Science, Belief, Intuition: Reflections of a Physician

Science,

Belief,

Intuition:

Reflections of a Physician

L.D.H. Wood, MD PhD

Copyright © 2012 L.D.H. Wood, MD PhD

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The author of this book does not dispense medical advice or prescribe the use of any technique as a form of treatment for physical, emotional, or medical problems without the advice of a physician, either directly or indirectly. The intent of the author is only to offer information of a general nature to help you in your quest for emotional and spiritual well-being. In the event you use any of the information in this book for yourself, which is your constitutional right, the author and the publisher assume no responsibility for your actions.

Balboa Press rev. date: 04/11/2012

Contents

Author’s Preface

Part I The Scientific Method and a Spiritual Source

of Knowing

1

There Is Much Beneath the Surface

2

Try Another Way

3

My New Home

4

Elaine

5

Our Wedding Trip

6

Science, Belief and the Still Small Voice

Part II Return of the Children

7

The Courage To Be First

8

The Joy of Being Loved

9

Longing For Home

10

Building Community

11

Leadership and Qi

12

Forgiving is Hard to Define

13

The Joy That Heals

Part III Excellence and Compassion in Medicine

14

Establishing an Exemplary Critical Care Program

15

Contributions of Research to Patient Care and Teaching

16

Reconsidering My Calling

17

Welcoming and Advising Students in the Profession of Medicine

18

Allopathic Medicine and CAM

19

Legacy

Part IV Living the Interface of Science and Spirituality

20

Whispers

21

Witness to Stewardship

22

School for Charismatic Spiritual Directors (SCSD)

23

Spirituality and Healing in Medicine

24

Now It Begins!

Epilogue

About the Author

Appendix

Footnotes

To

Liam Lionel Wood

my first grandchild

At the age of 2, he listened

as I whispered stories in his ear.

At 3 years old, he sat facing me in the blue chairs

and said Let’s discuss something.

At 4, he took his Grampa golfing

where he consistently hit the ball 100 yards and straight

and putted for par on many holes.

At 5, he read the Chronicles of Narnia and

became a playful caring big brother for Ansel.

At 6 he read The Hobbit and Fellowship of the Ring,

played in a Golf Tournament in Scotland

and excelled at Quiz Bowl at school.

For Liam is the promise of the future

who lives the interface of science and spirituality.

Then Yahweh Himself passed by.

A strong and heavy wind was rending the mountains

and crushing rocks before the Lord—

but the Lord was not in the wind.

After the wind was an earthquake—

but the Lord was not in the earthquake.

After the earthquake was fire—

but the Lord was not in the fire.

After the fire was a tiny whispering sound

when he heard this, Elijah hid his face in his cloak.

NAB 1 Kings 19: 11-13

LIST OF ILLUSTRATIONS

Figure 1 – Science is Sometimes Misinterpreted

Figure 2 – Methods of Inquiry

Figure 3 – A gift From Elaine to Larry in 1980

LIST OF TABLES

Table 1: Sequential Steps of Science and Belief

Table 2: Limitations of Inquiry and Knowing

Table 3: Therapeutic Goals in AHRF

Table 4: Characteristics of the Still Small Voice

Table 5: Attributes of Methods of Inquiry

Table 6: Teaching Schedule

Table 7: Research Programs and Publications

LIST OF POEMS

Winter

Dining

Questions of a Mustard Seed

Six Years Later

Teaching

Author’s Preface

It was 10:30pm when my home phone rang. The Dean’s message was terse: Larry, the 30 year old daughter of a friend is moribund in the ICU of a nearby hospital. He asks that you see her. At her bedside an hour later, my examination confirmed her hyperactive circulation and low blood pressure (90/40) likely due to a serious infection (T = 39°C), complicated by excess liquid in her lungs with 4-quadrant air space filling on her chest x-ray, due in part to excess circulating volume as indicated by a pulmonary artery occlusion pressure (PAOP) of 24mm.hg. She was intubated and ventilated with 100% oxygen, positive end expiratory pressure (PEEP) of 20 cm H2O, and a tidal volume of 800 ml at 20 breaths/min. She was oliguric, comatose, and receiving a large intravenous dose of broad spectrum antibiotics.

As I examined her, I prayed silently Lord, Agnes is dying, what can I do to help her get better? Out of the noisy background of her ICU cubicle, through the bells and whistles of alarm systems and the chug-chug sound of her laboring ventilator came the still small voice less circulating volume, more dobutamine, less ventilation, less PEEP.

