It’s a Fine Line Between Sorrow and Depression

Sometimes I don’t know if I’m just sorrowful over things around me, or if my mood is actually a reflection of clinical depression.

Is there really a difference? I.e. is clinical depression real (something organic)? I have to think that it is, based on what I’ve seen.

But I have a suspicion that the roots of depression may be more spiritual than most people think. What better way for Satan for rob us of joy than to have us react to the negative things around us and for us to internalize them and let it affect our “mood”?

I feel like the writer of Ecclesiastes, with that feeling that everything is futile, including one’s own labor.

I mourn for the difficult job I have. So many patients are so very difficult and complicated – medically, psychosocially…

I mourn for what I lack in medical knowledge and skills. There is so much I wish I were better at.

I mourn for the bitter, endless drought that we’re always in, that the grass has long since died, that the ground is rock hard and cracking, that the rivers have all dried up. This is indeed a land of death in more ways than one.

I mourn that we toil day in and day out and it feels like there is so little spiritual fruit.

I mourn that there is a general hate toward the Church here, that they have no idea of the immense love of Jesus; and they scorn Him.

I mourn for the lack of true friends here – deep, close friendships that you know are resilient.

I mourn for the general state of the country and the world – the rapid state of moral degeneration, the celebrating of what is evil, the wars and rumors of wars.

I mourn for the blatant racism toward us from our neighbors down the street.

“Blessed are those who mourn, for they will be comforted.” But when?

The main things from Ecclesiastes that stick out to me after a quick read-through are the following: 1. Even though it is futile, work with all your might (9:10), 2. Enjoy the fruits of your labor (5:18), 3. Fear God and keep his commandments, for God will bring every act to judgment, everything which is hidden, whether it is good or evil (12:13).

That last point really strikes me. The fearing God: the one all-powerful being whose presence is so powerful that I would die if I saw His face. Keeping his commandments: like a parent whose house rules are for the good of the child, his commandments are for our good. Why don’t people in church talk much about keeping commandments? God will bring every act to judgment: He is the final judge. This is WHY I should fear him and keep his commandments, even though I am saved by grace through faith.

I know I must stay focused on God and the many blessings I have. But still, all that’s on me. Only God can deliver me from my own mind and this wretched body of death. And only He can deliver me from spiritual attacks from an adversary that knows my weaknesses.

Taken in Spring

Politics – A Tool Satan Uses for Division and Making People Dislike Christians

Something I see happening more and more among Christians nowadays is that they are being dragged into the mud of the bitter political discourse and dramatic polarization within the U.S. Or, rather, they are jumping into the mud fight.

I use the term Christian in its most broad form here, because we all know examples of those to take the Christian label and show no outward evidence of true faith.

The roots for the current climate have always been present within the U.S. as far back as its founding and the same divisions hit its peak crisis during the civil war. The divisions flare up from time to time but this latest flareup seems particularly interesting because such strong political thoughts and ideas are seeping into the hearts and minds of very normal, every day people who otherwise wouldn’t have been overtly political in their thinking. And it is clear that there is primarily one source for this current trend which is causing further polarization and division: social media.

This issue is personal for me because I see it hurting people in my family. The intermingling of political beliefs and faith, and the loud expression of their opinions has actually caused certain people in my family to stop going to church and to be visibly weakened in their faith. They actually avoid going to church because they have the misconception that all Christians are very conservative Trump supporters. Obviously in some churches this would be the case. But to generalize all Christians as one particular political brand is not only very inaccurate but I also feel it is a tactic being used by Satan to cause division and to damage faith.

This perception is reinforced in stories like that caller who called into the White House on Christmas Eve and, after the Bidens talked with the parents and the 4 children, the father ended the call with social-media-generated catchphrase “Let’s go Brandon” that stands for “F*** Joe Biden.” Someone in the media tracked the caller down the next day and asked him about it. He insisted that he meant no disrespect to the President and that he was a “free-thinking American and follower of Jesus Christ.”

Now, depending on one’s beliefs, they may or may not support this person’s use of “free speech” in offending the president over the phone. But then he pulled the name of Jesus into it, and I had a sort of visceral reaction, like “someone is using my Savior’s name to go along with that?” I would ask: Is this man’s actions and self identifying as a follower of Jesus going to make anyone else want to become a follower of Jesus?

The clear answer is no. If you’re going to cause someone to turn away from the faith, make it because of righteousness, not for something done out of anger or bitterness against someone.

I can’t help but feel that extreme engagement in politics whether in the mind or with other people has at its root the issue of idolatry. This could manifest in various ways such as:

  1. We don’t trust that God is sovereign over leaders.
  2. We spend an inordinate amount of time on things that have a “political nature” such as watching the news, posting contentious things on Facebook or twitter, etc. If you find yourself getting angry often about political things, it’s time to look inward and see where your priorities lie.
  3. We place our highest personal religious value in who is president, which party controls congress, the makeup of the Supreme Court, what bills are being passed or repealed, etc.

In other words, when we make so much of the political system by getting angry or engaging in political squabbles with people whether in person on online, we are not acting like Jesus is the Lord of our life. If anger and vitriol spew forth, we act as though that particular subject matter is more important than Jesus.

