Today's Christian Doctor - Winter 2020

Volume 51 No.4 • Winter 2020

Today’s

Christian Doctor The Journal of the Christian Medical & Dental Associations

Growth Spurt

AftertheCrisiS A Lasting Courage: Stories from the Frontlines

CMDA National Convention April 29 - May 2, 2021 Ridgecrest Conference Center Ridgecrest, North Carolina

Register online at

www.cmda.org/nationalconvention Paid Advertisement

FROM THE CMDA PRESIDENT GLORIA HALVERSON, MD

NEW BEGINNINGS

2020—WHAT A YEAR! UNPRECEDENTED, FOR SURE.

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hile riding on the Corona-coaster, with life full of unexpected twists and turns and ups and downs, there are times you just want to throw your hands in the air and scream. COVID-19 brought fear, worry, isolation, depression, anxiety and loss. The drop in our economy seriously hurt countless numbers of people. Then came the tragic death of George Floyd, which brought issues of racism, justice and equality to the forefront. And through it all was politics and division and a country in chaos.

Bereshit is the Hebrew word for “in the beginning.” In Greek, the word is genesis.

As we anticipate the coming Christmas season and the start of 2021, we need to look at new beginnings.

This issue of Today’s Christian Doctor displays several new beginnings. We see what is being done to help at the very beginning of life with an embryo adoption program, new programs for our dental members and the importance of mentors coming alongside those who are new in healthcare. Many new beginnings—new beginnings in the midst of an unprecedented year.

From the CMDA Board of Trustees, we are seeing new directions for CMDA to take us into the future well positioned, as our new mission statement commands, “to educate, encourage and equip Christian healthcare professionals to glorify God. Christian healthcare professionals glorify God by following Christ, serving with excellence and compassion, caring for all people, and advancing Biblical principles of healthcare within the Church and throughout the world.”

We have added an additional day onto our next Board of Trustees meeting for the specific purpose of developing our next strategic plan—another new beginning. We have been working on it all year by looking at the process with a consultant, retooling our mission and vision statements, reviewing our core values and developing surveys and focus groups. Thanks to all of you who responded to help us know your needs so we can serve you better. We will be doing a situational analysis, looking at strategic issues and key result areas, developing a strategic plan and then passing it onto administration to start implementation.

The Board of Trustees also formed the R2ED Committee, which stands for racism, reconciliation, equality and diversity. As Christians, from the beginning we should be setting the standard and showing by example how to move ahead in these areas. We have already released a summary statement on healthcare disparity. A

lengthier, well referenced statement will follow. The committee has already made thoughtful recommendations for CMDA and will continue to serve as a resource to all our membership. We are also looking at ways to begin offering leadership training for our members, including those in leadership within CMDA. We have so much potential to move forward to better serve you and, ultimately, God. Speaking of Bereshit, what a celebration of a beginning we have coming up soon with Christmas. In the beginning was the Word, and the Word was God and was with God. The birth of a Savior as a baby brought us an entirely new personal relationship with God. May we focus on this blessing in the midst of all the busyness of the season and the challenges and concerns facing our world today.

Then the New Year. Some will breathe a sigh of relief that 2020 is gone, but I don’t think our problems will magically be gone. We need to reflect back. In the beginning, God created the heavens and the earth. Bereshit. There was initially chaos, but the Holy Spirit hovered over it all and God brought order. If God can create order out of chaos and create the earth and the moon and the stars and the skies, don’t we realize that He can handle the chaos in our lives? Doesn’t He also have our little worlds in His hands? As Psalm 62:1 reminds us: “In God alone my soul finds rest” (BSB). The peace that passes all understanding is available to us, even when we are still in the midst of the storm. As we enter this new season, what is God beginning in you? What part of your life—spiritual, emotional, physical, family, work or relational—needs a new beginning? 2 Corinthians 5:17 tell us, “Therefore, if anyone is in Christ, the new creation has come: The old has gone, the new is here!”

Bereshit! Let us go forth with Christ. www.cmda.org 3

TO DAY ’ S C H R I S T I A N D O C TO R

contents

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by William Polk Cheshire, Jr., MD, MA

12 Cover Story Growth Spurt

A physician shares his personal reflections

by Mark Mellinger

An update from the National Embryo Donation Center

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Feed My Sheep

by Jill R. Mattingly, DHSc, MMSc, PA-C

How to follow the Lord’s direction and mentor others to do the same

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Dentally Impacting the World for Christ

by William “Griff ” Griffin, DDS, and Jeffrey Amstutz, DDS, MBA

Exploring the ways CMDA’s new two-pronged approach to ministering to dental professionals

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I Got My Joy Back…Now What?

A Deeper Understanding of Joy Through a Trip to Israel

by Betsy Manor, MD Learning how to find healing from burnout and understanding joy

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WINTER 2020

The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.

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CMDA Ethics Statement on Opioids and Treatment of Pain

Earn Continuing Education credits and learn more about this topic

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Classifieds

EDITOR Mandi (Mooney) Morrin EDITORIAL COMMITTEE Gregg Albers, MD; John Crouch, MD; Autumn Dawn Galbreath, MD; Curtis E. Harris, MD, JD; Van Haywood, DMD; Rebecca Klint-Townsend, MD; Robert D. Orr, MD; Debby Read, RN AD SALES Brianna Snyder 423-844-1000 DESIGN Ahaa! Design + Production PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA).

Today’s Christian Doctor®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Winter 2020, Volume LI, No. 4. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2020, Christian Medical & Dental Associations®.

All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international).

Standard presort postage paid at Bristol, Tennessee.

Undesignated Scripture references are taken from THE HOLY BIBLE, NEW INTERNATIONAL VERSION®, NIV® Copy-

right © 1973, 1978, 1984, 2011 by Biblica, Inc.® Used by permission. All rights reserved worldwide. Other versions are noted in the text.

Christian Medical & Dental Associations P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www. cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same.

Implementation of the same is the decision of the reader and at his or her own risk.

CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.

MAKE THE SWITCH And Listen to CMDA Matters Online

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eginning in January, you will no longer receive a physical CD version of CMDA Matters. We encourage you to make the switch and start listening to the podcast on a weekly basis on your mobile device.

CMDA Matters is our popular weekly podcast with the latest news from CMDA and healthcare. Hosted by CEO Mike Chupp, MD, FACS, a new episode is released each Thursday, and interview topics include bioethics, healthcare missions, financial stewardship, marriage, family, public policy updates and much more. Plus, you’ll get recommendations for new books, conferences and other resources designed to help you as a Christian in healthcare.

You can listen each week as soon as it’s released, so make the switch and start listening to the podcast today!

6 Reasons to Make the Switch 1. It’s fast. You will receive the podcasts as soon as they are available, instead of waiting for a physical CD to arrive in the mail.

2. It’s simple. By subscribing to the podcast on iTunes or Google Play, you will get the interviews automatically.

You can also download the CMDA app or visit www. cmda.org/cmdamatters to listen to the interviews.

3. It’s safe. No need to worry about getting a computer virus from any of the ways you can receive CMDA Matters.

4. It’s convenient. You will easily find all of the CMDA Matters podcasts in one location.

5. It’s flexible. You can choose to listen to CMDA Matters on your smartphone, your computer, your tablet…wherever you are and whenever you want.

6. It’s more. More interviews are available online than were previously available on a physical CD.

New Specialty Section Joins CMDA This fall, CMDA welcomed the Christian Healthcare Executive Collaborative (CHEC) as a new specialty section. The mission of this section is to encourage connection, promote excellence and integrate faith and work through healthcare executives. The vision of CHEC is to be a community of Christian healthcare executives that inspires and supports one another. It’s an opportunity to connect and build up executives who can make a difference in their hospital systems and clinic settings.

The section’s goals are to develop an active community among Christian healthcare executives, develop resources to help healthcare leaders accomplish our mission, promote Christian truth in the healthcare industry, encourage ChrisGET INVOLVED

Among all of our various ministries, CMDA’s Specialty Sections give you the unique opportunity to equip, network and fellowship with colleagues in your specific healthcare specialty. Organized by CMDA members, the sections provide a wealth of resources for those who wish to connect with their colleagues. For a full list of the specialty sections, visit www.cmda.org/specialtysections. Don’t see a section for your specialty? Contact ccm@cmda.org for more information about starting a section.

tian mentoring for young and aspiring healthcare executives, support healthcare executive involvement with healthcare missions and develop a CMDA presence at healthcare meetings to add other like-minded healthcare leaders to our community.

For more information and to get involved, visit www.cmda. org/chec.

Regional Ministries Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 503-522-1950 west@cmda.org

Northeast Region Tom Grosh, DMin 1844 Cloverleaf Road Mount Joy, PA 17552 609-502-2078 northeast@cmda.org

Midwest Region Allan J. Harmer, ThM, DMin 951 East 86th Street, Suite 200A Indianapolis, IN 46240 317-407-0753 cmdamw@cmda.org

Southern Region Grant Hewitt, MDiv P.O. Box 7500 Bristol, TN 37621 402-677-3252 south@cmda.org

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TRANSFORMATIONS

In Memoriam Eugene Carroll Stone, MD, passed away at the age of 98 on August 1, 2020. Dr. Stone was born in 1922, and he attended Wheaton College in Illinois, where he met his college sweetheart, Althea. They were married for 70 years and had five children, five grandchildren and two great grandchildren.

He attended Boston University School of Medicine and joined the U.S. Navy in 1946. After 10 years in the Navy, he and his family moved to Wellesley Hills, Massachusetts to begin his private practice in general medicine. In 1964, they moved their family to Oxford, Mississippi. During his practice in Oxford, he served in a variety of capacities including Chief of Medicine for Baptist Memorial Hospital-North Mississippi, chairman of the Medical Ethics Committee, Chairman of the Bylaws Committee and others.

Dr. Stone was a member of CMDA while at Wheaton College, and he later organized local CMDA chapters in Massachusetts and Mississippi. In 2012, he received the CMDA Servant of Christ Award in recognition of his commitment to Christ and service to others. Most important to Dr. Stone was his faith in Jesus Christ.

He loved sharing his faith. He formed Covenant Church of North Mississippi in Oxford and pastored there for 40 years.

VIE Poster Session Do you know any students, residents or practicing professionals who are looking for an opportunity to be sharpened by like-minded believers while showcasing their research project? Please encourage them to join us for the annual VIE Poster Session at the CMDA 2021 National Convention in Ridgecrest, North Carolina on April 29 – May 2, 2021.

Any pre-healthcare student, medical student, resident, fellow or faculty member in the healthcare field is eligible to participate. They can share their clinical vignette, case report/series, basic-science report, clinical/ transaction report or literature review. We especially are looking for presentations in areas of spirituality, ethics, education, computational biology, mathematical modeling, biophysics, biotechnology, biomedical science, medicine, surgery, dentistry, nursing, medical humanities and more.

Cash prizes are awarded for content and presentation. Plus, scholarships to attend the National Convention are also available. The submission deadline is February 28, 2021. For more information and to submit an abstract, visit www.cmda.org/vie.