Recognizing each as plausible interventions not tried together yet in her management, we began. First we cut the tidal volume in half to a volume more appropriate to her size and acute lung disease, and reduced the ventilator rate to 12 breaths per minute. Immediately, the auto-PEEP fell from 8 to zero cm H20 and her blood pressure (BP) increased without much increase in PaC02. Then we removed 4 units of blood from her indwelling arterial line. As her BP decreased, we increased dobutamine from 2 to 12 microg/kg/min, and PAOP decreased to 4 cm H20. Her urine output increased to 80 ml/hour. Then we progressively decreased PEEP in small decrements to 8 centimeters H20 overnight. By dawn, her cardiopulmonary status was nearly normal.

As I left to make ICU rounds at the University of Chicago, I prayed Thank you Lord, still wondering whose voice I heard. So there I was, living the interface of science and belief.

Telling the Story

Reflection on my life as a Physician revealed inclinations to spirituality and science. Spirituality is my awareness of a relationship with a personal higher power characterized by her loving acceptance and affirmation, and by my experiences of awe, wonder, delight and gratitude in our communication and in my interactions with all of creation. Science is the evidence-based generation of knowledge—the discipline that channeled my curiosity about how the world works. Together, science and spirituality were 2 lenses though which I came to know how the world operates. Science looked outward to describe the physical world around me, and spirituality looked inward for purpose and meaning. Given these different goals there could be no antagonism between them, and their considerable overlap often left me living their interface. Self reflection and review of this topic reveals that there are many more beliefs than scientific truths which help people navigate the vagaries of life. How I integrated my worldviews seen through each of these lenses informs many of the transactions in my life, making this book read like a memoir: a narrative of my life as it evolved around science and belief as methods of inquiry used to discover truth. For 30 years, I had kept a spiritual journal meant to keep track of happenings in my life, often expressed as conversations between me and the still small voice (see Chapter 6). At times of outstanding events, I wrote poems. I include five of those poems at appropriate places in this book to express the accompanying feelings and emotional intelligence revealed in the stories.

The story begins as I complete my medical internship in 1967 and assume a research position with the Canadian Armed Forces in Toronto. There I learned research techniques and philosophy before moving to McGill University as a PhD candidate. In 1972, I returned to Winnipeg to complete my residency in Internal Medicine and my Fellowship in Critical Care. Along the way, I lost my marriage, separated from my children and lived for 3 years with the Marianist religious community where I experienced a quantum leap forward in my psychospiritual journey. At a spiritual retreat in Pecos, NM in 1979 I met Elaine from Chicago, who brought me back to life and to the University of Chicago after a wonder filled courtship and sabbatical/wedding trip to Israel and New Zealand. At Chicago, I established a first rate academic Critical Care program with strong research, education and patient care components put in place between 1982 and 1987. My calling as a Medical educator grew rapidly, aided by my role in chairing a task force on review and revision of the medical school curriculum in 1994. This lead to my appointment as the Dean for Medical Education in 1996. During this time Elaine and I were engaged in spiritual growth through leadership of diverse programs in our parish, and then through a six week course in the school for charismatic spiritual directors back in Pecos, NM. I retired in 2003 to tend to a new diagnosis of Parkinson’s Disease, moving back to Canada for the next phase of our life.

Science and Belief–Methods of Inquiry

and Knowing

People are curious and like to know about their surroundings. Some even want to know how they know. More than ever before, we live in a scientific age where our understanding is gained by science, the evidence-based generation of knowledge. It defines a process—the Scientific Method—of observation, forming and testing hypotheses to explain phenomena and falsifying, confirming, or repeating experiments by independent reviewers. This method of inquiry confirms results or finds errors. It is slow and tedious because there are so many possible explanations to be excluded before a plausible statement of reality stands out. The Scientific Method has acquired a good reputation for finding truth, but it is sometimes given too much credit, leading to over interpretation of its findings and to being mimicked by belief. Not that science ever proves anything—it only falsifies. And science has nothing to say about many subjective issues of great interest. What the Scientific Method does best is help us avoid illusions stemming from projection of pre-conceived ideas, for people tend to see what they expect. Accordingly, we disprove hypotheses and reality or truth is what is left. Searchers who reflect on their beliefs find the majority have not been put to the test in large part because we do not have ways to measure beliefs, and so we cannot prove them false.

Not too long ago, the principles of science were not generally practiced, so another method of inquiry prevailed. Belief is a state or habit of mind in which trust or confidence is placed in some person or idea without convincing evidence. Compared to science, belief lacks a method to disprove it, for the substance of belief is subjective. God is a common focus of belief, but we have no Godometer and it is difficult to refute hypotheses built on the subjective. In their book, Andrew Newberg and Mark Waldman¹ outline contemporary understanding of brain function as serving two purposes: a) self preservation and maintenance, by describing what is out there and how to deal with it, and b) self transcendence, by which the brain changes as we undergo major changes from birth to death. In both functions, the brain acts to interpret or make sense of disparate data in our surroundings. If it has no experience with how they go together, the brain makes it up—a myth or a belief, often without supporting evidence or proof. And so the brain is a great myth-making machine. This can serve survival, but hardly contributes to new knowledge. Indeed one wonders how we ever got to know anything.