I am not advocating for complete removal of oneself from all things political, nor the avoidance of political discussion if it so suits someone (although I personally feel that unless it is one’s job to be a policy maker, it is actually very rarely fruitful to discuss politics, on a practical level). What I am advocating for is two extremely basic ideas that seem to me to be somewhat dissolving in the chaos that is 2021(2022).

  1. If you’re going to engage in politics, make sure your beliefs are biblically informed as much as possible, not culturally (not just because everyone else around your thinks so).
  2. Always be loving, gentle, and respectful when engaging in discussion, and if you’re not, ask for forgiveness.

We are united to other Christians with a bond that transcends everything (or it should), and Jesus prayed for unity among believers. So when we allow our political beliefs to transcend this bond by creating divisions, we are letting it become a tool of Satan. Therefore, resisting this urge for division and maintaining unity is fighting Satan and strengthening the church.

Lastly, my main thought is this: If true Christians just focused on things above (Colossians 3:2) like abiding in Jesus and his commands, we would be much less concerned about all this social medial political bullshit anyway.  We would develop “a heart of compassion, kindness, humility, gentleness, and patience; bearing with one another, and forgiving each other, whoever has a complaint against anyone; just as the Lord forgave you, so must you do also. In addition to all these things put on love.” (Colossians 3:12-14).

A World in Decay

Lately there has been a string of patients coming into clinic for various reasons (e.g. a visit to the podiatrist, wanting medication refills, etc.) and incidentally found to have severely high blood sugars, often in the 500s or 600s. As I’ve said before, I’ve never seen any of these patients in diabetic ketoacidosis. Our normal protocol is to have them drink several cups of water (or IV fluids if they are dehydrated or found to have acute kidney injury), give them subcutaneous insulin, and to recheck their blood sugar in 30 minute increments until it’s in an “acceptable” range. The ER usually does not want us to send them there because they never admit for this, even though the ER in Missouri would very frequently call me for admission if a patient’s blood sugars were this high.

The patients are very commonly noncompliant with their insulin (but not always). Sometimes they go weeks without taking it, or maybe they just miss it for a day or two. Not only that, they live surrounded by the worst possible foods, in a milieu of refined carbohydrates, simple sugars, and saturated fats devoid of enough fiber from legumes, vegetables, etc. Their genetic predisposition also leads to premature insulin resistance and abdominal adipose deposition which sets them up for this condition. There also seems to be a sort of cloud of despondency over this place in which many people do not seem to want to take charge of their health by making the drastic changes necessary to treat these common conditions.

Seeing the same patients over and over again in a very precarious physical state often leads to a sort of “repetitive futility”, in which it feels like you’re treating something that will only matter for a very short amount of time (because you’re not addressing the root cause). I’m tempted to feel hopeless in many situations, which has prompted me to try to make sense of all the health chaos I see. Why do they have such bad diabetes in the first place? Why should they, as opposed to another, have to take such high doses of insulin 4 or 5 times a day. Not only has the lot fallen to them, it seems that their race (American Indians) seem to be more prone to diabetes and obesity than whites, as well as other major health complications. Why is there disease, drought, car wrecks, etc. to begin with?

I often ponder the beauty of nature. I think this world’s beauty is a gift from God. I also often wonder at our capacity to be awed by the beauty of nature, which I also believe is a gift of grace from God. God himself saw that his creation was “good” as recorded in Genesis 1. I am particularly drawn to places and things of rugged beauty like an ancient, twisted juniper tree growing on a rocky bluff; or the beauty of deserts; or the majesty of old growth forests where things are in such a balance, yet are still fragile. Yet there is a certain harshness to this beauty. An easy example is 35 minutes from our home – The Badlands. There is an undeniable rugged beauty but it is extremely harsh: hardly any rainfall, bitterly cold winters, intense heat and rattlesnakes in the summers. The settlers who tried living there didn’t stay long.

I was reading in Ezekiel 1 and was struck by how everything related to God is described as beautiful (“like the awesome gleam of crystal” vs22, “something resembling a throne like lapis lazuli in appearance” vs 26, “as the appearance of a rainbow in the clouds on a rainy day” vs 28). Even the scroll given to Ezekiel in chapter three was “as sweet as honey in my mouth.” Everything God creates is good and perfect, so I’ve been trying to come to grips with the difficult reality of the harshness in the world as well as the utter chaos and madness of society, prevalence of disease such as cancers and epidemics, and the fact that everything is seemingly spinning out of control.

I believe the first explanation is found in Genesis 3 after the fall in which God explains to Adam that “the ground is now cursed because of you; both thorns and thistles shall grow for you.” This is in addition to “painful toil” and “sweat” in working for food as well as greatly multiplied pain in childbirth. This indicates direct physical repercussions to sin to our bodies. You begin to see a gradual decline in life expectancy from 8-900 years with the first people down to 120 described at the time of Noah.

Then, according to the Genesis account, approximately 1,700 years later the great flood occurred due to the “wickedness of mankind being very great,” and because “every intent of their hearts was only evil continually.” And the “waters that were over the sky” first described in Genesis 1 fell to the earth.

Immediately after the floodwaters receded God says

“As long as the earth endures,
seedtime and harvest,
cold and heat,
summer and winter,
day and night
will never cease.”