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EVENTS For more information, visit www.cmda.org/events.

ates and locations are subject to change D due to COVID-19.

Remedy 2021 January 9-10, 2021 • Virtual Conference 2021 West Coast Winter Conference January 22-24, 2021 • Cannon Beach, Oregon Ethics Webinar with Dallas Theological Seminary Hendricks Center February 10, 2021 • Virtual Webinar Turkey Tour April 10-20, 2021 • Turkey 2021 CMDA National Convention April 29 – May 2, 2021 • Ridgecrest, North Carolina Italy Tour May 23 – June 4, 2021 • Italy Greece Tour May 28 – June 6, 2021 • Greece Israel Tour June 8-20, 2021 • Israel

MEMORIAM & GIFTS Gifts received July 2020 through September 2020

Memory Martha Fitzgerald in memory of John E. Eckerle William & Kathy Poston in memory of Dr. Eugene Carroll Stone Ashley Vien in memory of Marvin Cohen Fred Simon in memory of Laurence J. Smith, MD Honor Sharon Bartels in honor of the marriage of Evan Nix and Mariana Mickelsen Brittany Rainwater in honor of the marriage of Evan Nix and Mariana Mickelsen Sharon Weiman in honor of the marriage of Evan Nix and Mariana Mickelsen John Redman in honor of the marriage of Evan Nix and Mariana Mickelsen Paula Motzny in honor of the marriage of Evan Nix and Mariana Mickelsen Scott LeBlanc in honor of the marriage of Evan Nix and Mariana Mickelsen Chad Potts in honor of the marriage of Evan Nix and Mariana Mickelsen Rich and Karen Maurer in honor of the marriage of Evan Nix and Mariana Mickelsen Mark Zawodniak in honor of Rolando Castillo Terry Bailey in honor of Dr. Steve Sartori Holly Austin in honor of Debbie McAlear Bruce Steffes in honor of Phil Fischer Connie Hahn in honor of Debbie McAlear Sarah Rahkola in honor of Debbie McAlear Cara Brown in honor of Debbie McAlear Ken Nippert in honor of Rose Garrett Marilyn Whitney in honor of Debbie McAlear Tiffany Owens in honor of Debbie McAlear For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.

TRANSFORMATIONS

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What We Believe Orders What We Value

by John Patrick, MD

he entire world can be divided into two groups with one simple question: “How does one determine which wins when loyalty and truth clash?” Many graduates of the modern university have been taught that truth is just a concept to advance the power of one group over another. The right response is to ask, “Is that statement true?”

Some are so bewildered that they don’t see the problem.

One way to pursue the discussion is to ask this question, “Are there any consequences that follow from how we resolve this dilemma?” Where loyalty wins, jobs, positions and power are all dependent on whom one knows. But where the intent is to put truth first, jobs, position and power depend upon assessments of competence. Which society will win in any power struggle? Competence always beats nepotism, which is where loyalty unbridled by truth ends.

Identity politics, which plague our society at present, are all dependent on the error of rating loyalty above competence (truth). How we order these important immaterial realities (often called virtues) is critical to the effective management of all institutions. In the Judeo-Christian tradition, God took a rabble of slaves fresh from 40 years in the wilderness and gave them His law. He did not ask them about how they felt about those laws; instead, He simply stated them and said, “If you obey, then you will flourish, and if you don’t, you will not.” Those laws are not popular to this day. They can profitably be understood as the divine intolerances! Legitimate intolerance is the foundation of stable society! In the 10 Commandments, the Lord says He will not tolerate any God but Him, any idols, any lack of reverence, any neglect of the Sabbath, any lack of honor toward parents, murder, adultery, theft, lying and coveting.

The founding of America assumed this foundation. John Adams once said, “Our constitution was made only for a moral and religious people; it is wholly inadequate for the governance of any other.” We are forgetting these erstwhile self-evident realities.

None of us can live up to these standards, but if their truth is denied, self-delusion, entitlement and anger will follow. Jesus began His ministry with this foundation assumed, and our inability to do it taken as the problem. When we face the truth of our nature, genuine humility follows, and its solution begins with repentance and continues with repentance throughout our lives. Hence Bernard of Clairvaux wrote that the first four Christian virtues are humility, humility, humility and humility.

That is not hypocritical virtue signaling, but it is genuine humility rooted in the recognition of our fallenness and resolved by repentance and forgiveness through ongoing mercy and grace.

The courage to live this way comes from knowing that He is with us always and He will live in us and lead us through the worst things in life with the peace and joy that only He can give. Our world thinks the problem is ignorance, but the problem is in the will, not the faculty of reason. We know what we ought to do, but it is the doing that is the problem.

Progress in these things is slow but real.

JOHN PATRICK, MD, studied medicine at Kings College, London and St. George’s Hospital, London in the United Kingdom. He has held appointments in Britain, the West Indies and Canada. At the University of Ottawa, Dr. Patrick was Associate Professor in Clinical Nutrition in the Department of Biochemistry and Pediatrics for 20 years. Today he speaks to Christian and secular groups around the world, communicating effectively on medical ethics, culture, public policy and the integration of faith and science.

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Introducing CMDA’s

R2ED Committee A task force of the Board of Trustees focused on Racism, Reconciliation, Equality and Diversity About the R2ED Committee

Given the CMDA mission of educating, encouraging and equipping Christian healthcare professionals to glorify God, the R2ED committee’s purpose is to: • Guide the CMDA Board of Trustees and CMDA’s membership toward a biblical response both within the organization and the wider body of Christ as it pertains to issues of racism, equality and diversity, especially as they intersect healthcare.

• Ensure that CMDA reflects the multi-cultural body of Christ both within leadership and membership by making recommendations to the board via the president on various issues that impact the demographics of the organization.

• Address health and healthcare disparities, deficiencies or inadequacies that exist as a result of racial/cultural or socioeconomic bias.

• Be a resource for the board and CMDA members so they can lead in healing within this country in times of social and political unrest as it pertains to issues of racism, equality and diversity, as well as carrying a torch providentially to deal with issues still unaddressed.

Racial Public Policy Statement

In September 2020, the Board of Trustees approved the following statement:

Compelling evidence has shown that racial and ethnic minorities in the US receive a lower quality of healthcare than the majority, even when controlled for other factors. CMDA opposes racism in healthcare in all its forms, whether personal, organizational, societal, conscious or unconscious.

People of all colors have been created in the image of God, and all humans are unique and incalculably precious beings of elevated status and dignity. The Scriptures consistently express God’s concern for the marginalized and disenfranchised, the sick and the poor, and they speak of God’s promise to hold accountable those responsible for their care. Racism is a lapse in the ethic of love that Jesus commands.

CMDA calls for renewed commitment to the mitigation and prevention of racial disparities in healthcare at every level, including access to care, delivery of care, inclusion in the community of healthcare professionals, medical education, and research.

Eliminating racial bias is in everyone’s interest and a vital element of the ministry of reconciliation to which Jesus has entrusted those who follow him and call themselves Christians.

Committee Members Committee members are available to speak for webinars, workshops or other events for groups desiring to address racism and reconciliation. For details, visit www.cmda.org/ racism.

Brenda Abraham, MD, practices family and sports medicine in Minnesota. After college, she attended one of the most diverse churches in the U.S. She loved the diversity as they united and worshipped Jesus. There, she met her husband Mark, who is African American, and they have been married for 28 years.

George Gonzalez, MD, is from a Mexican American family. He was born during his father’s surgical residency in Ohio. His family moved to Arizona and lived in a middle class mostly white community. He enjoys serving on medical mission trips and worshiping with those who love Jesus and who speak different languages but are our family in Christ.

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Nicole D. Hayes, MPA, is committed to serving as a vessel of love and truth for Jesus.

She is the founder of Voices Against the Grain, a teaching ministry that helps navigate societal issues through the Word of God. She is CMDA’s Washington, D.C. Area Director and Director of State Public Policy.

Omari Hodge, MD, is a family physician in Georgia where he also serves as faculty in a residency program. As a Christian and Black male physician, he learned that the way to view something is correlated to the angle from which you stand.

Dr. Hodge and his wife Kiera have found that their faith in Christ and dedication to His work have sustained them.

Charles Jaiyeoba, MD, practices gastroenterology in Michigan and is married with four children. He received his medical degree from Morehouse School of Medicine and completed residency

and fellowship at Detroit Medical Center. He has a desire for unity among groups and wants to see this done God’s way.

Andrea Johnson, MD, is an OB/Gyn faculty member at University of Texas Southwestern Medical Center where she completed medical school and residency training. Having faced difficulties as an African American female in academic medicine, she desires church unity along with justice and wholeness for every individual.

Warren Yamashita, MD Dr. Yamashita is a fourth-generation Japanese American. He became the first in his family to trust Jesus, and he is the first physician in his family. He is an Addiction Medicine Fellow at Stanford University. He desires to lead in Jesus’ work of breaking the chains of racism in America.

TRANSFORMATIONS

New Director for the Center for Advancing Healthcare Missions CMDA is excited to welcome Doug Lindberg, MD, as the new Director for the Center for Advancing Healthcare Missions (CAHM, formerly the Center for Medical Missions).

Dr. Lindberg is a family physician, and he continues to work part-time in urgent care just outside Milwaukee, Wisconsin. He is married to Ruth and they have two children: Maddie and James.

The Lindbergs served as missionaries for four years in Nepal, where Doug was the medical director at HDSC TEAM Hospital Dadeldhura, a small mission hospital in the foothills of the Himalayas. They have been back in the U.S. since 2013, when they returned from Nepal for what was intended to be a one-year home assignment. During that time, Ruth was diagnosed with stage IV carcinoma of unknown primary, which later was found to be endometrial cancer. She has now

been miraculously cancer free for more than five years. They had been praying for ways to re-engage vocationally with healthcare missions, and they are absolutely delighted to step into this opportunity with CMDA. As a ministry of CMDA, CAHM is designed to serve both domestic and international healthcare missionaries in their work, as well as aid in the recruitment, training and retention of career healthcare missionaries. Through its resources and services, CAHM promotes involvement in missions for healthcare professionals across their career spectrum, while also supporting missionaries on the field. In addition, they work with churches and sending agencies to promote networking and best practices in healthcare missions. Each year, CAHM hosts the New Medical Missionary Training conference, which has trained more than 500 missionaries over the years. For more information about CAHM and to contact Dr. Lindberg, visit www.cmda.org/cahm.

CMDA Learning Center Higher Learning for Healthcare Professionals

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Offering complimentary continuing education courses for CMDA members www.cmda.org/learning

he online CMDA Learning Center is continuing to grow with resources and information to help you in your practice as a Christian healthcare professional.

CMDA members receive continuing education credits at no cost upon checkout.

Going to the Rock from a Hard Place

New Courses Now Available

Human Trafficking

CMDA Ethics Statement on Pornography and Interactive Sexual Devices

Two Hours of CE Burnout in healthcare professionals is common, which negatively impacts staff, clinicians and even patients. Provided by CMDA’s Center for Well-Being, this webinar helps explore these topics and challenge you to enhance your well-being.

