Four famous Catholic saints named Teresa

The Catholic Church has the custom of honoring certain individuals who have lived lives of great piety and virtue or for the heroic act of martyrdom.  Christianity is a difficult religion to follow. So much of what Jesus taught is extremely challenging to practice day in and day out, consistently, for years. Those individuals, who also had their faults, but who lived up to Christian ideals with remarkable success, are held up as examples of ordinary people who did extraordinary things. A saint is a role model.

It’s not easy to be declared a saint. The Church has a process that includes collecting all the possible data available on the individual whose name has been put forward, which includes any writing, interviews with people who knew them, interviews with people who did not know them but observed them publicly, as well as interviews with those who claimed to have had a miracle granted by this person’s intercession either before or after they died. These miracles must be documented and unexplainable by any other means.

A person put forward for sainthood must first be designated Venerable by the Pope, then a Servant of God, next as a Blessed and finally a Saint. The process may take several hundred years.

It is unusual for a series of saints to have the same name, because they deliberately chose to take a name they wished to be known by in their religious life, and then become a saint themselves.  This is the case, however, with four women who are all named Teresa in religious life.  (Although there are others, these four are the best known.)

The first was Teresa of Avila (1515-1582), or Dona Teresa de Ahumada y Cepeda , who took the name (this is a custom in some religious orders when an individual is accepted into the order, they take a new name) Teresa de Jesus (Teresa of Jesus). The second, Therese of Lisieux (1873-1897), was named for Teresa of Avila at her baptism, and took her name in religion as Therese of the Child Jesus and the Holy Face. Edith Stein (1891-1942), took the name Teresa, Benedicta de la Cruz (Teresa, Blessed by the Cross) because of her admiration for Teresa of Avila. In fact, she attributes her conversion to Catholicism to her reading of Teresa of Avila’s autobiography. Last was Gonxha Agnes Bojaxhiu, better known as Mother Teresa of Calcutta (1910 – 1997) who took her name in religion from Therese of Lisieux.  Other women, who took the name Teresa in religious life, are in the process of becoming declared saints themselves.

These four great women saints were all members of a religious order. All were known for their persistence in their faith and in the tasks they were to perform. Three belonged to the Carmelite religious order while the fourth founded an active missionary order (Missionaries of Charity).

All four Teresa’s had their faith revealed to the world either through their written autobiographies, through their personal correspondence or through other writings. In their time, they were pillars of strength to others, deeply in love with God, and demonstrated the Christian message through their lives. Whether they lived in obscurity or in international fame, they remained true to their calling: to love and serve God in the best way they could.

Two have been named “Doctors of the Church” (Teresa of Avila and Therese of Lisieux) meaning that their writings contain profound truths about spirituality. They are considered among the greatest teachers of Christianity and Christian spiritual practices.

All four were born in Europe, and three spent their entire lives in European countries: Teresa of Avila in Spain, Therese of Lisieux in France, Teresa Benedicta del la Cruz (Edith Stein) Germany and the Netherlands. Only Mother Teresa left Europe voluntarily.  Her order sent her to India where she spent most of her life.

Three died natural deaths. Edith Stein was gassed in Auschwitz.  They came from wealthy, well to do families (Teresa of Avila and Therese of Lisieux) or from poor circumstances (Edith Stein). They entered religious life at different times in their lives. Therese of Lisieux entered at age fifteen. Mother Teresa entered at eighteen. Theresa of Avila entered at around the age of 20, while Edith Stein was in her forties.

Of the four Teresa’s, only Edith Stein was a convert to Catholicism, having grown up a Jew. Edith Stein was also the best educated, having a PhD in Philosophy.

On the face of it, these four women don’t have much in common other than their religious names. What made them so notable that the Church says their lives reflected, at a heroic level, their love of God?

Teresa of Avila is famous in the Catholic Church for two things: she restored the Carmelite religious order to its original purpose and rule, and wrote some of the most profound books on prayer ever written (The Interior Castle). Her books, written in Spanish, were never edited or rewritten; they remain first drafts as she hand-wrote them during spare moments of the day.  She lived during the time of the Spanish Inquisition which attempted to stamp out any person or writing that was overly “spiritual” and was in fact, denounced to the Inquisition.  She lived in a time when kings and royalty ruled Europe and their word was final and binding. Everything that happened in a kingdom needed royal approval, including the founding of religious houses. She suffered from physical illnesses throughout her life, yet she traveled extensively to accomplish her goals. When exhumed, her body was found to be incorrupt.

Therese of Lisieux grew up the pampered youngest child of a well to do pious Catholic family. Like Teresa of Avila, her mother died when she was young. Her older sisters, one by one, left home to enter the convent. After a conversion experience, she too longed to enter the convent, and begged for permission to enter at the age of fifteen, one year before most girls were accepted into the order. Permission from the Bishop was requested and denied, so she appealed to the Pope.  She did enter at fifteen, dying at age twenty-four of tuberculosis. She left behind an autobiography (The Story of a Soul) written at the request of her superiors.  This book, like the works of Teresa of Avila, has become regarded as a giant in spiritual literature, documenting through her own life and experiences, how she followed Christian ideals in “little things” for love of Jesus. Just as she saw herself as only a “little flower” so her way to perfection became known as “The Little Way.” Her body remains incorrupt and is on display.