Cold, heat, summer, and winter were never actually mentioned until after the flood. My theory is that losing the waters above, which would have served as a protective layer shielding the earth from damaging UV rays, led to the massive temperature fluctuations, the intensity of the sun (it always felt so abnormal to me), sunburns, as well as other effects which I’m not smart enough to think of. If this is accurate, you already have an earth that is dramatically different than at the time of creation. God’s design for creation, marred by sin.

“Bondage to Decay”

But what about all the disease, famine, epidemics, and so on? I did not list things like wars, genocide, rape, etc. as these are blatant acts of sin against God for which the clear explanation is the corruption of the human heart (sin). I listed physical maladies which happen seemingly out of nowhere to a person (not a direct result of sin).

For this, I feel Romans 8 is helpful, when it says, “19 For the creation waits in eager expectation for the children of God to be revealed. 20 For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hope 21 that the creation itself will be liberated from its bondage to decay and brought into the freedom and glory of the children of God. 22 We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. 23 Not only so, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for our adoption to sonship, the redemption of our bodies. 24 For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what they already have? 25 But if we hope for what we do not yet have, we wait for it patiently.”

As stated above, “The whole creation has been groaning as in the pains of childbirth,” and is in “bondage to decay,” The world is in a state of constant decline, entropy, disarray, chaos, etc. Things are not as they were originally designed. This decaying process also affects our DNA leading to innumerable genetic diseases, predispositions to various inherited states, the aging process, and so on. “Who will rescue me from this body that is subject to death?” asked Paul in Romans chapter 7. In 2nd Corinthians 4:16, Paul says, “Therefore we do not lose heart, but though our outer person is decaying, yet our inner person is being renewed day by day.”

But why is this so? The quick and easy answer would be sin, which is accurate, as it triggered the disarray and chaos to begin with. But this implies that God was surprised by it, or that creation as he wanted it only lasted a short while before man changed his plans. But the passage in Romans states that it was the will of God to subject the world to frustration in order that there may be a redeeming process, a turning to Him, resulting in his glory. He wants the pain of this life to draw people to him. It is the rule, rather than the exception, that this life is full of pain and disease. There is absolutely no escaping it. It is a very modern idea to think that you can somehow skirt through life without pain, and if you do you are exceptionally lucky.

Some would say this makes God cruel, but we are the ones with the law of good and evil written on our hearts, and violate it constantly.

In this passage is also the promise of “redemption of our bodies” as sons of God. Even though in this world we will have back pain, headaches, and diseases of all kinds, there is this promise of redemption for those covered by the blood of the Lamb. In the new heaven and new earth described in Revelation 21, “He will wipe away every tear from their eyes; and there will no longer be any death; there will no longer be any mourning, or crying, or pain; the first things have passed away.” It goes on to describe the new city of Jerusalem and it a thing of amazing beauty.

So, in thinking of my patients with uncontrolled diabetes or other difficult-to-treat medical problems living in a broken world with little hope; yes, medical care is good and important, but the most important need to address is their spiritual poverty and the fact that without the Gospel, they have no hope of their bodies being redeemed from this very dark world we live in. This is not a new answer. Maybe their level of need is God trying and trying to get them to see how much they need a savior, to see that their ways are not sufficient.

Note to Self

This week we officially finished paying off my student loans, 8 years and 7 months after graduating medical school. We didn’t always make the right decisions (e.g. forbearance for the first few years which racked up interest), but the Lord showed mercy on us and allowed us to get rid of the debt burden. All in all, we ended up paying back $423,700 (on a loan with an original balance of $276, 108) of my loan debt, which was mostly from medical school and a little from undergrad. Before that we also paid off approximately $100,000 of Katy’s loans from Wash U. 34.8% of what we paid on mine was interest. That’s the real “crime” in all of this…the whole racking up of interest on a federal loan. If they were to just lower interest rates to a more manageable level…like 1-2%…it would take some of the burden off people. But that is another issue for other people to discuss.

I like to think that God allowed us to get out of such a ridiculous amount of debt because we were still consistent in tithing and trying to be generous in giving even when it was not easy. We also tried to live frugally and not buy luxuriously or things we wanted but didn’t need. This allowed us to make large monthly payments to get the principle down. In doing this, though, we were not able to save hardly anything (apart from the standard employer retirement accounts), but I think that’s overemphasized anyway.

While it feels good to be out of debt, I know that this is when the real challenge actually begins. You see, when I was in debt, I would often give myself an “out” of being overly generous by saying something like “We don’t actually have X amount of money…we’re actually in the negative.” But now, I have no excuse.

Even more importantly, now is when the challenge really begins to avoid the trappings of wealth. The Bible is full of warnings for people to love money and are wealthy. I am thinking of one example in Luke 12 when Jesus rebukes someone in the crowd for asking him to tell the man’s older brother to divide the inheritance with him. Jesus said “Watch out! Be on your guard against all kinds of greed; life does not consist of an abundance of possessions.” He then proceeds to give a parable about a farmer who had such an abundant crop of grain that he built many new and huge barns to store it in, not knowing that afterward God will demand his very life from him. The conclusion of the parable was “This is how it will be with whoever stores up things for themselves but is not rich toward God.”