Two Hours of CE Pornography is any medium that depicts erotic behavior and is intended to entice sexual imagination. Pornography has reached epidemic proportions in terms of the number of victims and those addicted around the world.

12 Hours of CE Human trafficking is an important global health issue of our time. Provided by CMDA’s Commission on Human Trafficking, this newly updated curriculum addresses the identifying signs of human trafficking; interfacing with law enforcement and others; and handling the spiritual needs of victims of human trafficking.

Nine Hours of CE This course will prepare you for 2021 healthcare missions with CMDA’s Global Health Outreach. It serves to train healthcare professionals on patient safety, pharmacology, diseases and vaccinations confronted in underdeveloped countries throughout the world when providing medical and dental relief.

Recorded Webinar (No CE) This collaboration between CMDA and Dallas Theological Seminary Hendricks Center discusses the current state of churches reopening around the country amid the ongoing COVID-19 pandemic. It also includes an update on the development and ethical concerns of vaccines against COVID-19.

International Health

The Church and Science in a COVID World

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ubbles billowed heavenward with every measured breath as I adjusted my mask, cleared my ears, checked my depth gauge, and glanced down at my Luminox Navy Seal dive watch. Kneeling on the silt floor of the Red Sea, 41 feet below the water surface, we watched and waited, hoping to spot a dolphin.

Underwater the temperature was 84 degrees Fahrenheit, while on the surface the weather in Eilat was a pleasant, sunny, 74 degrees. At the southern tip of Israel, Eilat sits directly on the Great Rift Valley at the intersection of two tectonic plates. Gradual divergence between the African Plate and the Arabian Plate formed the Red Sea, which fills an oceanic rift that is expanding at a rate of 1 cm/year. This tectonic junction also marks an age-old geopolitical dispute between Israel and its Arab neighbors. Eilat is wedged between Jordan and Egypt, the highly secured borders of which lie about three miles to the northeast and three miles to the southwest of where I was.

The Red Sea’s extensive shallow shelves support miles of colorful coral reefs, which are home to abundant marine life and make Eilat and nearby Aqaba prime destination spots for scuba diving. On previous dives that week off the shore of Eilat, I had seen numerous arrays of fish as well as moray eels, lion fish, nurse sharks, starfish, a sea turtle, and a striped

sea snake. Especially memorable was the night dive when Chico (a local Israeli divemaster) and I explored the wreck of the Satil. An hour after nightfall, from the sandy shore we waded into the briny blackness. Pushing our way past splashing waves, going deeper and deeper, within minutes we were immersed. Once underwater, the visibility was so clear that, even in the dark of night, the glow from distant shore lights provided sufficient illumination for us to see each other and to navigate. We turned off our flashlights.

As our eyes adjusted to the muted lighting, we descended into a strange, beautiful, ethereal, underwater world. It was as if we had entered a huge snow globe. Hovering over the nocturnal seascape, every movement of our hands and flap of our fins stirred up bioluminescent algae sparkling all around. The experience was magically unlike anything I had ever imagined.

Today I had come a mile to the north, to Dolphin Reef, an ecological site that cultivates botanical ponds and hosts a school of bottlenose dolphins. Visitors have the opportunity to observe and swim with the dolphins.

My Israeli guide was Moshe. His name translates in English to Moses—a fitting name for the guide of a journey to the floor of the Red Sea—but unlike the biblical patriarch, this Moses was not exactly Torah-observant. When

Everything

That Has Breath

by William Polk Cheshire, Jr., MD, MA

Editor’s Note: This article was previously published in Annotations: An Eclectic Collection of Family Anecdotes, Memorable Stories, and Notable Narratives written by Dr. Cheshire. This reflective piece from developed from notes written on November 21, 1998. It is republished in Today’s Christian Doctor with his permission.

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he learned that I was a physician, he asked for advice on cooking up homemade hallucinogenic drugs.

Still kneeling on the Red Sea floor ten minutes later, the sea was quiet. No dolphins were in sight. This might be a day that they just did not come. The staff biologist leader of our group of six had told us before the dive not to be disappointed if no dolphin approached any of us directly, as they typically came only to him, whom they recognized, but not to visiting strangers.

On the sea bed we sat, kneeling, waiting, our periodic exhalations rising here and there as if from an assembly of change bells, their rhythm an indication of life, their hushed melody a signature of ineffable human aspiration.

When submerged in the sea with an aluminum tank fastened to one’s back, inhaling compressed air through a regulator lodged between one’s teeth, it is still possible to pray—silently. Human vocal cords are not designed to work underwater, but language claims a broader territory than audible speech. As I prayed, the image came to mind of a storm that had once tossed and threatened a small boat on the Sea of Galilee, just 260 miles to the north. When Jesus spoke to the winds and the waves, they obeyed, and the sea became calm.1 I invited Jesus to be with us now.

The physician Richard Swenson has calculated that, assuming mixing of the Earth’s gases over the centuries, for every breath we take, we inhale 150 million gas molecules that were breathed by Jesus Christ. “For whenever we inhale,” writes Swenson, “Jesus is there with us sharing Himself minute by minute and molecule by molecule.” Swenson likes to think of this “as Jesus performing a kind of mouthto-mouth resuscitation on us.”2 No sooner had my prayer bubbles reached the surface than, suddenly, out of the distance a dolphin approached our group, but instead of going to the group leader, who was waving his hands trying to attract the dolphin’s attention, he—or it might have been a she—bypassed the leader and came directly to me. Paused at arm’s length right in front of me, the gray aquatic mammal gazed into my face. There was an intelligence in the way he studied me, something about his eyes that conveyed interest and curiosity. I had not expected this.

The dolphin seemed to invite contact, and I reached up and stroked his soft rubbery skin. Although the anatomy of

dolphins’ permanently curved mouths suggests a fixed smile, dolphins lack muscles of facial expression. They are nevertheless highly social animals and communicate through body language and blowhole vocalizations. Perhaps God has endowed dolphins with subtle ways of communication among themselves, if not also with Him, that we have not yet discovered.

As my mind spun in wonder, the dolphin sped away with a swiftness impossible for humans. He was in his natural element. I was not, but for a moment we connected in a way I cannot adequately describe.

BIBLIOGRAPHY 1 Matthew 8:23-27, Mark 4:35-41, Luke 8:22-25.

2 Richard A. Swenson. More Than Meets the Eye: Fascinating Glimpses of God’s Power and Design. Colorado Springs, CO: NavPress, 2000, pp. 29, 188-189.

WILLIAM P. CHESHIRE, JR., MD, MA, is a Professor of Neurology at Mayo Clinic and a CMDA Trustee. Dr. Cheshire received his AB in biochemical sciences from Princeton University, his MD from West Virginia University and his MA in bioethics from Trinity International University. He completed his neurology residency and pain fellowship at the University of North Carolina. He is board certified in neurology and in autonomic disorders. He is a past president of the American Autonomic Society. With Doris, his wife of 38 years, he lives in Ponte Vedra Beach, Florida and attends the Church of the Redeemer, which is affiliated with the Anglican Church of North America.

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Growth Spurt

by Mark Mellinger

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God is expanding the National Embryo Donation Center to place His tiniest image-bearers into loving families. And it wouldn’t be happening if not for one physician working through a crisis of conscience.

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ometimes reality is far more awe-inspiring than anything even the most imaginative of writers could dream up. Decades ago, the idea that a woman could become pregnant with her adopted child seemed like science fiction. However, reproductive medicine has long since crossed biological boundaries in ways that once seemed impossible, creating complex problems that require morally sound, technology-driven solutions.

Since 2003, the Knoxville, Tennessee-based National Embryo Donation Center (NEDC) has been the national leader for one such solution: embryo donation/embryo adoption (ED/EA). The NEDC specializes in honoring life in its very earliest stages and facilitating pregnancies for women who want to carry their adopted children. And these days, the ministry is busier than ever, adding new initiatives and team members to expand the quality and scope of its life-affirming work.

If you’re not familiar with ED/EA, here’s a quick primer on the basics: First and most importantly, it’s a part of the solution to the modern problem of surplus embryo creation. Traditionally, physicians performing in-vitro fertilization (IVF) have created far more embryos than couples plan to use to build their families. That leaves many of those couples in the precarious position of having “extra” embryos (embryos remaining after their family building is complete).

Think of it as the tiniest human lives left in limbo.

A national center dedicated to ED/EA was actually the brainchild of former CMDA CEO Dr. David Stevens, who called Knoxville reproductive endocrinologist Dr. Jeffrey Keenan in 1999 to discuss just such a possibility. A few years of teamwork and the Lord’s intervention followed. Then, in 2003, the NEDC opened as a life-affirming response to the problem of surplus embryo creation. The organization, which is now a stand-alone non-profit, accepts embryos without charge from fertility clinics all over the country.

These frozen embryos are stored in Knoxville, while waiting to be “adopted” out to other couples hoping to add children to their homes. (Embryo adoption is not technically legal adoption with the exception of a few states. But since it incorporates many features of traditional adoption, the NEDC uses the term “embryo adoption” informally, similar to the way phrases like “adopt a highway” or “adopt a pet” are used. Furthermore, it is a familiar framework for patients to consider the process and procedures involved.)

With more than 1,000 births facilitated, the ministry has proven even more successful than first envisioned. The NEDC is among the first organizations those seeking to donate or adopt embryos will find in their internet searches. Its work is regularly featured by media outlets throughout the country.

And the center is well-known to reproductive medicine specialists at clinics all over North America, many of whom refer both potential embryo donors and adopters to the NEDC.

Yet as much visibility as the NEDC has achieved, this year the organization embarked on an effort to publicize a lesser-known aspect of its operations: the availability of what the center categorizes as “special consideration embryos” for adoption. Special consideration embryos are those for whom testing or medical history indicates a potentially increased risk of the child having physical, emotional or intellectual problems. Some of those problems could include congenital heart defects, the potential for autism, Down syndrome or other chromosomal abnormalities.

“The NEDC has always supported the truth that every human being, even in embryonic form, is of equal value and worth,” said Dr. Keenan, who has served as NEDC President and Medical Director since the organization’s founding. “However, because not all adopting couples are equipped to deal with children with special needs, it is important to notify them of the possibility.”

Dr. Keenan went on to point out that the transfer of such embryos could often result in the births of “typical” children. The likelihood of a child being born with an abnormality varies by case. www.cmda.org 13

The special consideration category also includes embryos for whom one of the donating parents has tested positive for a sexually transmissible infection like HIV, Hepatitis B or Hepatitis C. “When these embryos are transferred, there is a potential risk of the infection being passed along to the child and adoptive mother. However, this has never actually happened in the sum total of frozen embryo transfer history,” Dr. Keenan asserted. “Neither the adoptive mother nor the embryo being transferred is likely to develop an infection. Yet, because of the FDA requirements that couples be informed of the theoretical possibilities, most couples decline to receive such embryos.”