Edith Stein (Sister Benedicta de la Cruz) was born and raised a Jew. Her autobiography (Life in a Jewish Family 1891-1916, Institute of Carmelite Studies, 1986) is unfinished. She was a brilliant woman. Her doctoral dissertation in philosophy was a phenomenological exposition of the concept of Empathy.  As a woman and as a Jew, she was prevented from taking up an academic career at any German university but she was able to obtain a teaching position at a Catholic girl’s school. She was a popular lecturer. Some of her speeches and writings on women have been translated into English and published (“Das Frau” or “Woman.” Institute of Carmelite Studies, 1987).  After her conversion to Catholicism she was drawn to the Carmelite order where she was eventually admitted. When Germany began purging its population of Jews, her order transferred her to the Netherlands where it was felt she would be safe.  When the Nazi’s conquered the Netherlands, she and her sister Rosa were part of the general round up and they were sent to Auschwitz. The Church honors martyrs or those who died for their faith. Ironically, Edith Stein was martyred, not for being a Christian, but for being a Jew.  Pope John Paul II named her a co-patron saint of Europe.

Mother Teresa of Calcutta became known to the world when she accepted the Nobel Peace Prize for her work among the destitute of India. She founded the Missionaries of Charity, whose work of mercy was, and is, to serve the poorest of the poor.  She saw the face of Christ in every person she met, whether it was Pope John Paul II or a dying Untouchable crawling with worms. She drew people to her and to the work but insisted that she and the members of her order were not social workers. Their service came from a deep need to be obedient to Jesus in all things, rooted in a consistent and profound prayer life. Like Teresa of Avila, she was a strong minded woman. She had a rock-like faith that sustained her through decades of long arduous days of fighting and caring for the unwanted. Her letters (Mother Teresa, “Come be my Light”) describe her “Dark Night of the Soul” (Saint John of the Cross) while remaining completely trusting in God. She exemplified the message that the virtue of the “Corporal Works of Mercy” comes about only through deep prayer and love.

All four are admired by the Catholic Church for living out their faith in a heroic manner.  What is striking is that they deliberately chose the same name by which to be identified and known. Each was groundbreaking in her own way, following in the footsteps of Teresa of Avila. They represent the best of Catholic womanhood: strong minded, persistent, dedicated, deeply spiritual and loving. They gave everything they had. They shared Christ’s love with their lives.


Reading and Interpreting Research Reports

I have been reading the research on diet for almost forty years. Over that time, I have become aware that research data are interpreted by the researcher according to their personal preference for the outcome of the research. In other words, the “findings and conclusions” are tilted toward the researcher’s biases. Very much like the divide between liberals and conservatives in politics, dieting researchers generally belong to either the “Low Fat” or the “Low Carbohydrate” group and interpret their data accordingly.

For the past thirty years, the FDA committee that writes the “Dietary Guidelines for Americans” has produced their recommendations every five years. In looking at the Guidelines, it is clear that the committee belongs to the low-fat camp. I have read their reports which rely heavily on epidemiological reports with some clinical trials.

For those who don’t know much about epidemiological studies of diet, they rely heavily on phone calls to selected people and ask them what they have eaten over the past week, their gender, race, ethnic group and what their current health concerns are, what foods and beverages were consumed over the past week, how much and how many times. (Data collection can last for decades producing interim reports of findings.) From the thousands of answers to these questions, the researchers do a statistical analysis of the data based upon pre-set questions. These are then categorized according to the breakdown of known nutrients: fat, carbohydrate, protein, sugars, vitamins and minerals. This data is then recategorized by the other factors of age, gender, and health issues. Researchers look to see which variables seem to influence which variables. When reporting their research (which has an enormous amount of data), the researchers can have selective inattention. They may report the data the supports their diet belief system and ignore all the data that does not agree with their POV. Since no one else sees the data other than the research team, there is no one to cry “foul.”

The results of these studies are published and shared with the media. What the media does not understand about epidemiological studies is that the findings only show a statistical association between two or more bits of information. Epidemiological studies can never say “this variable causes this other variable to change.” So, basing the Dietary Guidelines on epidemiological data primarily, is like building a house on shifting sand.

Diet researchers also report on their clinical trials/experimental studies. These studies are the gold standard in research because they are so tightly controlled. The researchers must have some reasons (previous research findings) for including a certain variable and then deciding how it is to be studied and how long it will be studied. In diet research, a thorough knowledge of the physiology of processing food is critical. If the research is trying to compare a low-fat diet to a low carbohydrate diet, the researcher must know that there are differences in how the genders process foods and age also impacts food processing. Therefor a good study will select only one gender and age group to study. (If a study includes both genders and a range of age groups, then all the data must be compartmentalized by these variables. The results are only valid for specific gender and age groups. Knowledge is needed on how long it takes the human body to adapt to a change in diet, how different foods trigger insulin production, store foods, breakdown foods, are eliminated without being absorbed. This knowledge is critical to creating a research project that is both reliable and valid. If the project is too short, the findings are invalid. If foods are prepared in certain ways, nutrients are lost which will influence the findings. The gold standard for dieting research is one year in length. The usual results looked for are: amount of weight loss, changes in body measurements, blood values such as cholesterol levels and blood glucose levels. Even more specific tests can reveal the action of food on subjects.

Since 2007, there have been publications challenging the research upon which the US Dietary Guidelines have been based. (To date, these studies have not been considered by the committee producing these Guidelines. They are not listed in the references the committee says it used to produce the Guidelines.)