So that is the challenge, to give abundantly so as to not excessively store up treasure for yourself for retirement, assuming that you will have that time or that you have to have a certain quality of life in retirement.

There’s also the questions of how to give “responsibly”, as people often mention the book When Helping Hurts by Steve Corbett and Brian Fikkert. While I don’t disagree with the idea that continuously giving a person a lot of charity can have the effect of keeping them in poverty, I feel that perspective is a little too black and white, politically-driven, and not led by the Spirit. Furthermore, blaming poverty on charity when the real causes are extremely complex (e.g. historical, geographical, racial, etc.) is an oversimplification, in my opinion. Furthermore even still, I think we often have the mindset of wanting to lift people out of poverty and then all will be right. They will have good schools to go to, good healthcare, personal security, jobs, etc. Ministry would be a lot easier. In other words, they will be more like the West, and isn’t everything just great spiritually in the West? But, obviously God loves the poor because they aren’t able to put their security in material wealth and are therefore more easily able to put their trust in Him.

So the real problem is not the poverty, and therefore focusing on “poverty alleviation” is not correct (“You will always have the poor among you”). The problem is spiritual…it is the absence of true love, of the Gospel. So I think the call of every Christian is to respond to every situation in front of us. If we see a need that we can meet, then it is our responsibility to meet it, otherwise it is greed and sin.

COVID-19 Increase and Lockdown

For the first 6 weeks or so of my being in clinic, I didn’t see any COVID-19 patients. It just didn’t seem to be a major presence here, even though it was around. However, the surge is here now. We just don’t know how high or severe it will be. The clinic probably tests at least 10 patients a day and the percent positivity rate higher than 60% for those who are symptomatic. So we are diagnosing at least 6 people daily. If I work in the “sick clinic” I will see some of these patients to assess them, particularly if they are older and/or with comorbid conditions, but unfortunately the clinic is so pressed for rooms that many are just tested in their car, assessed for severe symptoms like shortness of breath, etc. and sent home if their symptoms are mild.

The clinic was told to switch all “non-urgent” appointment to telephone calls. This is a little hard to do when managing chronic conditions like diabetes and hypertension, especially when I know there are patients who would be coming in for their “check-ups” with a blood sugars in the 400 or 500s, or, like the other day, 705. I am somewhat expecting those in charge to call me to work at the main hospital in Pine Ridge to treat COVID-19 patients there, though I hope that does not happen.

In addition, the tribe initiated a reservation-wide lockdown for at least 7 days starting on 10/23. This is in addition to the already present checkpoints which blocks anyone from out-of-state which means that neither side of our family can visit us, which they had both planned to do this month.

We found a very small local non-denominational church here in Kyle few weeks ago that is now shut-down because of the surge. We are praying that it can open up soon as major revival is needed here.

Bighorn sheep
Mule deer

First Impressions of a New Home

Sheep Mountain Overlook

For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.

Ephesians 6:12

Dry, arid, windy. But beautiful.

Thus far we have enjoyed our time here on the Pine Ridge Reservation, although it has not been without a few minor difficulties. The people have been pleasant (the few that we’ve been able to meet given the ongoing restrictions on any public meetings due to COVID-19). We are slowing growing accustomed to the different social nuances and living 1.5 hours from any major shopping.

I am somewhat in a constant state of shock over how dry the land is. The grass has long turned brown and yellow. It has basically rained a significant amount only once since we’ve been here. There’s a lot of dirt and dust blowing around.

Work in the clinic is good, although difficult. Unfortunately the clinic is fraught with inefficiency, a terrible EHR, and is woefully understaffed so the days are sometimes long and frustrating, especially when combined with patients that are very complicated. Another big impression is that patients don’t seem to mess around when it comes to their various disease states: they suffer major complications, have major drug side effects, etc. There’s a bizarre phenomenon of early onset diabetes in patients in their 20s and 30s, many of whom are not markedly overweight. I surmise that there is a genetic predisposition to it, possibly relating to omental adipose deposition combined with extreme deviation from their traditional diet within a relatively short time period. The modern western diet hit the Native population hard.

I sometimes get a feeling of a subtle and hard-to-explain urgency toward the providers, like me, to fix the patient’s serious medical issues, but at the same time notice a complacency on the part of the patient to take basic lifestyle measures that would be the first step in correcting the serious medical issues.

There seems to be a subtle haze of despondency or hopelessness over the reservation which I may be imagining or may be not. A generality or not, I definitely see it in the clinic. There’s so much alcohol abuse and drug use. I sometimes get the feeling that I’m really only seeing the “tip of the iceberg” of this world of substance abuse and darkness, as the majority of people involved in the drug world probably try to avoid the clinic.

I have also noticed the high rates of depression and anxiety. Most people immediately attribute this to a phenomenon called “historical trauma,” which is defined as “multigenerational trauma experienced by a specific cultural, racial, or ethnic group.” While that idea generally makes sense to me, I am a little curious about exactly how traumatic events that occurred in the 1860s-1890s reverberated through multiple subsequent generations to cause mental health disorders now. I do not discount the idea entirely, but I feel that blaming current problems entirely on the past seems somewhat incomplete, that there are likely other factors at play leading to such high levels of anxiety and hopelessness and turning toward mild-altering substances to distract from the realities of life. Even though I’ve only been here a very short time, I think one must consider economic factors (poverty, lack of jobs, marked lack of housing), physical factors (extreme weather, physical remoteness), and (most importantly in my opinion) spiritual factors as well.

