Tachypnea, Science, Origins, Delusions…


You’ve read on my posts a lot about malaria and the innumerable untimely deaths it causes.  Last week I saw a 54-year-old community leader from a village about 10km from us, who has likely had the disease 50+ times in his life, arrive in a coma and barely survive.  I was thinking of him these past few days…


I am still recovering today from my worst bout with the disease (update as of Tuesday: after resolving for a couple days, it has returned and I am beginning another round of meds), and it became severe because I didn’t make the diagnosis.  I had a week of gradually worsening muscle-aches, and for several days I attributed the muscle-aches to an awkward wrestling match with a battery and a ladder the previous weekend.  Another man and myself were putting a 70kg solar battery on top of a wall in the clinic (out of reach of the curious), each of us on a ladder.  When we neared the top of the ladder (about 3m), his ladder slipped out from under him and he fell to the floor onto his stomach, leaving me holding tightly to one corded handle of the battery and in an awkward, folded position on my ladder.  We were both somewhat bloodied and sore (but ok) and I was sure uncomfortable the next day, and thus the misinterpretation of the worsening pains in my muscles and joints (in hindsight, the aches from the malaria began the same day).


I certainly thought of malaria, but I’ve had malaria many times and never without an early fever, though I’ve seen delayed fever in locals, so when the fall became less likely as a cause for my pain, I began to attribute my generalized achiness to the TB meds I’ve been taking for about two months (I picked up this disease last year and it was discovered in the US), which can cause muscle pain in about 10% of patients.  And then the fever hit.  A further delay in treatment occurred when my initial malaria rapid-test was negative (I was forced to again consider that it might not be malaria), but the next day was positive, so I began treatment about 5 days after the onset of symptoms and almost 48hr after the onset of fever!  Smile.  Next time you are tempted to criticize (or sue) a human being called “doctor” for not catching something early and accurately, perhaps you will remember this story – it’s nothing personal, and not necessarily “negligent”!


One of the physical signs in low-resource settings of impending death from falciparum malaria is tachypnea, or rapid breathing.  Most of those who succumb to malaria in our hospital (about one/day this month) develop this sign, though not everyone with tachypnea dies (perhaps 50%).  There are many causes for the rapid, involuntary respiratory rate (severe anemia, renal failure, acidosis, lung injury, etc) and survival of the inflammation in the lungs often requires oxygen support and sometimes ventilator support, neither of which we have in our hospital (no electricity).  I simply could not get control of my breathing.  I was breathing more than 40x/minute and could not slow it down.  Knowing what it meant didn’t help and also knowing that I don’t have much cardiac reserve because of my heart disease didn’t help either.  Betsy and I talked about the pros/cons of transfer out but it wasn’t possible, because it was late afternoon and the earliest a plane could arrive an hour away was the following morning because the airstrip we use is dirt and has no lighting (Brent, our beautiful MAF pilot/servant, was waiting our word to alter his morning flight plans).  At some point that evening I fell asleep and, when I woke up a couple hours later, I was breathing somewhat slower and without a sense of suffocation for the first time in about twelve hours, and the next morning (after more sleep) I had turned the corner, and had passed my extended “cardiac stress test”.  Malaria has, once again, earned my utmost respect and hate…


Quite comforting, as well, was the care of our friends and family, and that of my Father through His kids.  In the middle of the respiratory distress, Betsy asked many of you to pray, and so many responded.  And within hours, the crisis abated.  I wouldn’t pretend to understand, as I’ve asked my Father to heal people and they have died.  I’ve asked Him to heal others, and they’ve survived.  I haven’t prayed and people have improved…  I rest on the words of Jesus, the One who beat death, that our Father hears, He does what He will (which is always best), He sometimes actually responds according to our desires, and we will all pass through earthly death relatively soon, one way or another…


It is healthy to again come face-to-face with my mortality and remember that my days are numbered, that this life is truly but a vapor in the setting of eternity, and that my Father is good, whether I live or die, whether I am sick or well, whether I choose to surrender to Him or walk independently of Him…  He is good.  In just a few years, each of us will see (more clearly) just how good He is…