Two publications are worth noting. Both published in 2007. The first is the monumental literature review of dieting research and politics by Gary Taubes (Good Calories, Bad Calories). The second is the publication of the A to Z study by Gardener et al. Gardener was a member of the low-fat group. He and his team at Stanford, designed an experiment that compared four different diets: Atkins, Dietary Guidelines, The Zone and ultra-low-fat diet by Dean Ornish. They wanted to know which diet his overweight over-forty women would stick to the longest and which diet showed the greatest weight loss, the best blood values and stayed on it longest. To Gardener’s surprise, The Atkins group lost the most weight, stuck to it the longest and had the best blood values. In contrast, the low-fat group gave up the quickest, lost the least amount of weight and had the worst blood values. The committee publishing the US Dietary Guidelines has consistently ignored these two publications.

A new publication, belonging to the low carbohydrate group, by Volek and Phinney (2011) is adding to the research data on low carbohydrate diets. They have conducted many clinical trials/experimental designs (with not much success at getting published in prestigious journals that espouse the low-fat belief system. What they have found, which flies in the face of previous research, is that exercise does not contribute to weight loss in many people (although it is important for fitness reasons), and that people with insulin resistance do better on a low carbohydrate diet, while people with insulin sensitivity do better on low fat diets (finding by Gardener et al.). This tells us that the dichotomy of low-fat versus low-carb isn’t the answer. It depends on the physiology of each individual person. One size does not fit all. To my mind, this s a breakthrough in dieting research. This publication is also ignored by the committee producing the Dietary Guidelines for Americans.

Why does the committee insist upon restating the low-fat mantra despite the research demonstrating that it is palpable false? Two answers are possible. Either the committee is unable to see that they have a low-fat bias which skews their report or there are vested interests that have convinced the committee to stand fast. Until the Medical Research Council funds a large scale study comparing the diets – similar to the Gardener et all study – there will be no changes in the Dietary Guidelines for Americans.

Rebecca “Becky” Self: Her Story

My family called Rebecca Self, Auntie BBecky Self 1951illie. She was not a blood relative but she was such a close friend to my parents, it seemed too formal to call her “Mrs. Self.” Becky Self was an army nurse. During World War II, she and her husband, Leonard, were imprisoned with us in Cebu and Manila (Santo Tomas Internment Camp). I mentioned her in my memoir as making my brothers and me, as a baptismal gift, small pillows we could take to Mass to kneel on. Auntie Billie told us that she was part Cherokee. When she let her dark hair grow, and twisted it into a braid, she did look Cherokee.

The following is a letter Auntie Billie wrote to me dated July 10, 1956, from Bono, Arkansas. Apparently, I had written to her dithering over what I should do with my life: enter the convent, wait for ‘Mr. Right’ to come along and get married, or go on for graduate education. The date of the letter reminds me that I had just graduated from school and was living on my own in my first apartment with my first graduate nursing job. I was a head nurse on the evening shift on a surgical ward at St. John’s hospital in Santa Monica, California. This letter is autobiographical. She was demonstrating to me that life is a series of choices. It is a remarkable story of a strong woman who persisted in following her dream despite all the obstacles. I am sharing her letter to introduce her to you. I left in her words of advice to me at the end of the letter. Only personal messages to me are deleted.

Dearest Pam,

The reason I am writing you now is mostly because I want to tell you something of my own experience and about my life, and give you some un-asked for advice. First, I am glad you are alone for awhile, but I was very glad too to be with older and experienced nurses when I first graduated. I also had the lost feeling when I left the Sisters petticoats and the shelter of my home hospital – also that striped uniform, to go to a strange place among what I considered foreigners, I shall never forget the first time I was on night duty at an army hospital in Fort Sills, Okla and a woman came in to have a baby and we didn’t get her any farther than from the car to the litter and she had it on the front porch. I had to deliver it with my bare hands all by myself. I left it there with her and we got her to the delivery room and I called the O.D. [Officer of the Day] and also an older nurse that was on night duty and she came over and made me tie the cord and finish up the job. When the O.D. arrived he asked me why I had called him? I had many such experiences in my career. It doesn’t take long till you feel at home.

When I was about 9 years old a horse threw my Mother and broke her hip. My youngest sister was 6 mos. old at the time, from then on, I was as grown up as I’ll ever be. I knew that someday, if it took me the rest of my life, I would be a nurse. My mother used to take us to Mass once a year. We lived so far away only 25 miles, but it might as well have been 500. We had no car only 2 old mules & a wagon, and we were very poor, so we could only go to church once or twice a year at the most. Every time I went I couldn’t take my eyes off the Student Nurses or the Sisters. I wanted to be a nun at the time but my practical mind got the better of me. I wanted to get myself and my family out of the poverty we had gotten in since we had left Kentucky & moved to Arkansas in 1918.

Pam, I struggled on going to school in the country 2 or 3 days a week until I finally finished the 8th grade. I was 14 years old and had no hope of going any further, but I never did give up. One day a missionary priest came along and talked to me. He got me a job at the hospital washing dishes and I could go to school to the sisters in my spare time. I washed dishes 3 times a day for 2 years. They paid me $20.00 a month and my room and board and schooling. I worked until my father had to go to Florida to get a job and my older brother and my mother were trying to keep the rest of the family from starving to death. There were 3 others besides my brother and myself and all younger. My mother got sick and I finally quit and went home. I was very unhappy about it but I was needed at home to take care of my Mother, so I packed up my little tin trunk and back home I went. Cooked and kept house and hired out by day to Chap Calton for a $1.50 a day. My brother and I could make $3 a day. That was in 1925. We lived in a small town in one of my uncle’s houses and didn’t pay rent so we could eat on $3 a day. I stayed home 6 months that time and helped my brother while my father was away. Then the priest came back again to say Mass at our house and see what I was going to do. Now that my family was sorta on their feet they still needed me but they could make out now without me.