Of the NEDC’s hundreds of donor embryo profiles, less than three dozen fall into the special consideration category. That may not sound like a lot, but because they are so hard to place, the center’s leaders are concerned those embryos could remain unchosen. So, in the spring of 2020, the NEDC began an awareness push aimed at finding families with a heart for adopting special consideration embryos.

That push has consisted of three initiatives: awareness posts on the NEDC’s social media platforms, putting out the call on the organization’s website and a new 50 percent discount on donor fees (the fees reimbursing the NEDC for the shipping and care of the embryos) to those who adopt from the special consideration category. Though it’s hard to measure, NEDC leaders say there are early indications the awareness campaign is reaching those with a heart for accepting these embryos. Couples are beginning to ask about adopting from the special consideration category when they call or email.

“We would love to have a large supply of special needs donors and recipients because this gives witness to our re14 TODAY'S CHRISTIAN DOCTOR Winter 2020

spect for the life and dignity of all,” Dr. Keenan said, adding that the NEDC accepts all viable embryos. However, before the NEDC can accept more special consideration embryos in Knoxville, he said that much of the current supply will need to be adopted. “Traditionally, the chance of adopting out embryos with certain health problems or risks has sometimes been very small, and the NEDC has limited storage capacity. That means there are some situations in which we need to find adopters before we are able to accept the embryos at the NEDC facility,” he said.

The increased focus on these particular embryos hasn’t been the only major change at the NEDC over the last couple of years. The organization also realized a long-held dream with the addition of reproductive endocrinologist Dr. John David Gordon as its second physician in August 2019. Dr. Gordon relocated to Knoxville from the Washington, D.C. metro area, where he had practiced successfully for more than two decades. His presence allows the NEDC to perform more frozen embryo transfers and welcome more adoptive couples for initial appointments. Just how Dr. Gordon arrived in Knoxville is a story in itself.

In fact, it’s quite possible the NEDC might never have appeared on Dr. Gordon’s proverbial radar screen had it not been for a sequence of events in 2018. On Valentine’s Day 2018, Dr. Gordon’s wife Allison suffered an ankle injury that left her confined to home while convalescing. Allison, an energetic mother of four (with only her youngest still in high school), suddenly found herself laid up on the couch with a lot of time to read. The forced slowdown in activity gave Allison some rare time to reflect and to form convictions that would ultimately upend her family’s lives.

ABOUT THE DOCTORS Jeffrey Keenan, MD Dr. Jeffrey Keenan, a highly respected infertility and reproductive medicine specialist, leads the NEDC team. He is the center’s president and medical director and a fertility specialist with Southeastern Fertility in Knoxville, Tennessee.

He is board certified in obstetrics and gynecology, as well as reproductive endocrinology and infertility. Dr. Keenan is also a professor at the University of Tennessee (UT) Graduate School of Medicine and is director of UT’s Division of Reproductive Endocrinology and Infertility. In practice since 1990, Dr. Keenan has performed innumerable fertility procedures with outstanding success rates.

John Gordon, MD “I came home one day, and Allison said, ‘I’m going to tell you something that you really may not want to hear.’ And I said, ‘Well, what is it you want to say to me?’ I had no idea what she was going to say,” Dr. Gordon remembered. “She said, ‘I am just concerned that the way you’re practicing is sort of generating blood money and perhaps the things that we own have been paid for with blood money, and I’m not sure this is a right path for you to be on professionally.’”

To say Dr. Gordon was in shock would be putting it mildly. After all, he’d pursued a career in reproductive medicine because it offered the opportunity to build families and provide happy outcomes for struggling couples. He was skilled at the work and enjoyed it. In addition to all of that, he was a practicing physician and also the co-owner of a vibrant practice that had provided a good quality of life for his family. Now his wife was questioning the very nature of his professional identity. He had to know her specific concerns.

While healing from the ankle injury, she explained to him, she’d done a lot of reading about some of the ethical problems inherent in reproductive medicine. The birth of NEDC baby Emma Gibson following the transfer of an embryo that had been frozen for 24 years and the loss of thousands of embryos from cryopreservation system failures at clinics in Ohio and California placed the issue in stark relief.

“One of the bigger things that bothered me was the fact that fertility clinics were creating all these extra embryos and they were all sitting there languishing, in my opinion, in a freezer,” Allison recalled. “I thought, in God’s economy, they’re all lives just as valuable in God’s eyes as my life or your life or John’s life. And I thought there’s so much about fertility where they’ve taken the sovereignty of God out of

Dr. John David Gordon is an NEDC physician and co-director of Southeastern Fertility. He was born and raised in suburban Boston where he attended Milton Academy. He graduated from Princeton University with a degree in biology, and he attended medical school at Duke University. Dr. Gordon was an intern in obstetrics and gynecology at the University of Texas Health Sciences Center in Houston, Texas.

He then completed his residency training in obstetrics and gynecology at Stanford University Medical Center and his fellowship in reproductive endocrinology and infertility at the University of California San Francisco. Dr. Gordon is board certified in obstetrics and gynecology and subspecialty board certified in reproductive endocrinology and infertility. In 1999, he became the Co-Director at Dominion Fertility in Arlington, Virginia. Over the next 20 years, Dr. Gordon was consistently voted as one of Washington’s Top Doctors in Washingtonian, Northern Virginia and Arlington magazines. He is the author of many scientific articles and several books, but he is best known to health professionals as Editor-in-Chief of Obstetrics, Gynecology, and Infertility.

it. Sometimes the embryo that gets put back (into a mother’s womb during IVF) is just the one that happens to look the most advanced at that particular stage or the one that’s in the dish that is closest to the front of the incubator. Life and the creation of life should not be based on convenience in man’s eyes. So that bothered me a lot that all those embryos were languishing and people didn’t know what to do with them.”

Dr. Gordon listened carefully as his wife passionately unpacked her deeply-felt concerns. “Each one of [the embryos] is a unique human being, and they’re not being given www.cmda.org 15

an opportunity,’” Allison told him. Knowing his wife—an engineer with a PhD—to be a bright, thoughtful woman of sincere faith, Dr. Gordon couldn’t just disregard what she was articulating. He had to wrestle with these and other related questions himself, and he wanted to see if there was another Christian whose brain he could pick for advice.

Truth be told, Dr. Gordon had been feeling more and more dissatisfied with how he was practicing. Couples without infertility were using IVF to create and genetically screen embryos to allow for the selection of embryos by gender. The use of donor egg IVF was pushing the limits of reproduction, allowing women in their 50s to conceive without much regard for what this decision might mean for their children or for the large number of surplus embryos created that would never be allowed the chance at life outside of a cryopreservation tank filled with liquid nitrogen. These and a myriad of other challenging clinical situations made him question whether or not he could continue to practice in the field of reproductive medicine at all.

With that impetus, Dr. Gordon searched the internet looking for Christian perspectives on IVF. He found his way to the CMDA website, which specifically referenced the ethical dilemmas so troubling to him and his wife. From the site, he learned about Dr. Keenan in Knoxville. So he picked up the phone, made a call and left a voicemail. Intrigued by the message, Dr. Keenan returned the call the same day.

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Not long before, Dr. Keenan had sent out an ad, flyer and email nationwide seeking a second physician for the NEDC, with little meaningful response. He asked if Dr. Gordon had seen any of those. He hadn’t. As they discussed the ethically charged issues confronting reproductive medicine specialists, Dr. Keenan said, “Well you should come here to Knoxville and join me and just work here,” Dr. Gordon recalled. “I said I’m the co-owner of a successful practice here and I really just called to talk. I’m not looking for a job change. He said, ‘Well, you need to think about it.

Nothing happens by coincidence. There is a reason that you were led to call me today.’”

Later that same evening, Dr. Gordon went over the details of the conversation with Allison. She immediately responded by saying they should take Dr. Keenan up on his offer and move to Knoxville. “I’m the type of person who hates changing toothpaste brands, so stepping out into the unknown after spending two decades building a thriving practice in the D.C. area was almost too much for me to process,” recounted Dr. Gordon. “But in my heart, I knew from the very first night Allison and I discussed the move that it was going to happen. I had prayed for God to show me a new career path, but now that it was right in front of me, I was paralyzed.”

For the next year, Dr. Gordon and Dr. Keenan discussed various options and the timing of a potential move. “Over and over again, there were signs that moving to Knoxville

was the right choice. God’s fingerprints were all over this move,” said Dr. Gordon. In April 2019, it became clear that a change was needed, and so what had been a two- to three-year plan for a move to Knoxville suddenly became a two- to three-month plan. Now, more than a year after their arrival, it’s a move they don’t regret.

“To take care of these donated embryos and to find loving families for them, I am so excited about being a part of it,” Allison said. “After being where we were and John practicing the way that he practiced there, we’re just ready for this.

It seems redemptive, honestly.”

Dr. Gordon concurred, “For the first 23 years of my career I was part of the problem. We were and still are creating too many extra embryos in our efforts to help couples conceive. We have failed to adequately discuss these issues with our patients. Many patients, including those without faith or a belief in God, soon realize that discarding their extra embryos is an emotionally devastating decision and one that sometimes leads them to simply abandon their embryos rather than face these difficult choices.”

Now that he is settled in Knoxville, Dr. Gordon feels more at peace with his career than he has in several years. “Prior to leaving my former practice, I was told by the practice attorney and our accountant that my faith was incompatible with the goals of the practice,” he said. “I am so glad that I am in a place now where that is no longer the case.”

NEDC leaders say the entire staff shares Dr. Gordon’s joy in being able to give life and hope to families, all while caring for the smallest of God’s image-bearers. The Lord is authoring a wonderful, unpredictable story in Knoxville that’s having an impact all across North America. Going forward, NEDC leaders say their trust will remain firmly in the Master Storyteller, knowing it’s simply their job to turn the pages as He writes the next chapters.

MARK MELLINGER serves the National Embryo Donation Center (NEDC) as marketing and development director. In that role, he handles all marketing and public relations functions for the NEDC, and he is also in charge of helping secure the capacity to develop the organization. His background includes almost three decades in broadcast journalism, mostly as a TV news anchor and interviewer. Mark has also written for outlets like The Washington Post and The Gospel Coalition.

About the National Embryo Donation Center Since 2003, the National Embryo Donation Center (NEDC) has been the country’s leading comprehensive non-profit embryo donation program. Its mission is to protect the lives and dignity of human embryos. They do that by promoting, facilitating and educating about embryo donation and embryo adoption (ED/EA).

They are also the only clinic-based organization that works with families of all races, faiths and ethnic backgrounds.

When couples go through in vitro fertilization (IVF), the remaining embryos are often frozen and stored for later use. An estimated 1,000,000 human embryos are stored in the U.S. right now. The NEDC handles the medical, legal and social aspects of ED/EA. When someone donates embryos to the NEDC, they become the interim caregiver and store them at no charge to donors. From there, their team works hard to match the right embryos with the perfect family.

For more information about the NEDC, visit www. embryodonation.org.