An illness like this, like separation from our family and other challenges of serving cross-culturally, prompts again certain questions: “What are you willing to do for My sake, and for the sake of those I love?”  “Are you willing to endure this again to serve the rural people in Angola?” and “Are you willing to die from malaria?”  I never want to go there again… but am I willing?  My true beliefs (see below) will be expressed in what I do, much more so than in anything I say or write…


Foundational beliefs and biases are difficult to overcome.  Most people in rural Angola have a fatalistic world view, involving a relationally distant god who is aloof, self-focused, no respecter (or lover) of persons, and has little concern for our activities/joys/difficulties.  There is minimal understanding of cause and effect and the influences of the unseen on that which is seen (in both science and in the unseen Kingdom).  The biggest influencers of behavior are relationships and community.  This fatalistic world view appears to result in peace, but also a lack of motivation to change anything. “What will be, will be.” “It is what it is.” are culturally common attitudes and, because of this perspective, little ever changes.  Fatalism is close to how some people in the church view sovereignty. There are those who believe that the biblical God controls every moment/action/thought on the earth and the only difference between this and the fatalism of the people I serve is that one can trust in the sovereign “Controller’s” good purposes vs the randomness of chance.  In neither world view, however, does one partner with God in the improvement or modification of the world or the people in it, and in both views the “believer” is free of any responsibility regarding outcome.  Jesus’ invitations to us to partner with Him (in both the OT and NT), to have an impact on people and the world, support neither of these views and, in any question re doctrine or belief, I always try to understand and embrace Jesus’ philosophies and methods.  Jesus describes His Father as more of a “Ruler” than a “Controller” …


The patients often look at me dumfounded when I encourage them to take action re their illness, either in prevention or in treatment.  They really do not believe that anything they do can truly effect the outcome and they actually fear intervening, embracing the myth that there is less risk in doing nothing than in doing something.  My opposite (and often unhealthy) world view of illusionary control over all outcomes can cause frustration!


In some respects, our nurses are gaining understanding.  They have now seen so many malaria deaths (almost daily) when the sick child (sometimes adult) arrives after more than 4 or 5 days of fever and they’ve seen so few deaths when the child arrives within three days of onset.  They now appreciate that the time to treatment matters and that this is obviously the result of the parents’ decision.  They sometimes yell at the parents immediately after the death of a child, and tell them that if they had brought the child sooner, he/she wouldn’t have died.  Not the best “bedside manner” but theirs is already not the typical Angolan’s perspective and understanding is the first step to change.  The nurses believe because they have seen, and those who have seen are few.


Our newly hired hospital techs (do anything/everything) haven’t seen much health care and bring their unmodified-by-experience world view to work.  Our vital signs are all automated and simple and should be easy and accurate, yet they are consistently inaccurate and, even after demonstrating multiple times that the blood pressure cuff must be placed in this manner, or that the pulse-oximeter needs to be put thusly… they just don’t believe that anything they do (accurate placement of equipment) really makes a difference.  They also, of course, don’t understand the significance of abnormal vital signs.  I also find medication errors daily (I simply ask the inpatients how many shots/pills they received that morning and compare to my order) and I’m sure we’ve had deaths and harm caused from more or less medication given than ordered. Virtually every day I, graciously and respectfully, address the issue with the med-giver and make a little progress for a few days (only because they don’t want to disappoint me) and then it happens again, often in a critical patient.  It is, of course, a lack of understanding of the different potencies of the various chemicals in medications combined with the world view issue.


I gave a talk one morning to our staff lining up different substances on a shelf and explaining that if we inject soap, gasoline, alcohol, peroxide, ketamine, or penicillin into them, the effects on their bodies would be different and I explained that medications were similar in that each medicine can bring health or harm, depending on how it’s used. There were many, “Really?” looks and “Why” questions that became difficult to answer to their understanding.  The best analogies were eating poisonous plants/bugs (they all have) and putting water in the gas tank of a motorbike, concepts they understood but hadn’t projected to their work.  We all struggled to learn our basic biology and chemistry as kids, but it really helped give us an understanding of the makeup of the unseen, yet very real, material world.  Early scientists were motivated by humble adoration in learning and admiring the world as their God had designed it.  There is no science taught to kids here…


At least here the kids are not being indoctrinated by the religion of evolutionary origins which, with all of its knowledge gaps and non-answers requires more faith than I have.  Faith.  For starters: Science has a sound Law of Biogenesis that establishes that there is no such thing as spontaneous generation and yet “science” claims that something, everything in the material world, came from nothing – without a god or intelligent design!  Then they postulate that life originated from non-life (it’s never been observed), contradicting the solid scientific law. We marvel at our simplistic technology (in comparison to nature), yet in all of our 2017 scientific intelligence, we cannot even duplicate most of that which we say came about by unintelligent chance!  We are taught (everywhere) that humans are more complex than lesser-developed evolutionary creatures, yet we are continually finding examples of both incredible (beyond our understanding), and irreducible complexity in single cells!