I told the priest I was not going back to dish washing. I had the amount of education necessary to enter nurses training and that’s what I always aimed to be and the quicker I got started on it the quicker I could help my family. And if I wasn’t old enough in years, I sure felt like it. He told me to pack my tin trunk again and come on back to the hosp. he would talk to the Supt. of Nurses and also the Rev. Mother. He had a royal battle I heard later, years after, but we both won out.  I had to promise him I would not go anywhere without his permission and he had to promise the nuns he would be responsible for me. On Dec. 23, 1925, I entered Nurses Training and on May 12, 1927, I walked out of the chapel with a diploma in my hand and a white uniform on. That was one goal I had successfully reached. I knew from there on what I was going to do. I was only 19 and I had no desire to get married. In fact, I hadn’t yet had my first real date with a boy. I got me a job and started from there helping my family. It was a long slow struggle up, but it kept me going. When my baby brother was 6 yrs. old a mule kicked him & ruptured his spleen. I had only been in the Army 2 weeks. It took me almost 2 years to pay for his operation and Hosp. bill and live on $70 a month. My father and I bought their first 40 acres of land when I finished that debt. Then I went in for $500 more. The year of 1935 I left the States to come to the P.I. I still owed 40 dollars for a mule I bought my Father. I paid that off after I got to Manila. I was 26 years old the August after I got to Manila. I felt for the first time in my life I was free and that I could live a little and that I had paid off a debt I had promised myself to do if God would be so good as to give me the chance.  When I left the States my family was definitely on their feet and on the way up. My sister Shirley, 5 years younger than I, was already married and owned her own farm, even had a baby. My baby sister was about to get married and my youngest brother seemed to want an education so he was going to high school. My Brother Glenn, older by 23 months than I, was still at home helping my Father farm and didn’t seem interested in getting married. In fact, he was the last one to get married in 1942 just before he went to war in Asia.

Well, Pam, nothing that happened to me was planned, nothing except I wanted to be a nurse and after I became one I wanted to help my family and did. When I felt I had done that I just kept on nursing and let God and fate do the rest. I was 27 years old when I met Leonard and I knew the minute I laid eyes on him he was the man I would marry. And it will happen that way to you if it’s to be. Maybe you have a vocation to be a Nun, but unless you desire that more than anything else in the world you don’t have one, my dear. Don’t be in a hurry to decide. After you have nursed awhile and seen some of the sordid side of life you may want to become a Nun yet on the other hand you may fall in love and marry. Whatever you do, you still have plenty of time. Just don’t rush life, it has a way of passing by on its own. I was 28 years old when I married and soon will be married 20 years so you see you have time. And if marriage is your lot, you don’t have to find a husband, one will just come along, or you will stumble up on one, don’t just hunt one but just keep your eyes open.  Ha!

I will give you the last piece of advice and then I will shut up:  Pam, stop thinking about what you are going to do and just live day to day and let happen what will for a while and see if something doesn’t happen sooner than you expect. Get down to living, have fun, save a little money, and come see us. And anything can happen in Arkansas. Just let yourself go. You don’t have to think about anyone but yourself now do you? Bob, Bill and your Mother seem to be doing all right for themselves so I don’t see why you are doing all this serious thinking. Pray – yes.

Do you remember Curt and Elizabeth Hogan from San Carlos Sugar Central in the P.I.? They were here to see us the latter part of May.


Auntie Billie

P.S. That little brother is now an M.D.  in Hazard, Kentucky.

Pamela J. Brink, Robert A. Brink, and John W. Brink. 2016. Only by the Grace of God: One family’s story of survival during World War II as prisoners of war in the Philippines. Archway.

A Biographical Sketch of Edith Stein

Edith Stein was a German Jew who converted to Roman Catholicism, entered a Discalced Carmelite order of nuns, was gassed at Auschwitz in 1942, and was canonized a saint in 1998.

Edith Stein (Sister Teresa Benedicta of the Cross OC), born in 1891, was the youngest child in a large Jewish family living in Breslau, Germany. She attended university and served as a volunteer nurse on the Russian front during World War I. What is known about her early life comes from her unfinished autobiography in which she chronicles her family with awesome recall. (Edith Stein, “Life in a Jewish Family:  An autobiography.” ICS Publications. Washington, DC.  1986.)  Brief sketches of family members as well as a chronological account of her life within the family are treated with honesty, describing failings as well as triumphs. The love in the family shines through every page.

At the university, she studied under Husserl, the founder of Phenomenology, one of the newest concepts in Philosophy. She wrote her doctoral dissertation in only two years. Husserl considered Edith his most promising student; but the academic appointment she had expected and he had led her to believe she would receive went to a fellow student, a Christian male named Heidegger. Instead, Husserl hired Edith to be his assistant which meant she was essentially a glorified secretary. A magnificent intellect was wasted simply because she was a woman and a Jew.