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Feed My Sheep

by Jill R. Mattingly, DHSc, MMSc, PA-C

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I

“Feed my sheep.”

—John 21:17b, ESV

took in a sharp breath reading these words. Three words packed with meaning, promise and responsibility. Words I would hang all of my hope on for the next leg of my journey.

As Christians in healthcare, we are called to take our faith into the workplace, whether it be in a clinic, in a hospital or in academia. My journey in medicine led me from the clinic into academia. I actually consider myself an accidental academician who never meant to end up in charge of training a portion of the physician assistant workforce. This, however, is exactly why I am writing this story, to encourage my colleagues and help them understand who the sheep are, why they need feeding, how to feed them and when to stop feeding them.

In November 2016, I had just stepped off the plane at Atlanta’s Hartsfield Jackson International Airport after a 17-hour flight home to the U.S. from Johannesburg, South Africa. What had preceded this long flight was a two-week journey to Antsirabe, Madagascar with two physician assistant students to develop a clinical rotation. Traveling with medical mission teams to this remote site was one of the highlights of my life, as we had the opportunity to serve several rural villages during the first week of the trip. I left my students in Madagascar with an adjunct professor to work with the hospital surgical team for three more weeks. On the flight home, I was concocting an escape plan from my current position due to my feeling that others were planning to do the same, and I did not want to be the last one left holding the bag. Several of my peers had sailed for calmer waters in the face of a rigorous accreditation year and other difficulties.

Our team had whittled down over the last year, and our leader was teetering as well.

the terminal after landing in Atlanta. The text was ominous.

The leader who had been teetering had tottered. She was leaving at the end of the year. I was not too shocked, but when I started to project my concerns over the next eight months, I became distressed. If a new leader was not installed immediately, this could be a sinking ship scenario, and I wanted out.

Then I saw the faces of the students, one by one these people spilled out in front of me in a lucid dream. This sticking point would not allow me to slide out the door so easily.

A week later, I was driving to work continuing to pray about my next steps and my future. I turned onto a residential road that led to the university, and for the second time in my life felt as if someone spoke to me in an audible voice. The voice said, “Tell the dean that you will take the director position.” I froze at that moment, gripping the steering wheel. This is not what I wanted to hear. The next six months preparing for accreditation in June and filling the holes left by departing employees meant endless hours of work and no promise of success.

I stood at my desk that morning sifting through my thoughts, “Did I actually hear that, or was that just me throwing a wrench into my processing?” I called my sister and said, “I think I just heard the Lord tell me to become the director. Do you think…,” and before I could say another word, she said, “ABSOLUTELY!” No discussion,

My cell phone was beeping for my attention as I moved through

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just emphatic affirmation. After hanging up, I stood there thinking that I simply could not take that as the end of the discussion. What I did next is not a move I recommend for big decisions, but I needed a miraculous intervention to believe. I took my Bible off the desk and proceeded to close my eyes. I opened the Bible to a random page and blindly hit the page with my index finger. I opened my eyes and read the words under my finger. It said simply, “Feed my sheep.”

I immediately sat down and wrote the dean an email letting her know I was willing to take the interim director position and all that entailed. She responded enthusiastically and graciously. However, she told me it would not be interim; instead, it would be a permanent position as director of the physician assistant program. Over the next few weeks, a whirlwind of activity occurred as I prepared to take the helm. One thing kept playing in my head: “Feed my sheep, feed my sheep, feed my sheep.” I was desperate to understand everything those words meant.

I searched the Scripture for stories that echoed the story of Jesus telling Peter to feed His sheep. Stories about sheep, about caring for sheep and about protecting the sheep. Psalm 23 creates some of the most prolific imagery in Scripture of shepherding sheep. Most of those stories and images carried me for the year, but they never crystalized anything for me personally.

My roles and responsibilities as a physician assistant program director give me direct access to hundreds of brilliant, passionate people, many with strong faith and discipleship.

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More than a year passed before more light was shed on the “feed my sheep” exhortation.

“So I exhort the elders among you, as a fellow elder and a witness of the sufferings of Christ, as well as a partaker in the glory that is going to be revealed: shepherd the flock of God that is among you, exercising oversight, not under compulsion, but willingly, as God would have you; not for shameful gain, but eagerly; not domineering over those in your charge, but being examples to the flock. And when the chief Shepherd appears, you will receive the unfading crown of glory” (1 Peter 5:1-4, ESV ).

The day I read 1 Peter 5 was a turning point in my understanding. At that time, I was preparing to travel with eight of my students to Honduras on an annual Global Health Outreach (GHO) mission trip, and this passage of Scripture changed everything. I started to clearly see the program was not only a place of training incredibly promising medical professionals, but it also had a spiritual benefit for those seeking to grow stronger in their faith. Not every student is looking for a spiritual benefit, even though I know the intensity of the physician assistant training has enhanced numerous prayer lives. I am speaking about those He sends to us to mentor and guide.

When we as shepherds stay obedient to the Great Shepherd, these young disciples will be plopped on our doorstep for us to train, in whatever way the Master leads. It may be that we never know the ones we are affecting when we model humility and practice servant leadership. I may not know them, but He does, and He knew I could be the next mentor to feed them for a little while until He moves them to the next place.

GET INVOLVED

The Fellowship of Christian Physician Assistants (FCPA) is a specialty section of CMDA. This section provides a support network for the spiritual, professional and personal lives of its members. It also equips and encourages physician assistants to share their faith in all aspects of life and to glorify God in service to others. For more information and to get involved with FCPA, visit www.cmda.org/fpca.

As you feed His sheep in your own spheres of influence, I encourage you to follow these three guidelines I learned during my experiences.

1. “Exercising oversight, not under compulsion, but willingly, as God would have you” (1 Peter 5:2, ESV). This changes our attitude and reminds us to be the kind of leaders who see the sheep as our highest mission. Their care and training as a ministry is designed to allow them to grow and mature.

2. “Not for shameful gain, but eagerly” (1 Peter 5:2b, ESV).

Leaders can become bogged down in focusing on enhancing themselves, instead of mentoring those they are leading. When this addicting behavior overtakes the leader, it turns those being led into a commodity for advancement.

Love cannot be found in this type of environment, and the structure will weaken, rendering it ineffective.

3. Do not domineer over those in your charge, but instead be an example to the flock. Authoritarians relish dominance. The role of student is a vulnerable position with an obvious imbalance of power between student and professor. Feeding students is the same as serving students. We willingly take on the role as tutor and bring teaching and instruction to those placed in our care. Then we let them go.

The food for the sheep is the Word, the Word we hide in our hearts and live daily. I may not ever preach a single sermon to my students about how He changed a selfish, angry heart to a loving, humble heart; however, I can oversee a spiritual waystation for the disciples growing in faith and

works. Whatever your role—clinician, administrator, professor—we all have the ability to feed the sheep He places among us for a season. Whether it is for one student or for 101 students, as disciples we have the Great Shepherd’s example and admonition to…

“Feed my sheep.”

JILL R. MATTINGLY, DHSC, MMSC, PA-C, is the program director and department chair of Mercer University Physician Assistant Studies in Atlanta, Georgia. She practices family medicine as a volunteer healthcare professional at the Grace Village Refugee Clinic in Clarkston, Georgia. She attended Emory University Physician Assistant Program in Atlanta, Georgia. She received her Doctor of Health Science from Nova Southeastern University in Fort Lauderdale, Florida.

She serves on the Global Health Outreach (GHO) Advisory Council as the Physician Assistant Representative.

She has served as a board member for CMDA’s Fellowship of Christian Physician Assistants (FCPA). The Georgia Association of Physician Assistants (GAPA) awarded Dr. Mattingly the Humanitarian of the Year Award in 2015 and again in 2016. With her Mercer physician assistant students, Dr. Mattingly has served on medical mission teams in El Serrano, Nicaragua; Jalapa, Nicaragua; Rivas, Nicaragua; Siguatepeque, Honduras; Antsirabe, Madagascar; and Cusco, Peru.

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Dentally O Impacting the World for Christ

ver the last two years, CMDA’s dental outreach has developed into a two-pronged approach, ministering to traditional private dental professionals and also those seeking to serve the underserved, both domestically and internationally. Vice President for Dental Ministries Dr. William “Griff ” Griffin focuses primarily on engaging with our dental members, while Vice President for Dental Education Dr. Jeff Amstutz is developing general practice dental residency programs to equip dentists in ministering to the poor in the name of Jesus. Both aspects of CMDA’s Dental Ministries have been made possible by the generosity of the late Dr. Pete Dawson, who we seek to honor in this article, as we trace the Lord’s guiding hand over the last decade.

by William “Griff” Griffin, DDS, and Jeffrey Amstutz, DDS, MBA

Growing Dental Ministries

by William “Griff” Griffin, DDS

M

y involvement with CMDA began in dental school, shortly after I came to faith in Christ. Since then, the Lord has used CMDA to grow my understanding of the relationship between physical and spiritual health, while also fostering my increased involvement in ministry through dentistry.

In the early years of my association with CMDA, my involvement was mainly through reading CMDA’s publications and attending the CMDA National Convention. It was an encouragement to know other healthcare professionals considered faith essential in treating patients holistically. Each article I read was a reminder that other Christian healthcare caregivers across the country and around the world were seeking to live for Christ. I wasn’t alone in this endeavor.

Along with another dentist friend, my wife Linda and I attended the first Saline Solution conference (eventually repackaged as Grace Prescriptions) in Asheville, North Carolina in 1995. This experience confirmed and advanced my 22 TODAY'S CHRISTIAN DOCTOR Winter 2020

belief that healthcare can indeed be a viable platform for the gospel. A year or two later, the conference was repeated in Washington, D.C., and I was compelled to register once more, this time accompanied by a staff member. A few years later a conference was held in Williamsburg, Virginia, a mere 30 minutes from our home, and there I was again, with additional staff members. The opportunity to hear coauthors Dr. Walt Larimore and Bill Peel speak so powerfully to this topic, plus the privilege of interacting with others in healthcare who shared this goal, was a tremendous source of inspiration for my day-to-day patient encounters.

One of my patients came to faith in Christ, as did one of my staff members, and opportunities to speak of the love of Christ became more and more frequent during the course of everyday treatment. It was exciting to see how the Lord was at work, using dental needs to accomplish His eternal purposes.

In 2011, I received a startling email from CMDA announcing the search for a leader for the Dental Ministries, and they were asking me to apply for the position. The timing was not exactly ideal. I was the sole owner of a threedoctor dental practice, and I had just assumed the position of Board President of a local Christian medical-dental clinic. Linda and I prayed about it, and I submitted an ap-

plication, but I let CMDA know up front that the timing was not conducive to us making a change at that time. The wheels were turning, however, regarding how we could make ourselves available for ministry possibilities in future years.

The Lord brought just the right person to CMDA to assume the position, Dr. Jeff Amstutz.