INTUITION AND THE STILL SMALL VOICE

¹ My belief system includes God’s gender as both masculine and feminine, so I alternate randomly.

In this book, I raise and discuss the possibility that proof of belief is the still small voice confirming or denying the questions we ask Her¹ about beliefs. Bill Hybels recently published a compilation of incidents by which his life was profoundly influenced by hearing and following the still small voice². Citing characteristics of God’s voice, he wrote as Pastor to his entire congregation of Willow Creek near Chicago one Friday afternoon requesting they write him about any spiritual experiences in which they believe God spoke to them. By the following Monday, his e-mail was flooded with over 500 replies! I told you that to tell you this—God’s whisper is a common occurrence among believers, and it may constitute a proof of whatever belief is under scrutiny.

When the still small voice is heard, distinguishing it from intuition is difficult. Intuition is defined as a quick and ready insight, or the power of attaining knowledge without evident thought or inference. The most obvious distinctions between the still small voice and intuition are the words. Intuition is an awareness that comes wordlessly, while the insight provided by the still small voice is often captured by recalling the words heard. Beliefs ratified by intuition or the still small voice constitute a spiritual source of knowledge which may be a method of inquiry as effective as the scientific method. Furthermore, in any comparison with science, belief is more than a method of inquiry, for beliefs which seem true also build relationship with God, provide gifts more than expected, and pursue explanations of interior experiences more effectively.

Interface is defined as the process or place where independent and often-unrelated systems act on each other, for example, science and belief. As a man devoted to exploring the discipline of Medicine with the investigative tools of science, I often found myself living the interface of that science with my beliefs. When I purported to being instructed by a still small voice within, I sensed no conflict with my efforts to ensure objectivity in testing hypotheses. In fact, scientific revelation often caused me to give thanks and praise to the God of my beliefs. So science enhanced belief! On the other hand, when I was stuck in processing the results of an experiment and found myself seeking insight through prayer, the new interpretations of my data were easily attributed to my God. So belief enhances science!

I believe I am far from alone in noticing this interface, that a growing number of people are drawn to explain life or to understand it as living this interface of science and belief. Such company is the intended audience for this book, which attempts to define and reveal how I live this interface of science and belief. Growing interest in the relationship between science and spirituality is evident in the birth of relevant publications, such as War of the Worldviews³, and Principles of Neurotheology⁴. Neurotheology is the discipline which studies correlations of neural phenomena with subjective experiences of spirituality, as well as hypotheses to explain these phenomena. This discipline offers promise to provide Neuroscientific explanations for spiritual experiences.

In my sub-specialty of Pulmonary and Critical Care Medicine, the prevalence of suffering and death in our patient population tends to bring spiritual concerns out into the open. My activities as a teacher in the School of Medicine and as Dean of Medical Education brought me in contact with diverse manifestations of spirituality and science. I believe there is a large interest in the medical community in how one lives the interface of science and belief. My transactions relating science and belief described in this book are a basis for discussion of living this interface, where I attempt to explain how science and belief work in the life of a Physician-Educator who believes a lot. I hope the reader will find part of themselves in my stories.

Acknowledgements

Many friends and colleagues contributed to this book.

First and foremost is the love of my life, Elaine, who consistently brought joy, delight, love and laughter as she read several times the details of this book, which she knew well. I valued especially her suggestions as to how to make the science more relevant and interesting to possible readers more focused on belief.

Then I am grateful to my daughter Catherine, who selflessly lent herself to the challenging task of transcribing this physician’s handwriting—already obscured by the micrographia of my Parkinson’s Disease. She performed this task admirably and without letting it interfere with her sense of writing for clarity, as she made innumerable suggestions to enliven my writing style and to clarify background material.

I am grateful too for the encouragement of my other adult children—John, Peter, Teresa and James and for input when my memory failed. Their return to relationship with me was a major source of joy for me, which drove me to write it down.

My friend and brother-in-law Jack Hansen served as a foil for my ideas, while reading several versions of this book, each time helping to clarify my communication. It was so helpful to have such a colleague share his medical background and his love of God freely in responding to my writing.

To that extraordinary group of Canadian scientists and mentors who showed me and their other protégés how to do it right while having fun: Charles Bryan, Peter Macklem, J. Milic-Emili, Nick Anthonisen and Reuben Cherniack.

And for reading and commenting on earlier versions of this work, I am grateful to my colleagues Jesse Hall, Greg Schmidt and Iasha Sznajder; having published so much together, a trust developed that created space for the constructive criticism we shared.

To my friends from our TGIF group Jan Deckenbach, Diane Durante, Jack Farry, Donna Harris and Lissa Romell, I acknowledge how our faith sharing and shared prayer made Eucharist come alive for me as we lived the interface of belief and science.