What is clear is that this is a not a spiritually neutral or ambiguous place. There does seem to be a purposeful engagement of the spiritual realm done for what seems to be both in the name of maintaining cultural tradition and petitioning spirits for blessings, asking them to help the spirits of loved ones pass on into the afterlife, etc. In talking to just a few people, we are slowly coming to understand some of the native spiritual beliefs that seem to culminate annually in the Sun Dance ritual. And the more we learn about it , the more we are realizing that it is an engagement with demonic forces.

On the day we first drove in to the reservation we were briefly behind a large caravan of vehicles, the first of which was a truck with a large trailer hauling a very large tree. The vehicles all turned down a long road following the tree, and I wondered what this was, but didn’t think much of it.

The other day in clinic a patient showed me one of her arms which was completely covered in scars from near the shoulder down to near the elbow. She told me this was for flesh offerings. Since meeting her, I have seen several other people in the clinic and community with scars on their arms. I asked her to tell me more about it and she said it was from the Sun Dance. She said there were almost 100 Sun Dances on the reservation this year, which occurred in August as opposed to June due to Covid-19. She said the dancers dance in the sun for four days while also praying to a tree and giving flesh offerings from their bodies. The ritual starts by cutting down a large tree, moving it to the Sun Dance sight, then erecting it in a hole in the ground.

Another person we met said that each Sun Dance utilizes “heyokas”, which are a kinds of sacred clowns or spiritual men of sorts. The heyokas go into a “sweat” and ask the spirits to come upon them. The heyokas then act and “do everything backwards” for the remainder of the Sun Dance. Everyone prays to the tree and to the spirits for their various requests and blessings, culminating in a sacrifice of a puppy by a heyoka. The animal is prepared in a soup and consumed.

I don’t know a lot of detail regarding the Sun Dance. I know that it is usually closed to outsiders (non-natives) and a lot of people don’t openly talk about it. But from the little I’ve heard, there seems to be a willingness to open oneself to the spiritual realm which can obviously lead someone and possibly a whole community open and vulnerable to forces of darkness. I have to think that this may be part of the reason why there seems to be a cloud of anxiety, despondence, etc. here. I felt something very similar on mission trips to the mountains of Oaxaca where idol worship was extremely prevalent. The areas were extremely spiritual, yet extremely dark and filled with substance abuse, domestic abuse, etc.

I wanted to share with that patient about Jesus who was God incarnate and who was the ultimate and final flesh offering who gave himself for all sins of the world. But I wasn’t brave enough and I haven’t figured out how to broach the subject yet with people steeped in the tribal religion. But I will keep trying to figure out how to do that in a way that won’t get me fired. In the meantime, I take hope knowing that people from “every nation and all tribes and peoples and tongues” will be standing before the throne worshiping in heaven, as noted in Revelation 7.

Arrival to Pine Ridge Reservation


We departed Missouri on Friday July 31 and stayed overnight at my Grandpa Hadsall’s house on the Osage River near Taberville, MO.  It was a great family reunion of sorts.  He surprised us with the mounted deer antlers from the buck I shot last fall.  He and I fried catfish from one of his trotlines.  Our family slept in their large camper which the kids were excited about.  Overall it was a grand time.

We arrived in Kyle, SD on Sunday August 2.  My parents drove with us to help with the kids, etc.  The landscapes are gorgeous as you enter the southern part of the reservation because of a preponderance of large, rugged hills topped with Ponderosa Pines.  As you drive north into the open plains the vistas are largely bereft of trees but still strikingly beautiful in their own way as one can see for miles and miles as you look upon the gentle rolling yellow hills.

Our house is standard government employee housing of 1300 square feet with an unfinished basement. They had done some major remodeling to the kitchen and bathrooms which we really appreciated. We were very pleased with the house despite some needs for quick repairs such as a leaking toilet, bathtub faucet that leaked into the basement, a water heater that periodically shut off, and other more minor things. Our belongings arrived Sunday August 9.

I started work yesterday. So far it is mostly endless online computer modules for all employees which seems to be the government’s way of trying to kill your joy from the very “get-go,” but I won’t let it get to me. The people in the clinic have been very kind. I look forward to starting to see patients but feel I still have so much to review. The clinic seems slightly more higher acuity than the typical primary care clinic, which I believe is due to its physical isolation.

In general, we are happy with the isolation, forced focus on intentional living, being the minority, and other major changes, although difficult. One of the biggest difficulties is that people seem somewhat socially distant which I assume is because we are different in so many ways. We have been praying for opportunities to meet people and to develop good, solid relationships.

Before we moved, our son Jesse cried one night that he was scared because all the kids in his new school would be “speaking Spanish.” We thought this was cute and funny and reassured him that Native Americans speak English now. But we just found out that his online-only “preschool” will be some sort of immersion preschool which is taught entirely in Lakota, so his fear is coming true. We are trying to navigate the wisest way through that one. Fortunately, just tonight our kids met 3 kids who sometimes stay with their grandmother a few houses down and they had some fun riding bikes together. At one point Jesse told Katy as he rode his bike “Mom, they don’t speak Spanish!”