In order to support herself, she taught at a Catholic girls’ school until she entered a Discalced Carmelite convent in Cologne, Germany. When the persecution of Jews began in Germany, her order sent her to another Carmelite convent in the Netherlands where her superiors felt she might be safe. When Germany invaded the Netherlands, Jews were rounded up and sent to concentration camps. Edith and her sister Rosa were among those taken.

There is a story that a young man was standing at a railway trestle in Breslau when a cattle car stopped. The doors to the cars were opened to reveal people packed in. The stench was horrific. A Carmelite nun moved to the opening in the car saying, “This is the last time I will see my beloved Breslau.” Edith Stein was never seen or heard from again. Speculation has it that she was immediately taken to the gas chambers where she died and was cremated. The young man, when shown a picture of Edith Stein, confirmed that she was the nun he had seen in that cattle car.

In her autobiography, Edith describes a few experiences she had that lead her from Judaism to Catholicism. She tells of one incident that affected her very powerfully. She was visiting a church as a tourist when she saw an old woman enter, genuflect, then go down on her knees to pray. This was the first time Edith had seen anyone pray in an empty church or outside formal services. It lead her to question what made this church so special that someone would come in to pray alone.

After this experience, she spent all night reading the autobiography of Teresa of Avila. Although this was the beginning of her conversion experience we know little about it or her decision to enter a Carmelite convent. Whether this apparent reticence signified a desire to keep her spiritual life private or because she never had the time to detail what had happened to her, we will never know.

Edith Stein was a remarkable woman. In a time when women were expected to be homemakers and not academics, she was an academic. In a country where to be a woman or a Jew meant there was a glass ceiling for almost any academic position, she was both a woman and a Jew.

Most American academics (and even phenomenologists) may never have heard of Edith Stein simply because her work is in German. Only recently (since the 1980’s) has the Institute for Carmelite Studies translated some of her works into English. Her doctoral dissertation on “Empathy” is yet to be translated. She is, however, well regarded and well-read in Europe.

In the Collected works of Edith Stein, translated into English and published by the Institute of Carmelite Studies, the first volume is her unfinished autobiography, “Life in a Jewish Family 1891-1916.”  (ICS Publications. Washington, DC.  1986).

The second volume of her translated works is “Edith Stein: Essays on Woman” (ICS Publications. Washington, DC. 1987), is a collection of her published articles as well as unpublished speeches.

The third volume is a collection of papers given at an Edith Stein symposium (John Sullivan, Editor. “Edith Stein Symposium: Teresian Culture.” ICS Publications. Washington, DC. 1987). The first section includes biographical papers on Stein. The second section is on the Carmelite order and the third section is on themes derived from the writings of Saint Teresa of Avila. The final section of the book covers Pope John Paul II’s comments about Edith Stein at her formal beatification ceremonies in Cologne.

Edith Stein lived her life being discriminated against because of her gender and her religion. She died for her natal religion despite having been converted to Catholicism. She lived under an unjust political system. Despite these persecutions, or perhaps because of them, she developed a great spirituality. She was canonized by Pope John Paul II in 1998 and was named a co-Patron Saint of Europe.

You are the Triage Nurse in the ER

You are working the night shift in the emergency room. Four ambulances arrive at the admitting door at the same time. The attendants say they have gunshot wounds to the head. All four patients are critical. Which patient do you see first, second, third and last? This is the job of triage. There is not enough staff to see all four at the same time. In fact, you are so short staffed, only one patient can be seen at a time. How do you decide which one to see first? All have exactly the same medical emergency. All four are bleeding profusely from a gunshot wound to the head.

Patient number 1 is a four-year-old boy who was playing with his father’s gun.

Patient number 2 is a beautiful young woman. She had attempted suicide by shooting herself in the head.

Patient number 3 is an elderly man who was cleaning his gun and did not check to see of it was loaded first.

Patient number 4 is an elderly obese female who has been shot by an intruder in her home.

How do you decide the triage? Each patient has certain characteristics that influence decision making.

One characteristic is age. Many people will unconsciously consider a child more worth saving than an elderly person, so would choose Patient number 1 over Patients 3 and 4.

A second characteristic is gender. Many would treat males before females, seeing men as more important than women.

A third characteristic is attractiveness. Patient 2 would be seen before Patient 4 as a beautiful young woman is seen as more valuable than an obese elderly woman.

A more subtle choice is based upon a judgement about the victims responsibility for causing the gunshot wound.

Patient number 1, the little boy, was playing with his father’s gun, something I am sure he had been told not to do. So, the accident was self-induced. But children don’t really understand that actions have consequences.

Patient number 2 is a suicide and therefore the gunshot wound was self induced. She is totally responsible for her condition. Health professionals don’t really like people who commit suicide. After all, the health professionals job is to keep people alive, so suicide is contrary to their professional values.

Patient number 3 was being careless in his handling of his gun. Any gun owner would say he should have known better. He is seen as being responsible for his own gunshot wound.

Patient number 4 is totally innocent of causing her own wound. A stranger had broken into her home and shot her for no apparent reason.

Since the triage cannot be based upon the severity of the wound or time of arrival, which of these characteristics are the defining characteristics upon which the triage will based? Which is more important? Age? Gender? Responsibility for causality? Attractiveness? Gender?

The only way to answer this question would be to design a research project in which each of these patients is listed in a multiple-choice test. The sample would be different groups of professionals to rank order which patient will be seen first and which last. Their decisions will be made on their priorities based upon unconscious preferences.