I became part of the Dental Advisory Council, which enabled me to participate in several initiatives to grow the dental portion of CMDA. Then, in 2018, I received another email informing me of Dr. Amstutz’s plans to devote all of his time to the development of CMDA’s Dental Residency [+] program, and they were asking me to once more prayerfully consider coming on board with CMDA as Vice President for Dental Ministries.

At this point, the Lord had provided two excellent Christian dentists who were working in my practice, and five months later they purchased the practice as I put on my CMDA hat in January 2019.

Since joining CMDA, it’s been a fascinating whirlwind of activity. I have had the privilege of speaking at numerous dental and medical schools, interacting with students who are passionately pursuing excellence in the realms of both physical and spiritual health. I have been given the opportunity to speak at healthcare conferences, exhorting fellow Christians to see God’s hand in their chosen profession. Through the Dental Sound Bytes Podcast, I have been able to share the stories of inspiring Christian healthcare

professionals with our membership. At an age when many people are looking for retirement activities, I wake up each morning anxious to see what the Lord will do next through the lives of His faithful followers at CMDA. Our efforts to continue growing CMDA’s Dental Ministries include three primary goals: 1. Connect every Christian dentist and dental student with CMDA. Despite the great blessings of a career in dentistry, there can be severe bumps in the road along the way. We all need the fellowship and camaraderie of others who can understand the peculiar challenges we face and how the gospel ministers to us like nothing else can.

2. Inspire and equip Christian students and healthcare professionals to share God’s love with their colleagues and patients. As important as physical health is, the excellent care we seek to provide for our patients is inspired by the even higher motive of showing them the love of Christ (2 Corinthians 5:14). Truly holistic care recognizes each patient as being more than flesh and blood, having a soul and being made in the image of God. What a privilege it is to help patients discover that we are indeed “fearfully and wonderfully made” (Psalm 139:14).

GET INVOLVED

CMDA’s Dental Ministries is dedicated to encouraging and supporting dentists in living out their Christian faith in their professional and personal lives. For more information and to get involved, visit www.cmda.org/dentist.

3. Utilize dentistry as a platform for the gospel through domestic and international mission opportunities. Galatians 6:2 calls us to, “Carry each other’s burdens, and in this way you will fulfill the law of Christ.” What better way to do this than to give away our services to the needy around the world?

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In addition to the resources and services available to CMDA members, a variety of resources are available for dental professionals through CMDA’s Dental Ministries, including: • Dental Impact e-newsletter with regular updates on dental events.

• Dental Sound Bytes Podcast with interviews from dynamic dentists sharing their stories.

• Continuing dental education through the online CMDA Learning Center at www.cmda.org/learning.

• Dental school Bible studies where students come to know and grow in Christ.

• Regional Dental Coordinators who serve our members and students around the country (see sidebar for more information).

What is God Equipping You to Do?

by Jeffrey Amstutz, DDS, MBA

T

hrough its dental initiatives, CMDA is helping to meet the dental and spiritual needs of underserved populations in the U.S., while also equipping young dentists for long-term service to underserved and underreached populations in both the U.S. and around the world.

When I joined CMDA in 2012, I asked the Dental Advisory Council this question: “What is God equipping us to do?”

Little did I know the trajectory the answer to that question would provide. Having just returned to the U.S. after 12 years of missionary service in West Africa, I was well aware of the lack of dental care in most parts of the world, as well as the multitude of unfilled opportunities for dentists to serve in missions through dentistry. What I was less aware of, but becoming increasingly burdened by, was the tremendous need right here in our own U.S. cities and rural areas. Sitting around that advisory council table were some of the nation’s leaders in dentistry, women and men who God was using in the situations to which He had called them in their practices, their communities and in serving short-term around the world.

But who was focused on the care of those with less access to quality dental care? Might God bring together, through 24 TODAY'S CHRISTIAN DOCTOR Winter 2020

CMDA, a program that would focus on care to the least served while preparing for care to the least reached—all while living out the gospel through dentistry? Out of these questions was birthed the CMDA Dental Residency [+] program, and along with it came a major change in trajectory for my life and for CMDA’s Dental Ministries. God provided the way forward, through leadership and financial stability, for this new training focus, but also to bring in a new leader, Dr. Griffin, to grow and expand Dental Ministries while we also expand our incarnational service and training programs.

The work is hard, but God is calling young dentists to serve Him in new ways. As we approach dentistry to the poor and dentistry to unreached areas around the globe, we are thinking in new ways as we approach the problems and opportunities with a different mindset. While our programs certainly focus on dental training and delivering excellent care to those we serve, our primary focus goes well beyond the dental operatory as we equip our program participants to serve with resourcefulness, in humility and with generosity. Discipleship, community and dental excellence are paramount in building our culture. Building cross-cultural understanding and living it out daily in our neighborhoods, sharing our faith and praying with our patients are just some aspects built into the three-year program.

Launched in 2014, four cohorts have graduated to date from the dental residency’s Memphis, Tennessee location.

All of the graduates continue to serve God and underserved populations, with three serving as dental residency directors and one as dental director. Plus, all eight are faculty members, with seven in urban areas and one in a rural area, and a couple are in preparation for international service. Two graduates have moved to Detroit, Michigan to help launch our second program, which is in partnership with Covenant Community Care. In Memphis, our dental program through Christ Community Health Services cares for up to 15,000 individual dental patients in a given year. These are patients who otherwise would have nowhere to turn to begin the path toward oral health. While in our clinics, many are prayed with and the gospel, both spoken and lived, is present in the dental operatories through our dentists and staff.

What is God equipping us to do? We must continue to ask that question and respond. Recently, God seems to be providing an opportunity to expand our PLUS[+] programs to grow beyond just the resident program and to explore the addition of a PLUS[+] Fellowship program. We envision PLUS[+] Fellowship as a post-clinical training program to equip dentists and other healthcare professionals, including administrators, as they seek to live out their call to serve God cross-culturally through their vocations.

Introducing CMDA’s New Regional Dental Coordinators Midwest Region Katherine J. Musser, DMD Dr. Katie Musser is a general dentist in Memphis, Tennessee, working at a Christian federally qualified health center. She graduated from the CMDA Dental Residency [+] program in 2019 and now serves as faculty. She and her family live an intentionally missional lifestyle alongside other like-minded individuals.

She graduated from Asbury University with a degree in biology in 2011, and then she received her Doctorate of Dental Medicine at The University of Kentucky’s College of Dentistry in 2016. She is blessed with two daughters and a loving husband who has been a faithful flosser since the 7th grade.

Northeast Region Gary M. Beaudreau, DMD Dr. Gary Beaudreau is married to Nan, and they have two adult children. Gary is a general practice dentist in Augusta, Georgia. He graduated from Medical College of Georgia (MCG) School of Dentistry and came to know Christ personally while in college. He volunteered for years in dental student ministry at MCG leading student discipleship groups. He served on dental mission trips for MCG students and with the local CMDA council. Additionally, Gary worked on the development of an indigent care dental clinic at Christ Community Health Clinic in Augusta. In his free time, he engages with younger dentists and enjoys outdoor activities.

Southern Region Lee Bridgeman, DDS, MABS Dr. Lee Bridgeman grew up in the church, coming to a saving knowledge of Jesus Christ in elementary school. During his undergraduate training, he was challenged by a campus ministry worker to commit his life to sharing Christ with others and making disciples. Dental training at Baylor College of Dentistry was next where he learned that dentistry and other healthcare professions are a great platform for sharing the gospel and making disciples. A Master of Arts program at Dallas Theological Seminary gave him a good biblical and theological foundation. Ministry opportunities over the last 23 years include short-term mission trips to Africa, Asia, Central America and Eastern Europe, plus a year in Cusco, Peru. He is also an ordained minister in the Presbyterian Church in America, serving in a local church as an assistant pastor.

Western Region Malieka T. Johnson, DDS, CPT

GET INVOLVED

CMDA Dental Residency [+] is preparing a generation of dental disciples to go throughout the United States and the world providing excellent quality dental care to the poor in the name of Jesus. For more information, visit www.dentalresidency.org.

Dr. Malieka Johnson is a general and adult special needs dentist who holds additional certifications in personal training and nutrition. Dr. Johnson graduated from UCLA School of Dentistry in 2011.

In 2012, she completed a general practice residency at Rancho Los Amigos National Rehabilitation Center and received training in treating people with special needs. Dr. Johnson loves service and volunteers on multiple boards and within her local church and community. She has gone on multiple dental and housing mission trips abroad. Dr. Johnson enjoys learning and creating and is the author of the daily devotional, The Rx for L.I.F.E.

www.cmda.org 25

We continue to walk in obedience through faith into the areas God is leading us. This includes both expansion of services and opportunities for our members and students, adding Regional Dental Coordinators and caring for underserved populations, while also equipping dentists (and others) to live out their call with a lifetime, missional mindset.

WILLIAM “GRIFF” GRIFFIN, DDS, is CMDA’s Vice President of Dental Ministries. He has been a member of CMDA since dental school and has served on the Dental Advisory Council since 2013. He is a 1983 graduate of Virginia Commonwealth University School of Dentistry, and he has been practicing in Newport News, Virginia for 37 years.

Dr. Griffin formerly served as Board Chairman and Dental Director at the Lackey Clinic, a Christian medical-dental clinic in Yorktown, Virginia. He averages four internation-

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26 TODAY'S CHRISTIAN DOCTOR Winter 2020

al dental mission trips each year, and he is passionate about opportunities to communicate the love of Christ to others, both domestically and internationally. He and his wife Linda have been married since 1983, and they have enjoyed many mission trips together.

JEFFREY AMSTUTZ, DDS, MBA, is a graduate of Case Western Reserve and its School of Dental Medicine. He also completed an MBA at Kent State University. In 1999, he and his wife Carrie were called to the mission field where they opened a dental clinic in Gabon, established a program to train Gabonese dental technicians and launched a mobile ministry to reach remote villages. They also served in Mali and Senegal. He joined CMDA in 2012, and he now serves as Vice President for Dental Education, Peter E. Dawson Chair of Dentistry. His primary focus is the development of a Christian dental residency program to train dentists to help the underserved, both domestically and internationally.

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I Got My Joy Back…Now What?

A Deeper Understanding of Joy Through a Trip to Israel

by Betsy Manor, MD

GET INVOLVED

Burnout is a serious concern in healthcare today, and it only has the potential to get worse as a result of the global pandemic. CMDA’s Center for Well-being is here to help you during this time. For more information about the resources available to you to face burnout and get your joy back, visit www.cmda.org/wellbeing.

I

n the fall 2017 edition of Today’s Christian Doctor, I wrote an article about burnout stealing joy in my personal and professional life. I am thankful the Lord brought me out of that low place. He has continued to work on helping me understand what I initially wrote: “Joy is not a feeling of happiness; it is a daily commitment. According to Psalm 51:12, joy stems from understanding our worth in Christ and what we receive through His salvation. Joy starts with having the humility of a child that Jesus talks about in Matthew 18:4. Joy continues through an obedient life and trials that lead to perseverance according to James 1:2-3.”1 The practice of medicine has such a focus on the natural world with its patterns of order and human behavior.