The bike riding ended as a storm rolled through and afterward an amazing rainbow appeared over the town of Kyle. We thank God for these blessings.

Rainbow over Kyle, SD, 8/11/2020

Kyle Grocery
Thornless honeylocust tree


Wommack Mill, Fair Grove, MO, 1985

We are leaving Missouri in August, headed to a new life in South Dakota. The feeling at the forefront for me is a sense of excitement, as I feel this is something we have been called to do – to live among the people there (in this case the Oglala Lakota), learning from them, showing them love, trying to be light in a place that is at least characterized by things of darkness (e.g. alcoholism, suicide, low life-expectancy). I’m excited about learning about another culture and seeing a new place. I’m nervous of the challenges of the primary care job with patients with advance disease and limited resources. I am glad that our kids will be exposed to hardship and race. This physical departure from the Ozarks also conjures up a feeling of nostalgia in remembering where I grew up. My families on both sides resided here for several generations. My parents moved from Buffalo to Fair Grove in 1985, just before I was born. Growing up there I was ingrained with a deep sense of community and “place” that I feel is increasingly lacking in modern American culture. Do I romanticize the life and time? No doubt. I am aware of many imperfections to my community (which exist in all) such as drug use, racism, “cultural Christianity”, etc. And I see this strange phenomenon that each individual’s experience and view of the same exact place is drastically different based on their upbringing, friends, exposure to adverse childhood events (ACEs), extracurricular activities, etc. With those caveats in place, here are a few sort of symbolic experiences for me that stand out in my mind and their associated lessons I feel I learned from them.

Spending all evening driving all over the countryside to go Christmas caroling to older church members such as Raymond (1913-2010) and Zetta Ricketts (1916-2000), Eileen Farmer (1919-2009), Hubert and Joann Harral, and many others. Lesson for me: By showing love through upholding traditions of music to the aging people in the church, great memories can be formed.

Visiting Eileen Farmer at her home and seeing her husband’s very extensive arrowhead collection tediously mounted in wall displays throughout the house. Lesson for me: Value the history of the land and those who came before us.

Playing in and around the restored Wommack Mill. It always struck me as impressive that people would be so daring to undertake such a large project like restoring a dilapidated gristmill built in 1883 despite all the naysayers. One time I got several of my fingers stuck in an old apple cider press on the front porch of the mill while my mom was attending a meeting there. Members of the Historical Society used butter to get my fingers out. Lesson for me: In this flash of life we’re given on earth, we have the freedom to pursue hobbies such as restoration of very old structures from the pioneer days.

Kayaking the flood-stage Pomme de Terre River with friends, usually from just east of Fair Grove downstream to Pleasant Hope. Lesson for me: Nature can be beautiful, powerful, and exciting. And fellowship with fellow Christians need not be boring.

Going with Darrel Crawford up to re-roof a small country church near Stoutland, MO with some of his friends from Campers on Mission. We spent two days taking off 100+ years of old shingles and put on a metal roof which was badly needed. We spent the night at the Laclede Baptist Camp and had a very peaceful time around a campfire with the others. Darrel and I walked down to the nearby Gasconade River and admired that for a while. Lesson for me: Christians use their gifts/skill set to meet the needs of others.

Margaret Hotelling (1929-2018), with whom I went to church, would write me notes and letters while I attended medical school in Saint Louis. These were like a glimmers of light and hope during difficult days. Lesson for me: we are made to be in community; when one is absent, reaching out can be of tremendous encouragement to them.

I will miss the landscape of hills, bluffs, dense forest, and creeks. Last year Katy, the kids, and I spent a few days in Shannon County, MO in the eastern Ozarks. We hiked down to Greer Spring (with an 8 month-old baby, a 4-year-old, and a 5-year-old) just before sunset, visited Blue Spring, Round Spring, Alley Spring, Rocky Falls, and Klepzig Mill. It was a delightful and slightly treacherous time with little kids, but the simple natural wonders are great to behold. Lesson for me: Fun vacations need not be expensive and one does not need to travel across the country to enjoy one.

Growing up appreciating nature and community I have often longed to settle down on a hilly piece of land with a spring or creek and build a home and have a simple, somewhat agrarian life. We would be comfortable, have the freedom to garden and have animals if we wanted to, go to church, and try our best to be in community. I could even fulfill my dream of building a hand-hewn log cabin with concrete daubing, making it look like one of those old restored pioneer cabins (no pre-fab red brown logs for me). But as time went on, I realized that I clung to this picture of an idyllic life such that it had become somewhat of an idol. It was not only idyllic but probably idealized, for such a life may bring some joy and peace but it would not ultimately satisfy. Jesus told us that “if anyone would come after me, let him deny himself and take up his cross daily and follow me” (Matthew 16:24). Next he said “Whoever wishes to save his life will lose it, but whoever wishes to lose his life for my sake will find it” (Matthew 16:25). There seems to be a paradox that those who live seeking their personal satisfaction actually end up bringing themselves more dissatisfaction. I see it in doctors who buy very large houses and nice cars and keep their kids busy in many extracurricular activities. They keep working more and more to support their expensive lifestyle but no deep or underlying peace seems to be found, just more work on the treadmill of life and moving along with the cultural undertow. I don’t fault them for this because it is a logical thought process to seek after the things one assumes will bring contentment, and probably no one has told them clearly that they are pursuing a mirage in a desert. No, I think the only way to find actual peace and contentment is to not seek it, but rather to love God with all your heart, soul, mind, and strength; and to love your neighbor as yourself. That is the paradox. Seeking pleasure or peace or contentment in anything else is self-deceiving. The more I think about this idea, the more ground-breaking and life-changing it is and can only come from an omniscient God who is all-loving.