Will the obese old lady be the one to wait to the end? If so, her obesity and gender override the fact that she was totally innocent of causing the gunshot wound. If it is patient number 2 who waits, then the suicide (responsibility for causation) is more important than age, attractiveness or gender.

As health professionals, we make unconscious valuations of patients all the time, and act on them. The important thing to stress here, is that health professionals need to be aware of their unconscious preferences and their reasons for them.

Studies such as this one are all part of the science of Patientology.


A review of Patientology: Toward the Study of Patients by Nancy L. R. Anderson, RN, PhD, FAAN

57212020_high-resolution-front-cover-6803979Reading this book brought back many memories for me.  Some beginning when I as a young child, I first became a patient.  Other memories originated from my nursing career as well as from being an adult patient.  Those memories came along with me as I read this book and periodically pricked at me, resulting in some ‘aha’ moments.  Some memories were heart-warming; others brought on a sensation of sadness, still others rekindled annoyance, sometimes even anger, as occurred when recently discharged alone from ER to lobby at 4AM.  I consider this a sign of an exceptionally good book.

Each chapter in Patientology builds on the original premise that patients are not a participating part of the Health Care Delivery System (HCDS).  This continues to be true in many instances, although innovations are periodically tested with enlightened focus on patient participation.

It is important to begin reading this book with the Preface as it provides important background information and examples that explain the history behind this book, as initially crafted, beginning in 1974. When Dr. Brink studied Victimology and she quickly saw the relevance to her own patient and nursing experiences as well as those of others in relationship to being a victim.

 I think most of us can recall times when we felt like helpless patient victims and when we most needed understanding.  Many of us also recall at least one truly positive patient experience.  Mine came when in extreme pain after surgery, the night nurse commented on my low moan, asked if I was in pain, and not only gave me much needed pain medication, but also took time to give me a back rub. Her kindness and hands-on-care dissipated the tension and eased the pain as much if not more than the narcotic.  Now instead of back rubs there are electrified mattress pads that massage bed-ridden patients.  Technology while innovative and time saving also removes the need and motivation to spend time learning about the patient beyond the intake questionnaires.  Staffing issues and the time needed to manage the technology shortens the time clinicians have for patients.

On page 4, Dr. Brink asks, “What Can We Learn from the Study of Patients?”  This question sets the tone and agenda for the first chapter and all the subsequent ones.   In Chapter 3, Dr. Brink calls “. . . attention to patients as an integral part . . .” of the HCDS.  Making the point that removing the ‘C’ and ‘D’ for care delivery and making it the Health System means that “The patient, then, becomes an integral part of the health system as the recipient of care” (page 24).  Subsequent chapters focused on The Patient’s Career, The Patient as a Victim and The Patient Perspective all demonstrate the absence in many situations of the patient as part of the system.

In recent years some health researchers are using participatory strategies to involve the people we formerly called “research subjects” as direct participants in the research process.  The strategy works particularly well with qualitative designs serving to involve people in the research endeavor and enabling them to assist in planning projects that are truly relevant to their beliefs, values, and daily lives.  In many cases those participants go on to work in their communities designing projects and securing funds.   This much participation in the Health System (HS) would be un-realistic; however, I have noticed that some clinicians now do pay more attention to the patient as a person not just as a condition needing unquestioned treatment.   I hope we don’t lose sight of that goal.  Thank you, Dr. Brink, for giving us the incentive to be more attentive to patients and more inclusive of them in decision making.

Causes and Treatment of Gastric Torsion in Dogs

Gastric torsion in dogs is referred to in veterinary manuals as Bloat, Gastric Dilation or Torsion Complex. (See Delbert G Carlson, DVM and James M Giffin MD “Dog Owners’s Home Veterinary Handbook. 1992,  Simon & Schuster MacMillan. Pp. 199-202.) It is a medical emergency and needs treatment as soon as it is noticed.

During the first phase of the process, the stomach swells or distends due to gas or excess fluid. When the stomach has swollen, it may twist abruptly. If the twist is less than 180 degrees, it is called “torsion.” If it twists more than 180 degrees, it is a “volvulus.” Both are lethal. Gastric torsion, therefore, is the twisting of a distended stomach.

Bloat was at one time referred to as the “overfeeding syndrome” as it tended to be associated with dogs who ate too large a dry meal once a day or tended to eat too fast. In addition, dogs who exercised vigorously after a large meal tended to torsion.

Large, deep-chested breeds appear to be more frequently associated with the possibility of getting bloat. If a dog has a history of gastric upsets, it may be more prone to bloat.

The German Shepherd Dog Club of America (GSDCA) produces an annual “Blue Book” (named for the color of the cover) that discusses genetic and other health issues. In 1985, they published an article on the signs and symptoms of bloat which offered a very clear description of how a dog acts when it has started to torsion. (“Toxic Gut Syndrome of the GSD” by Charles Kruger, DVM and Helen Sherlock. Genetics: 1984-85 Volume 1 (The Blue Book). German Shepherd Dog Club of America Inc. pp. 11-17.) Unfortunately, a copy of this publication is extremely hard to find.

In a study conducted by the Veterinary College at Purdue University (the live link to this study no longer exists, but the study findings are excerpted here.), the following “risk factors” were identified as being significantly associated with, or contributing to, the onset of bloat:

  • increasing age (the older the dog the greater the risk)
    • having a relative with Toxic Gut Syndrome (parents, siblings, grandparents)
    • eating from a raised food bowl (in spite of all the beliefs to the contrary)
    • feeding a dry commercial dog food containing fat in its first four ingredients
    • feeding a dry food containing citric acid that was also moistened by the owner before being eaten.