Knowing these patterns does help reveal God to us, and it is what helps us become competent healthcare professionals, but it can be hard to consistently see life through the lens of a biblical worldview. It is much easier to see the world in our present circumstances and forget the span between eternity past and eternity future. Just as I was feeling this in my heart one night, the Lord directed me to Ephesians 1:17, which gave me the prayer I was longing for: “…that the God of our Lord Jesus Christ, the glorious Father, may give you the Spirit of wisdom and revelation, so that you may know him better.”

Traveling to Israel a couple years ago began a revelation for me, as it allowed the beautiful story from creation to Jesus to prophetic modern-day Israel come alive. I continue 28 TODAY'S CHRISTIAN DOCTOR Winter 2020

to work on really understanding that we are made in God’s image (Genesis 1:26; Hebrew tselem) and that we are His workmanship (Ephesians 2:10; Hebrew poiema). Furthermore, God loves us so much that He “sent His Son as an atoning sacrifice for our sins” so we might have eternal life (1 John 4:10). How could we possibly be more loved than this? Understanding these truths is foundational for having joy in all we do.

I was in Israel during election time, and it was hard not to think about the vulnerability of Israel and the worldwide hate that abounds. While praying with a group of friends that God would reign, I was struck by a verse I have known for many years but now had new meaning. Romans 5:8 says, “…While we were still sinners, Christ died for us.” What a humbling realization that at some point we are all separated from God in need of His forgiveness and most of us are “grafted in” by His grace (Romans 11:17-18). In a world that so desperately needs the gospel but so adamantly denies it, having this humility is important to be able to show love and forgiveness to others. It can be so easy to fall into the trap of thinking we are better than others or we are responsible for all of our own achievements. From our salvation to the very nature of who we are, God deserves the praise. Just when we begin to forget that, it seems our circumstances promptly remind us. In the last few months alone, I have been confronted with several clinical scenarios that have made me question my abilities. The scenarios ranged from a mere feeling of inadequacy to deep fear during a sudden life-threatening event that I couldn’t have prevented. While I cannot say I was grateful for the circumstances at the time,

I am now grateful for the role they play in understanding how small I am and how mighty God is. I keep 2 Corinthians 3:5 posted in my office as a reminder: “Not that we are competent in ourselves to claim anything for ourselves, but our competence comes from God.” Hopefully these moments of humility that God provides can draw us in to a deeper understanding of true joy by trusting Him. While in Israel, I had the opportunity to fellowship with 40 like-minded believers, many of whom were examples of lives lived for Christ across the decades and through countless different circumstances. They followed Paul’s prayer for the Philippians: “I pray that your love will overflow more and more, and that you will keep on growing in knowledge and understanding. For I want you to understand what really matters, so that you may live pure and blameless lives until the day of Christ’s return. May you always be filled with the fruit of your salvation—the righteous character produced in your life

by Jesus Christ—for this will bring much glory and praise to God” (Philippians 1:9-11, NLT).

The world needs Christians to live different lives because we are citizens of heaven and should point others toward our Heavenly Father (Ephesians 3:20; Greek politeuma). But in this day and age, it seems to get harder to want to be set apart, as that can easily mean persecu-

Travel with CMDA Join a CMDA Tour in 2021 and travel with your CMDA colleagues. These trips are filled with fun, fellowship, learning and wonderful Bible teaching. Go deep into the Word of God as we explore the roots of our Christian heritage. (Dates are subject to change.) For more information and to register, visit www.cmda.org/events.

Turkey – Seven Churches of Revelation April 10-17, 2021 April 17-20, 2021 Extension Italy May 22 - June 1, 2021 June 1-4, 2021 Extension Greece – In the Footsteps of Paul May 28 - June 6, 2021 Israel – In the Footsteps of Jesus June 8-17, 2021 June 17-20, 2021 Jordan Extension New Zealand/Australia Fall 2021 dates to be determined

tion and mischaracterization. As Matthew 16:26a says, “What good will it be for someone to gain the whole world, yet forfeit their soul?” I am certainly not as bold about my faith as some, but as I get older it has become increasingly less fulfilling to live in the way of the world and set my faith aside out of a misguided respect for others. How can we truly have joy if we live at odds with the life we have been called to live?

Traveling to Israel was such an amazing experience as it really brought to life so many aspects of the Bible. But it also helped to remind me that I have no less access to the Lord at home in Milwaukee than I did in Jerusalem, because He gave us the Holy Spirit to work in us no matter where we are.

Part of the evidence that we are living in the Spirit is having joy (Galatians 5:22). I hope a few of the things I have learned can bring us each to a deeper understanding of joy.

BIBLIOGRAPHY 1 Manor, B., MD. (2017, September 01). Where Did My Joy Go... and How Do I Get it Back? Today’s Christian Doctor, 48(3), 30-33.

BETSY MANOR, MD, has been a Christian since she was a young girl. She grew up in Madison, Wisconsin, where she attended the University of Wisconsin for undergraduate education. She moved to Milwaukee, Wisconsin to attend medical school at the Medical College of Wisconsin. She then completed residency at Columbia-St. Mary’s Family Medicine Residency in 2008 and has remained there as an assistant professor since then. They predominantly serve the inner city community in Milwaukee.

www.cmda.org 29

CMDA Ethics Statement on Opioids and Treatment of Pain

The goals of medicine are to restore health, prolong life, relieve pain, and ameliorate suffering. Among the medications available to relieve pain are opioids, which in the United States are controlled substances, that act on opioid receptors in the central and peripheral nervous system to produce a morphinelike analgesic effect. Opioids are addictive, and dose escalation or transition to potent illicit opioids such as heroin, or non-prescription fentanyl, can result in fatal overdose due to their suppression of respiration. Excessive prescribing of opioids with the intent to relieve or avoid undertreatment of pain, unlawful diversion of opioid prescriptions, direct-to-consumer marketing, and illicit recreational use for its euphoric or dissociative effects have contributed to a grave crisis of opioid abuse.1,2

DEFINITIONS

Pain is defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”3 Pain has a physical basis. Nociceptive pain occurs in response to ongoing tissue damage, whereas neuropathic pain is caused by disrupted neural pathways or altered neural thresholds for sensory perception.4 Suffering is a state of distress in response to pain, unpleasant bodily symptoms, anxiety, or anguish. Suffering is multifaceted and encompasses mental, emotional, social, existential, and spiritual components.5,6 Suffering is unique to the individual and his or her particular response to a past, current, or anticipated future situation. Suffering magnifies the existential experience of pain. 5,6

BIBLICAL

1. Pain and suffering are unavoidable aspects of human life as a result of sin (Genesis 3:16-19; Romans 8:1827).

2. Pain can have purpose in protecting from harm.4,5,7 30 TODAY'S CHRISTIAN DOCTOR Winter 2020

3. Pain or suffering should not be desired or sought as an end in itself (the whole counsel of Scripture).

4. Suffering is a mystery; it has a spiritual dimension and, even when it seems otherwise meaningless, can provide an opportunity for intimacy with God ( Job 42:5; Luke 22:39-46; Philippians 3:10, 4:11-13; 2 Corinthians 11:23-30; Hebrews 4:14-16).

5. Those who have suffered may thereby be equipped to comfort others (2 Corinthians 1:3-7, Galatians 6:2).

6. Suffering may be used by God to refine moral character (Isaiah 48:10, John 9:3, Romans 5:3-5). Reflection on suffering, in humility before God, may produce growth and maturity ( James 1:2-4; 2 Corinthians 1:3-7, 4:8-9, 12:9).

7.

God can use suffering to conform Christians to Christ’s image (Romans 8:28-29).

8. In heaven, pain and suffering will be abolished (Revelation 21:1,4).

MEDICAL

1. Almost all pain can be mitigated, but not all pain and suffering can be relieved by medical intervention.8-13 2. Pain is sometimes a necessary condition of medical or surgical treatment in the pursuit of healing.10-11 3. Appropriate uses of opioids include analgesia during surgical procedures, short-term treatment of acute pain, treatment of cancer pain, and management of pain or dyspnea in the terminally ill. 8-13 4.

Opioids are rarely indicated for the treatment of chronic nonmalignant pain.8 5. Many effective options other than opioids are available for the treatment of specific types of pain.8-13 These include, but are not limited to: a. Healthy lifestyle, including restorative sleep, appropriate nutrition, and exercise b. Control of chronic medical conditions c. Nonsteroidal anti-inflammatory drugs (NSAIDS) d. Acetaminophen e. L idocaine patches and other topical modalities f. Voltage-dependent calcium channel α2δ subunit inhibitors, for example, gabapentin or pregabalin g. Tricyclic antidepressants, for example, amitriptyline, nortriptyline h. Select SSRIs and SNRIs, for example, duloxetine i. Anticonvulsants, for example, carbamazepine j. Corticosteroids k. Local injections, without or with radiology guidance, using local anesthetics or corticosteroids, biologics, and viscosupplementation l. Nerve and spinal cord stimulators m. Biofeedback n. Acupuncture o. Manual therapy 6. Ministering to the spirit by prayerful reflection and contemplating Scripture, individually and in the community of faith, are important components of healing and ameliorating suffering.14,15 (Philippians 4:6,7; James 5:12-16) 7. Effective treatment of pain may involve a multimodal approach, which may include physical exercise, physical therapy, massage, medically appropriate osteopathic and chiropractic manipulation, and counseling to reframe one’s thoughts so as not to focus excessively on symptoms.8-13 8.

Caution and patient warning are strongly recommended when prescrib-

ing opioids for patients who consume alcohol or in combination with benzodiazepines or other sedative medications because of the danger of a combined suppressive effect on respiration.16,17 9. Prior to prescribing opioids for a given patient, screening for opioid dependence and addiction is recommended, including checking applicable prescription records or databases. Education about opioid prescribing is a component of medical licensure in many states.8,18 Additionally, ongoing monitoring of the patient’s access and use of opioids is helpful to promote patient safety.

10. As a general rule, with limited exceptions, the first line of treatment of pain should not be opioids.8-13 11. Proper and adequate control of pain is desirable as an important component of medical care.

12. Opioids cause constipation, urinary retention, impairment of judgment, and may cause delirium or increase a patient’s sensitivity to pain (opioid-induced hyperalgesia)8,10,11,19 13. Opioids should not be stopped abruptly for patients with long term use, but rather tapered.8 14. The bureaucratization of pain management can lead to excessive or inadequate prescription of analgesics (for example, unintended consequences from viewing pain as the “fifth vital sign”).20-23

www.cmda.org 31

EARN CONTINUING EDUCATION 1.5 HOURS NOW AVAILABLE

We are now offering continuing education credits through Today’s Christian Doctor. 1.5 hours of self-instruction are available.

To obtain continuing education credit, you must complete the online test at www.pathlms.com/cmda/ courses/24492.

•T his CE activity is complimentary for CMDA members.

•T he fee for non-CMDA members is $60.00.

If you have any questions, please contact CMDA’s Department of Continuing Education at ce@cmda.org.