For a couple years or I’ve had sort of an internal conflict of whether we should stay and work locally or go as missionaries, sort of a pulling in two directions. I have been greatly impacted by people who have “stayed” and lived amazing Christian lives in primarily one place. I’ve also been greatly impacted by missionaries who gave up so much to go to where there was great spiritual and physical need. Obviously, a Christian can love God will all his heart/soul/mind and love his neighbor anywhere whether he goes or stays. But at the same time I believe God controls all details of every believer’s life if He so chooses, and He can specifically call a Christian to a specific town in Ethiopia or Mississippi or China, just as He answers specific prayers. I was never tempted to join a country club or own a mansion or drive a Porsche to work or achieve high societal rank. But I am drawn to other worldly pleasures. As time has gone on, Katy and I have learned through God’s word and the Holy Spirit that (for us) we do not feel called to stay, even though it may be more comfortable.

So, we are responding to what we feel God is calling us to do for now. I don’t know what our lives will look like in the next 2 months, 2 years, or 20 years. We will continue to listen to the Lord, whether it be in obvious signs or a “sound of a low whisper.”

Rocky Falls “Shut-Ins,” 2019
Blue Spring
Eileen Farmer, August 2004
Fair Grove Square

Things I didn’t learn

I value my K-12 education, for in general it was decent in setting me up for future “success.” But why didn’t I learn about the French Revolution, the Wounded Knee Massacre and other atrocities against Native Americans, the Holodomor, or how Stalin destroyed the Cathedral of Christ the Saviour to build his planned Palace of the Soviets, just to name very few examples? I don’t know how or why school curriculum is set up the way it is, but surely it would be feasible to cover major topics and pivotal events of domestic and world history throughout one’s middle school and high school years.

Some Unconscious Ills of Social Media

Within the last year I have tried to simplify my life in part by relinquishing some of the modern social norms such as Netflix, Twitter, and Facebook. I never had an Instagram account but I grew somewhat dependent on the constant scrolling feeds (all this new information!) as well as silently peering into the lives of others. It never quite felt normal, but I accepted it as normal. It became normal to spend 5 or 10 minutes or longer several times a day checking on these feeds while at work or at home with my family, as I halfway paid attention to them. After already making many important and healthy changes in my life, my wife confronted me with the idea that maybe I should do away with social media because they seemed to be functioning as a great distraction and because they were acting as hindrances to my walk with God. At first I was somewhat angry and resentful that she would suggest this, as all addicts react when you confront them; then, gradually, as I came to terms with more of my own weaknesses and insecurities, I realized she was right and I somewhat reluctantly gave them up. Since then I have had time to process the above in more detail. I wanted to write out my thoughts on the issue because I feel it is such a major one in society and for Christians. Also, I believe it can be dangerous to just passively accept things culture throws at us without questioning what effects it is having on us.

I do not believe that all social media use is bad. It can be used for good…espousing good ideas, good causes, promoting things of beauty, keeping people connected. Many things are probably just neutral. But I am saying that one must weigh the costs and benefits. For me personally, after weighing everything I feel the costs are too high and the resultant benefits of being off social media are worth more than the benefits social media provide. Since quitting these things I have been more efficient with my time at work and at home, have read more books, caught up on old journal articles, started painting, have found a deeper joy in reading the Bible, and have generally felt happier.

1 Corinthians 10:23: “All things are lawful, but not all things are profitable. All things are lawful, but not all things edify.  Let no one seek his own good, but that of his neighbor.”

Here are some of the inadvertent “harms” that may passively affect someone:

1. Relaxation of behavioral norms (i.e. less likely to be polite). Most importantly, social media in almost any form brings out the worst in people, as rules of social behavior are often relaxed or ignored. This is easily identifiable when reading comments on YouTube and Twitter. Apart from simply being rude, extreme viewpoints are espoused and promoted as though they were the norm, and those who are weaker and of like-mind latch on and adopt these views as their own. This leads to a mob-mentality that further perpetuates the underlying “culture wars” that have existed in society for centuries. False dichotomies arise. “Is it the carbs or the fat??!” It easily amplifies one’s preconceived notions regarding any topic by allowing one to “follow” those with whom they tend to agree. They therefore only see data that will support their beliefs and their ideas, right or wrong, become more entrenched. People are established in their various “camps” as though they were preparing for a Civil War battle. It goes without saying that social media is a breeding ground for misinformation, which I will not belabor as it is discussed in great detail elsewhere. This is all a distraction.

2. Distraction. Carving out time for something digital that takes us away from more important things like family, neighbors, nature, books, other hobbies, etc. Most seriously it gives us less time for meditating on God’s word, serving our neighbor, pursing humility, becoming more like Christ.