Irreducible complexity is simply the most basic complexity necessary for function.  For example, a simple, conventional, spring-loaded mouse trap could not have developed into that same mouse trap and performed its function without five, pre-manufactured-to-scale, independent pieces (four of these pieces will never produce the same mouse trap) (adapted from Michael Behe).  Blood’s principal function involves transporting nutrients and waste from one part of the body to another and cannot provide this function without microscopic exposure of new molecular nutrients to the blood (a separate mechanism to break down food to these molecular nutrients), a separate pump mechanism, variably permeable plumbing for the blood and a mechanism for elimination of cellular waste…  Several independent, interdependent, complete and functional pieces, prepared to function both independently and synergistically with other already-fully-developed pieces, must join forces to create a function that, prior to these pieces fitting together, didn’t exist, but one that will now give this organism a selective advantage in evolutionary terms.


Irreducible complexity.  The minimal number of parts of a functioning, irreducibly complex machine or organism can’t “develop” or evolve over time, they must be already fully formed at the outset of function. The parts of the mouse trap must be pre-manufactured and exist independently, be brought together and assembled together just right (prior to destruction of any of the independent pieces), to function.  No single cell is nearly as simple as a conventional mouse trap and no one would claim that a functional mouse trap evolved via chance and time, but we simply accept and believe (faith), almost without question, that the radically complex cellular organism evolved (or even a multi-celled animal or plant, the complexity of which is still very much beyond our understanding).  We allow our ignorance, arrogance and imagination (it’s never been observed) to form world views supporting evolution of something exponentially more complex than a mouse trap.   The vast majority of the people who “believe” in evolution have never really studied or questioned it, and cannot begin to explain it except in the most rudimentary, passionate, opinionated (and incomplete) manner.  Our increasingly arrogant and godless culture passionately advocates putting our faith in the opinions of “unbiased” scientists re origins rather than “foolishly and ignorantly” placing our faith in a Designer for this world, which is still-way-beyond-our-understanding and our ability to even replicate!


The only way that the sciences, especially at the cellular level (of which Darwin was almost completely ignorant!) can be used to support a theory of evolutionary origins is by applying irrational and unscientific faith to data, forming a theory and calling it science.  A few of the foundational hallmarks of the integrity of science are its observability, reproducibility and predictability, and where these are not possible, we are discussing a matter of faith, not science (intellectual honesty is lacking in our discussions).  There is no more factual, scientific evidence for evolutionary origins than there is for creation, alien invasion, or Santa Claus.  All require faith and our primary decision is, therefore, “In whom/what will I place my faith and, ‘Why?’”  What we believe about whose we are and from where/whom we originated (created by God with purpose and love vs a product of random chance) affects greatly our self-esteem (the lack of which is a glaring problem in our US culture today) and how we see ourselves and others.  It was precisely this (Jn 13.3) that motivated Jesus to wash the feet of the disciples and embrace the cross…


Those who support an evolutionary and designer-less (godless) theory have no alternative but to label me as a delusional lunatic for daily conversing with, following, trusting and worshipping a figment of my imagination for the last 30+ years…  My bias (faith) is pretty clear and quite difficult to explain via all-natural, materialistic means.  No one in my family is doing cross-cultural work (genetics/nature) and no one in my medical school class is doing what I do (experience/nurture).


So many people advocating for cultural moral “choice” and equality actually support a world view that doesn’t support moral choice.  A designer-less, evolutionary-origins-world-view cannot support free and rational moral choice, because we are all simply a product of our primary genetic makeup (not within our moral control) and the life-experience (chemical reactions) on those genes (not within our moral control).