Review Date: August 26, 2020 Original Release Date: November 23, 2020 Termination Date: November 23, 2023

EDUCATIONAL OBJECTIVES • Discuss how to implement a multimodality approach to pain management for your patients.

• Identify reasonable expectations for treatment of pain for your patients.

• Describe risks of opioids, including in combination with other respiratory suppressants.

ACCREDITATION The Christian Medical & Dental Associations is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

PHYSICIAN CREDIT The Christian Medical & Dental Associations designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

NURSE PRACTITIONER The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines. Nurse practitioners may receive up to 1.5 credits for completing this activity.

PHYSICIAN ASSISTANT AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit(s)™ by an organization accredited by the ACCME or a recognized state medical society. Physician assistants may receive up to 1.5 credits for completing this activity.

DENTAL CREDIT CMDA is an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 1/1/2018 to 12/31/2022.

Provider ID#218742. 1.5 Hours Self Instruction Available. No prior level of skill, knowledge, or experience is required (or suggested).

DISCLOSURE None of these authors, planners or faculty have relevant financial relationships.

Christine Toevs, MD, MA (Ethics); Mandi Morrin, CMDA Today’s Christian Doctor Editor; Barbara Snapp, CE Administrator; Sharon Whitmer, EdD, MFT; and CE Committee Members.

CMDA CE Review Committee John Pierce, MD, Chair; Jeff Amstutz, DDS; Trish Burgess, MD; Stan Cobb, DDS; Jon R. Ewig, DDS; Gary Goforth, MD; Elizabeth Heredia, MD; Curtis High, DDS; Bruce MacFadyen, MD; Dale Michels, MD; Shawn Morehead, MD; Michael O’Callaghan, DDS; and Richard Voet, MD THERE IS NO IN-KIND OR COMMERCIAL SUPPORT FOR THIS ACTIVITY.

32 TODAY'S CHRISTIAN DOCTOR Winter 2020

ETHICAL

1. Healthcare professionals are obligated to respond to their patients’ pain and suffering by actively listening, by applying their knowledge and expertise in an effort to relieve pain and suffering, and by providing compassionate care.5,8,11 They are to provide education for the patient and family or other caregivers.

2. Prescribers should be knowledgeable about the medications they prescribe.

3.

Healthcare professionals have the responsibility to learn about current methods of pain management, to develop treatment plans that utilize the range of multiple available diagnostic and therapeutic services to treat the underlying cause, and to refer when the patient’s condition is beyond their expertise (for example interventional radiology, pain services, palliative care, appropriate surgical specialists, etc.).8-13 4. Healthcare professionals should be sensitive to the shame or guilt that some patients on chronic opioids may experience and avoid adding to it.8,13 5. It is ethical, permissible, and recommended to inquire if the suffering patient has a personal faith or belongs to a faith community, as it may be advisable to recommend that the patient access appropriate resources.14,15 6. Not all patients are able to find meaning in their pain and suffering or have the spiritual or community resources to grapple with their circumstances.14,15 The Christian physician should be willing to encourage such patients to explore options that may provide meaning and purpose.

CONCLUSION

• CMDA recognizes that treatment of pain and suffering is a critical component of medical therapy. Opioids are but one small part of the multimodal treatment of pain.

• Christian healthcare professionals who know the unique hope Christ offers to suffering humanity, should be alert to signs that a patient’s request for opioid medication for pain may signify or be a part of a deeper need.

• Christian healthcare professionals should work to relieve pain and suffering for their patients using a multimodal approach, which may include encouraging their patients to seek support from a suitable faith community.

See also: CMDA Statement on Pain Management CMDA Statement on Double Effect CMDA Statement on Suffering CMDA Statement on Professionalism

REFERENCES

1. Rose ME. Are prescription opioids driving the opioid crisis? Assumptions vs facts. 2017. Pain Medicine. 0:1-15.

2. Clark DJ, and Schumacher MA. America’s opioid epidemic: supply and demand considerations. 2017. Anesth Analg. 125:1667-74.

3. Bonica JJ. The need of a taxonomy. 1979. Pain. 6:247-252.

4. Millan MJ. The induction of pain: an integrative review. 1999. Progress Neurobio. 57:1-164.

5. Bueno-Gomez N. Conceptualizing suffering and pain. 2017. Philos Ethics Humanit Med. 12:7.

6. Cassell. EJ. Diagnosing suffering: a perspective. 1999. Ann Int Med. 131:531-534.

7. Brand P. The gift of pain; why we hurt and what we can do about it. 1997.

Zondervan.

8. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain – United States, 2016. 2016. JAMA. 315:1624-1645.

9. Hsu JR, Mir H, Wally MK, et al. Clinical practice guideline for pain management in acute musculoskeletal injury. 2019. J Othop Trauma. 33:e158182.

10. Chou R, Gordon DB, de Leon-Casasola OA, et al. Guidelines on the management of postoperative pain. 2016. J Pain. 17:131-157.

11. Ng L, Cashman J. The management of acute pain. 2018. Medicine.

46:780-785.

12. Skou ST, Roos EM. Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice. 2019. Clin Exp Rheumatol. 37 Suppl 120:112-117.

13. Gauthier K, Dulong C, Argaez C. Multidisciplinary treatment programs for patients with chronic non-malignant pain: a review of clinical effectiveness, cost-effectiveness, and guidelines – an update. 2019. Ottawa: Canadian Agency for Drugs and Technologies in health.

14. Cronje FJ, Sommers LS, Faulkner JK, et al. Effect of a faith-based edu-

cation program on self-assessed physical, mental and spiritual (religious) health parameters. 2017. J Relig Health. 56:89-108.

15. Koenig HG. Religion, spirituality, and health: a review and update. 2015.

Adv Mind Body Med. 29:19-26.

16. National Institute on Drug Abuse. Benzodiazepines and opioids. https:// www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids. Accessed 10-19-2019.

17. Jones CM, Paulozzi LJ, Mack KA, Center for Disease Control and Prevention. Alcohol involvement in opioid pain reliever and benzodiazepine drug abuse-related emergency department visits and drug-related deaths – United States, 2010. 2014. 10:881-5.

18. Strickler GK, Zhang K, Halpin JF, et al. Effects of mandatory prescription drug monitoring program (PDMP) use laws on prescriber registration and use and on risky prescribing. 2019. Drug Alcohol Depend. 199:1-9.

19. Hayes CJ, and Painter JT. A comprehensive clinical review of opioid-induced allodynia: discussion of the current evidence and clinical implications.

2017. J Opioid Manag.13:95-103.

20. Levy N, Sturgess J, Mills P. “Pain as the fifth vital sign” and dependence on the “numerical pain scale” is being abandoned in the US: why? 2018. Brit J Anesthes. 120:438-440.

21. Ahluwalia SC, Giannitrapani KF, Dobscha SK, et al. “It encourages them to complain”: A qualitative study of the unintended consequences of assessing patient-reported pain. 2018. J Pain. 19:562-568.

22. Gordon DB. Acute pain assessment tools: let us move beyond simple pain ratings. 2015. Curr Opin Anesthes. 28:565-569.

23. Baker DW. The Joint Commission’s pain standards: origins and evolution.

2017.The Joint Commission.

Unanimously approved by the House of Representatives April 21, 2020 Bristol, Tennessee (and virtual locations)

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34 TODAY'S CHRISTIAN DOCTOR Winter 2020

tunity offers the candidate a large volume practice that is expanding, a four-day work week and an attractive call schedule with the call center handling all nightly calls.

Partners manage inpatient well newborns and general pediatric rounding. Neonatal coverage and deliveries are handled by excellent hospitalists, allowing time for outpatient focus. Exceptional candidates who are board eligible or board certified can expect a generous compensation package and great future earning potential. To learn more about this opportunity, please contact Physician Recruitment Coordinator Robin Lockett at 334-747-4507 or rjlockett@baptistfirst.org.

Pediatrician — Lighthouse Pediatrics of Naples, LLC, is looking to hire a board certified/board eligible pediatrician to join our growing medical practice. We are a physician-owned practice and Level 3 Patient Center Medical Home with a diverse and growing patient base. Spanish speaking is preferred. Lighthouse Pediatrics is located in beautiful Naples, Florida where we can enjoy the beach and other outdoor activities year-round. Please contact Diane or Amy at 239-449-9882.

Periodontist — A periodontist is wanted for established practice in beautiful Portland, Maine. Join as an associate leading to ownership or purchase the practice outright. Profitable and well-respected practice. Contact Dr. Donald Theriault at gumsrus@gmail.com or 207-776-4991.

CMDA PLACEMENT SERVICES

BRINGING TOGETHER HEALTHCARE PROFESSIONALS TO FURTHER GOD’S KINGDOM We exist to glorify God by placing healthcare professionals and assisting them in finding God’s will for their careers. Our goal is to place healthcare professionals in an environment that will encourage ministry and also be pleasing to God. We make connections across the U.S. for physicians, dentists, other healthcare professionals and practices. We have an established network consisting of hundreds of opportunities in various specialties.

You will benefit from our experience and guidance.

Every placement carries its own set of challenges.

We want to get to know you on a personal basis to help find the perfect fit for you and your practice.

P.O. Box 7500 • Bristol, TN 37621 888-690-9054 www.cmda.org/placement placement@cmda.org

“Our practice has a long history with CMDA. One of the partners in our practice was presented to us over 20 years ago by CMDA. Since we are a faith-based practice, we are looking for healthcare professionals with the same vision we have. The recruiters at CMDA have taken the time to understand our mission/vision and have worked with us to recruit Christian physicians and mid-levels for over 20 years. It has been my pleasure to work with various employees and recruiters with CMDA. In my position, I have had the opportunity to work with various recruiting agencies through the years, and CMDA has been and still is one of our most preferred agencies.”

—Donna J. Warner Human Resources Manager Family Medical Center of Rocky Mount

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My

CMDA

Story

Bill Sasser, DMD, while serving on a Global Health Outreach trip to Nicaragua.

“It’s a privilege to share my life with the CMDA family.

In a secular society such as ours, it’s a privilege to walk alongside men and women who seek to follow the great commandment of Christ, to love God and love our neighbors.

Scripture calls us to live examined lives before the Lord. Who’s really on the throne of my life? How am I using my time? Dental disease is a great need throughout the world, and I’ve learned how dentistry can be portable up to a point. As such, it’s a great vehicle for loving, serving and sharing the good news of the gospel. The call to serve is ongoing. We just have to respond to the call and say ‘yes’ to participation in a Christian organization like CMDA. Then get ready to mentor young people, donate your time and services at home and follow Christ’s order to support the Great Commission efforts around the world.”

—Bill Sasser, DMD P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.cmda.org/join memberservices@cmda.org

JOIN CMDA TODAY Join Dr. Sasser and more than 19,000 healthcare professionals across the country who are part of this growing movement of “bringing the hope and healing of Christ to the world through healthcare professionals.”

Visit www.cmda.org/join or call 888-230-2637 to join today.

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