the correct prescription, and you can be happy if he does not prescribe you antibiotics. If the latter were true, it’s good and it probably means that you’re in a much better condition than if you would need them in the first place.

https://www.cdc.gov/drugresistance/about.html