3. Self-focused. I am presenting myself in a digital form to the world. It is my life, how I want it to be seen, with my opinions, my outrage, my children, my whatever. I can promote any thought that comes to mind, no matter how well informed or uninformed, no matter how judgmental or alienating, no matter how wonderful. There will be some actual great things said. Is what is portrayed on social media real? One could easily argue that is it merely a virtual reality. You never really know someone until you are face to face, spending time in actual deep conversation, learning their hopes, dreams, fears, insecurities. This seems to be getting rarer and rarer in society nowadays.

4. Hysteria. Easily promotes hysteria or mass-outrage at whatever big story is going on or whatever crazy thing someone said. People see others get worked up about an issue and think “Maybe I need to be outraged about this as well” and find themselves caring about something a lot more than they would if they were not on social media. This heightens controversies. This “mass hysteria” can exacerbate underlying anxiety in prone individuals.

5. Targeting easy targets. Related to the point above, high profile individuals on social media are good at identifying easy targets (i.e. the low-hanging fruit) of whoever or whatever is thought to be outlandish, all paired with its associated scathing comment/critique. This is posted and then commonly spreads through the “viral” sharing by others on the platform, leading to more mass outrage among those who are like-minded. This specific anger burns for the day, until the next day brings forth the next outrageous thing. An example would be the sharing a clip of an outspoken “evangelical” leader who says the 2019 novel coronavirus is God’s punishment on sinners, then espousing this as clear proof that Christianity is nothing but hateful bigotry. This is low-hanging fruit. It is lazy. It is divisive and further broadens the bitter culture wars in America. It is clear that social media thrives on heightening tensions and divisions. In our sinful nature, we are drawn toward drama (like gossip and controversy), if for no other reason it is cheap excitement under the guise of “something important” like politics, religion, sexuality and other social beliefs, human rights, diet-wars, music, and everything else they are up-in-arms about.

6. Dependency. Easy to get pulled in and feel dependent on it. Once one is signed in to the digital world of (literal) endless scrolling, flowing pictures, “viral” videos, and words, it gradually becomes something you feel you need. That endless dopamine release when scrolling and seeing new pictures and videos pop up literally changes pathways in the brain causing it to feels like something you need. If you don’t get it you feel like you’re missing out on a whole world of people and knowledge and information. Spend much time away from and you’ll start feeling a pull to check it again to see what you’ve missed, like those who are thirsty unconsciously start desiring a drink of water. Breaking away can be hard. For me, I had to do away with it completely, because, like a box of doughnuts sitting in the kitchen, if I know it’s there, I am 95% more likely to eat it than if I hadn’t bought them at all. But why do we feel we have to have the information immediately? Why is just getting the news once a day any less ideal? I believe it is simply because our brains have grown used to it.

My biggest personal dilemma in abandoning Facebook is the feeling of not being as connected with people I once was. But as I reflected on this, I realized that when I was on Facebook I actually very rarely interacted with people in a personal way (and vice versa). Usually it was time spent at seeing photos and videos others had posted. I suppose the level of actual human interaction is dependent on what you make of the social media platform, but it never quite seemed conducive to conversation. I believe humans are meant to be in an actual community, face-to-face, where they can’t easily ignore you or unfollow you.

One might rebut by asking “what if I use social media to advance the gospel by spreading uplifting messages, standing up for the truth against those denying Christ, etc.?” But isn’t it common knowledge that no one ever changes sides after a social media debate. Something about it inherently causes dissension and discord in ways that face-to-face interaction do not.

One may see and grasp these ills and retreat from technology as a whole and instead turn to a more isolated existence. They see the ultimate ideal as being a secluded cabin and a more agrarian livelihood, free from all the problems of modern life. But while there may be beneficial psychiatric effects with this approach, I’d say it’s the wrong avenue to take as we were still made to be in community. Self-isolating in order to flee from modern ills is still ultimately a selfish act and is therefore less focused on how to serve others. Like the monks of Mount Athos, the risk is to be so isolated as to produce little spiritual fruit on earth. So what does being “in the world but not of the world” really mean? Where does one draw the line of “too worldly”?

The ultimate answer is a radical pursuit of holiness and being pleasing to God, yet still being involved in the community in which one lives. The question of “how far can I go” is immediately wrong, as the ultimate aim is pleasing the Lord. Instead of asking “can I watch this R-rated movie,” one should ask the harder question of “is this going to be beneficial in making me holier and closer to God.” Civil service, work, community involvement, helping the poor, etc. can all be directly supported by and motivated by the God’s word without being watered down by the world. You don’t have to be a socially awkward recluse trying to avoid human interaction for fear of being “tainted.” In fact, to do so would be antithetical to the spread of the Gospel.

At the core of the matter is faith– faith that our brief life here on earth matters and that God desires our full obedience not only to bring honor and glory to Him, but also for our own betterment and thriving while we’re here. For we must believe that the pursuit of holiness is actually worth it, that in the end it will pay off for us, that this physical world is not all that there is. So, if social media is an encumbrance to pursing God to your absolute maximum, “let us throw off everything that hinders us, and run with perseverance the race marked out for us.”