To my neighbours and new friends in Furry Creek—Anil and Veneeta Sethy, Paul Ryan and Martin Humphries for providing the community where these ideas were brought to fruition.

Last but certainly not least, I am grateful to the Lord of my life who first suggested this project, then stood by me when the going got tough and the benefits became obscure.

Lawrence DH Wood

Furry Creek, BC, Canada

2012

Part I

The Scientific Method and a Spiritual Source

of Knowing

1

There Is Much Beneath

the Surface

It was June 1966 when I graduated with my medical degree from the University of Manitoba in Winnipeg, Canada. Almost immediately, I began a rotating internship at St. Boniface Hospital in Winnipeg. The training there was provided by affable excellent clinicians, and proceeded very well, in part because I was industrious and diligent.

When I finished my internship in June of 1967, I was most fortunate in being assigned to the Canadian Forces Institute of Environmental Medicine (CFIEM), where a Physician-Scientist with MD PhD training published especially good work. Charles Bryan took me under his wing early in my time at Toronto, and taught me science with one-liners of philosophy and with active participation in our experiments. Always coming up with good ideas for study, he encouraged getting started—Let’s do a quick and dirty, or if you need statistics, it can’t be important.

Larry, said he, there is a hyperbaric chamber here which changes the density (ρ) of the air we breathe. And Jere Mead just published an analysis of factors governing maximum expiratory flow (Vmax) which predicts that Vmax will vary inversely with ρ. And we have a new wedge spirometer, which faithfully records flow and volume in the hyperbaric chamber unaffected by the gas ρ. I think this would be a great project for you to start on.

Now, when you measure the Vmax at several gas densities in some volunteer divers, take some graph paper and plot Vmax versus ρ—if there is a linear relationship, write the equation and we will explain it. If it is not a linear relationship, get some semi-log paper and plot Vmax versus ρ—again, if it’s a linear relationship, write the equation and we will explain it. If it is still not linear, get some log-log graph paper, plot Vmax versus ρ, and if that is linear, write the equation and we will explain it. I am going to the Yukon for 3 months to study altitude sickness, and when I return, we will discuss your progress.

He left. I began. The data was linear only on log-log paper. I learned that the slope of the line was the exponent n in the equation Vmax ∝ ρn, that n was about -0.5 at all but the lowest lung volumes, and that these data showed that Vmax varied inversely as the square root of ρ.

I read Dr. Mead’s paper, which predicted that relationship based on the dominant contribution of convective acceleration (Pca) to the expiratory pressure drop during maximum expiratory flow. Then I wrote the paper, which Charles read on his return. He got so excited, I thought he would have a seizure. He marched me down to the office of the Commanding Officer, Dr. Pete Kidd, barged in, and made me stand there while he explained the phenomenal job I had done! Then we three went to the Officer’s Mess for a celebratory drink or two.

Do you think this was an enticing way to get introduced to science?!!

For the sake of brevity and continuity, I skipped over one small glitch in the progress of the story. It turns out that by Canadian Navy Regulations, not just anyone can enter a working hyperbaric chamber. The entry and use of the chamber is restricted to certified Navy Divers. When I heard this, I inquired what I needed to do to become qualified. That is straightforward if not easy, explained Dr. Kidd, you just need to pass the Navy Divers 3 week course in Halifax Harbour. The next course was scheduled in September of 1967, and Dr. Kidd said he would enroll me. And how should I prepare? Just be in very good physical condition and be able to swim the two miles across the harbour and back.

Well, I was in pretty good shape for running and lifting, but I wasn’t a very good swimmer, and I didn’t especially like the water. But learn to swim I did, with the help of a few lessons and daily swimming exercise at the pool on the Downsview Base where I worked. I was told that doing 30 laps of the 50 yard pool would predict that I could handle the course. So I aimed at that target. Before the course began, I had increased my swimming stamina from 10 laps to 30 laps. So off I went, confident I would be back in the hyperbaric chamber in 3 weeks.

I was billeted to stay on the HMCS Granby, the ship outfitted for diving training. Come day 1, we 30 matriculants of the course were awakened at 6AM, ran for half an hour, did calisthenics for another half hour, and then dressed hurriedly in our wet suits and dove off the ship to swim the harbour before breakfast.

Then we assembled at 9AM for classroom review of the learning materials for the course, and we received the course schedule. Monday through Friday inclusive, class time was from 9 to noon, and 1:30pm to 4:30pm with free time in the evenings except on several occasions when we had a night swim or a paper to write and submit. We worked through that day, and I believe we all slept well that night. I first noticed something was up on the morning run on Day 2, when the group seemed distinctly smaller. And after our morning swim, the changing room for doffing our wet suits was distinctly less crowded. At the first class, I counted only 18 students, and those present commented on the smaller group. Rumors