Only one factor was identified as significantly reducing the risk of getting bloat by over 50 percent and that was feeding a dry commercial food containing a rendered meat meal, with bone, among its first four ingredients.

A raw diet was not mentioned in the report. The study apparently involved only commercial dry kibble.

Treatment for Gastric Torsion depends upon the stage in the process and the severity of symptoms.

If the syndrome is caught very early and the dog seems to be experiencing only a distended stomach, a small amount of Mylanta may relieve the gas. If this does not work, a stomach tube can be inserted. If the tube cannot reach the stomach, this means that the stomach has already twisted and only emergency surgery can help the dog.

The best advice anyone can give is this: If the dog has started to torsion, call the vet immediately, then get in the car and take the dog to the vet. This is not a problem to fool around with.

Interesting Canada Day Facts

Canadian flag

Canada Day, also known as the First of July or July First, was originally proclaimed as Dominion Day.  It is only one of two federally mandated holidays that occur on a specific date rather than on a Monday.  If July 1st falls on a Sunday, however, the holiday is celebrated on Monday.

The following is a list of some interesting information about Canada and Canada Day:

  1. Canada’s name is derived from the Huron-Iroquoian word “kanata” or village.
  1. Canada’s independence as a sovereign nation is due to the proclamations of two Queens: the first, Queen Victoria, who signed the act making Canada a “Dominion” (1867) and the last, her great granddaughter, Queen Elizabeth II, who signed the act making Canada a free and independent state in 1982.
  1. Royals have been frequent visitors to Canada since its inception. Some of whom have actually lived in Canada serving as Governors General (most notably Queen Victoria’s son Prince Arthur, The Duke of Connaught, who was the 10th Governor General since the confederation). Others were visiting military, the first being Prince William in 1786. Five of Queen Victoria’s children have either lived in or visited Canada.

July 1st is a date for many Canadian anniversaries in addition to the founding of the original confederation on July 1st, 1867, including the following:

  1. Swearing in and knighting of John McDonald as the first Prime Minister of Canada and appointing Lord Monck as the first Governor General by Queen Victoria (1867);
  1. Formal declaration of July 1st as “Dominion Day” (1868);
  1. Entrance of Prince Edward Island (PEI) to the confederation (1873);
  1. Dedication of the new center block of Parliament to the founding fathers of the confederacy and to the troops serving in Europe (1917);
  1. Laying of the cornerstone of the Confederation Building and inauguration of the Carillion in the Peace Tower in1927, allowing for coast to coast radio broadcasts. This event was attended by two of Queen Victoria’s grandsons: the Prince of Wales, later to become King Edward VIII and his brother the Duke of Kent, later to become King George VI;
  1. The first formal celebrations of Dominion Day in front of the Parliament Buildings (1958). Prior to that time, there were no formal ceremonies.
  1. The first CBC (Canadian Broadcasting Corporation) coast to coast television broadcast (1958) and subsequent first color broadcast (1966);
  1. Inauguration of the Order of Canada (the highest civilian award in Canada) by Her Majesty Queen Elizabeth II (1967);
  1. Establishment of “Oh Canada” as the national anthem and changing the name “Dominion Day” to “Canada Day” (1982);
  1. Signing of the Canada Act making Canada an independent nation (1982).
  1. Queen Elizabeth II was the second reigning monarch to visit Canada, the first were her parents (King George VI and Queen Elizabeth, later Queen mother) in 1939 just prior to World War II. She has visited Canada 22 times beginning when she was Princess Elizabeth in1951. Her last visit was in 2005.  She has attended a number of July 1st ceremonies – 1967 (the Centennial), 1990, 1992 and 1997

Other interesting facts about Canada 

Canada stretches five thousand miles from the east to the west coast but has only one trans-Canada highway (Highway 1).  At one time the easiest way to reach the west coast from the east was by the Trans Canadian railway system (completed in 1885) taking one week to traverse from Toronto to Victoria. Prior to that time travel across Canada was by horse, ox cart and boat taking about 3 months.

The Hudson’s Bay Company established forts or trading posts on major rivers in the Northwest Territories to receive the fur pelts by trappers and to receive goods and supplies in return.  Transport was primarily by canoe.  The Hudson’s Bay Company wass the sole proprietor of the Northwest Territories until 1870 when it turned over its control of the North West Territories to the government of Canada in1870.

The border between Canada and the United States is the longest unprotected border in the world.

Canada is a confederation of 10 provinces and 3 territories, the main difference being that provinces receive their power and authority from the crown while territories are under the jurisdiction of the Federal government.

The first four provinces to form the confederation (New Brunswick, Nova Scotia, Quebec, Ontario) were created on July 1st, 1867.  Three more provinces were admitted in rapid succession:  Manitoba (1870); British Columbia (1871); and, Prince Edward Island (PEI) on July 1st 1873. Alberta and Saskatchewan were formally separated from the Northwest Territories and were admitted in 1905.  Newfoundland and Labrador (a Dominion of the British Commonwealth) was the last of the provinces to be admitted to the confederacy (1949)  The Yukon was also created from the Northwest Territories in 1898. Nunavut, Canada’s newest province, was also created from the NWT.  In 1999.

CBC radio and television acknowledge Canada’s multicultural roots by broadcasting their programs in English, French and Inuktitut.