I have worked in science all my adult life and believe in it, love it and practice it for the benefit of many, but I have shared with so many people over the years that science is developed by (flawed, biased, passionate, lovely) human beings like you and me and its historical strength is the safeguards that have been developed over time and experience to promote research integrity and to protect against the influence of human passions.  This includes intelligent and appropriate analyses of the comparative value of research studies (not all conclusions are sound, nor all collected data worthwhile) and the development of controlled and appropriately blinded research that can be reproduced.  When biased people try to use science to label something a fact which is not a scientific “fact” (read the “facts” on the labels of animal origins at your local zoo), it tremendously compromises true science (the kind that saves the lives of the people I treat with scientifically developed problem-solving methods and products).


We incorrectly label faith issues as “science” (future eventualities referred to as factual rather than theoretical, events from the past that are not reproducible, and the opinions of scientists).  We are too proud to admit that we are ever learning and all of our conclusions are “in process” (a joke in scientific circles is that the one constant of scientific conclusions is change), too insecure in our (more opinionated than studied) beliefs to defend them (intellectual honesty is rare), too inattentive to anything longer than a sound bite to respectfully explore the beliefs of someone with a different perspective, and too tired of so much emotional rhetoric to care.  A major scourge of science today is its politicization.  Science cannot be influenced politically and remain science but, like in every other facet of American life, greed has entered the scientific world in the form of financial grants/support and the very integrity of the profession is at risk.  Many scientific studies are now sponsored financially by people desiring a specific political or financial outcome and the methodology and integrity of the research is sacrificed for political/financial leverage!


Seeking to understand how the world around us operates through solid, scientific research can be an impetus for worship of the Creator of this wondrous world, which is (still) far beyond our comprehension, and leave us grateful for the opportunity to learn, explore, participate, understand…


I am for freedom of thought and belief (all belief choices have consequences, both pleasant and unpleasant) and people can believe that the moon is made of cheese (plenty of people consider my life and beliefs foolish and that’s ok), but language quickly disintegrates to meaningless when definitions of words like fact, law, and theory are altered to promote a specific agenda.


Our foundational, always biased (bias is the core of what we believe, not what we say), system of beliefs is established via significant relationships, life-long input from the world around us, learned facts, unseen forces (our Father’s constant revelation of Himself to us through people, events, thoughts, nature, etc), wounds, circumstances, etc, and we all then align various, selective facts (data) to support what we believe.  Our culture largely believes the lie that those working in the scientific community are unbiased (delusional thinking – there is no scientific research to support this conclusion) and many delusional people (there has never lived an unbiased human being) follow and use science’s “unbiased” rhetoric to support their biased, and largely ignorant (but passionate) world-view…


I worked for a highly intelligent, skilled, and passionate biochemistry scientist in graduate school who insisted that he never used faith/bias of any kind in his life.  He bought the lie that he was completely objective and he was convinced (he had aligned much information to support his rationale) that only evidentiary science was factored into any/all of his decisions and he completely disregarded (any/all) faith as legitimate, because he was a pure materialist scientist (no god).  He was inconsistent, however, in that he saw his choices about belief as sound and mine as foolish.  And, of course, he found joy in mocking Jesus, Christians and any believers in God.  This is inconsistent if one has no moral control (all decisions and beliefs are the result of chemical reactions apart from moral choice) over their decision to believe in God (of course, he couldn’t help himself – his own chemistry caused him to ridicule!).  But he was so passionate about denying faith of any kind that he was delusional when defending his position, mocking christians, speaking of origins and denying faith as necessary for past, unwitnessed/undocumented events, etc.   It seems quite clear to me that, along with evidence, faith plays a significant role in all of our daily lives (so difficult to admit for the scientific materialist) and in our decisions about what is true (whether discussing God or otherwise).  “Will this chair hold me?”


Our primary decision is, therefore, “In whom/what do I place my faith (trust, bias) and, ‘Why?’”  I am grateful that it is so stimulating intellectually, physically, emotionally, relationally, and spiritually to place my trust/faith in my Father and that everything I learn about His world creates another platform on which I can bow before Him in joyful worship (this will continue for eternity).  Jesus indicated that following Him would require courage and be fraught with ridicule and misunderstanding from “the wise”.  His words, of course, have far more weight than those of any scientist because of what He did.  What a privilege to believe in, converse with, follow, and worship the risen Jesus!


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