Canada’s nationalism is reflected in her symbols.  The Beaver appeared early on coins and coats of arms reflecting the fur trade that gave rise to the initial impetus for exploration and settlements, by both France and England.  The maple leaf on the national flag, coinage, and coats of arms reflects the Maple Tree as a source of maple sugar and building materials so necessary to the early colonists.  Every province has its own tartan reflecting Canada’s early Gaelic settlers.  Each Province and Territory has its own flag reflecting its unique origins.

2008 was the 400th anniversary of the founding of Quebec City.

Love your Neighbor

The United States Constitution was drafted as a document of rights and freedoms for the American people. Anyone reading the document can see the influence of Christian teachings running throughout. “Love thy neighbor’ is a continuing theme. It is emphasized repeatedly in the New Testament and is reflected in the Constitution. The responsibilities of citizens toward each other spring from that one clear message. Yet, today, there is great anger and divisiveness. If you don’t agree with me I have a right to shoot you, or destroy your business, or have a violent protest march. The news media have been fomenting anger and divisiveness for months. Then everyone seems shocked when Republican congressmen, playing baseball, are shot. Why the surprise? The media deliberately created the climate for this act of violence to occur.

A very strange response to the heroic actions of the police who were in attendance at the ball game came with this article that was widely shared on social media:

Oddly enough, the reporter thought the gender preference, gender and race of the police officers was the most important issue in this tragedy. I wondered why.

We live in a society where there are many public services paid for by taxation. The people trained for these public services are accepted for their jobs regardless of race, gender, gender preferences, religion or political party. If they meet the job qualifications and can pass the training, they are given their responsibilities. In the case of the police service, it is to protect and serve the public. There is no qualification about which members of the public are to be protected and served. There is no matching of police officers and public by any criteria other than the equal rights and responsibilities under the law. This is as true for firefighters and health professionals as it is for police officers.

Why then, did this reporter emphasize the race, gender, and gender orientation of one of the police officers injured in this confrontation? Only to foment dissent, anger, divisiveness and sell his paper. Emotion and divisiveness sells. The American public has come to expect gossip, negativity, sexual deviance and violence in its news reports. The more violent, the more readership. A sad commentary on who we are as a nation.

The implication generated from this article is that public servant can pick and choose who they serve. The reporter seems to imply that sexual preference and race take precedence over the duties and responsibilities of the job. Is he right?

To use a parallel situation, what if there were an automobile accident or a terrorist attack and the victims were all taken to the nearest emergency room and the triage included race, sexual preference and gender in addition to the physical trauma? How would the American public react to that scenario? Americans expect to be treated equally in a health care facility.

But are they?

Pamela J. Brink, RN, PhD, FAAN. 2017. Patientology: Toward the Study of Patients. Charleston: Create Space.

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Right to Life versus Abortion – continued

freestocks-org-73878I am disappointed by the lack of response to my post asking Catholic Democrats how they justify the Democratic party’s position on abortion. Perhaps it’s because they feel it is none of my business how they believe. And that’s true, it is none of my business. I merely want to understand how someone resolves a seeming conflict in values.

In Catholicism, we have a label called “Cafeteria Catholics.” These are Catholic Christians who, seemingly, pick and choose which tenet of the Catholic faith they believe. Is the Catholic position on abortion one of those tenets?

Democrats, unlike Republicans, have what some reporters call a “herd mentality.” What one decides to do, all will do. This has been amply demonstrated during recent confirmation hearings and committee votes where no Democrat shows up to vote. As they say in the Three Musketeers, they are “one for all and all for one.”

It would seem then, that to be a Democrat, one votes and behaves according to the party line regardless of personal belief.

There are famous Catholics who are staunch Democrats. Think of President John Kennedy and his family. Or, think of the famous priest/author Andrew Greely. He, too, was a staunch Democrat. What did they think of Roe Versus Wade?

Roe versus Wade could not have passed Congress without the Catholic vote.

So, our Catholic congressmen and women approved of abortion in direct contradiction to the teachings of the Catholic Church.

Will they tell me that they were not voting in favor of abortion? Or, will they tell me that they voted for a woman having the right to choose what happens to her own body?

If the second is their answer, do they realize the woman is making a choice to kill her baby? That when she chooses an abortion she is killing her unborn child who is as much her child whether it is born or unborn?  And that those who perform abortions are deliberately killing a human child with the same lack of concern they would show in drowning a sack of kittens?

The Roman Catholic teaching is that all human life is sacred and to be protected from conception to natural death. Abortion is in direct contradiction to that teaching.

Or do Catholic Democrats see the human fetus as an “it” or a “thing” or a “growth?” This is how atheists view an unborn child. They say it is not a “person” therefore it has no rights. For centuries, Canadian and American women were not considered “persons,” which was why they were deprived of their right to vote. American slaves were not considered “persons” and so could be bought, sold or killed at their owner’s command. But if a human fetus is not a “person,” what is it? It is not the fetus of a cat or dog.

A human fetus is a human being in development just as all living beings develop.

I am aware of the issues surrounding an unwanted pregnancy. Who can deny them? But aren’t there other solutions besides abortion? It seems abortion is the easy way out without having to develop more humane solutions to an unwanted pregnancy.

The question in my mind remains – how do Democrat Catholic Christians resolve this issue for themselves? Is it a question of being a cafeteria Catholic or a cafeteria Democrat?