Science in Christian Perspective

The Christian's Role in 
Medical Teaching and Research
Walter C. Randall
Professor of Physiology
Loyola University Medical Center
Maywood, Illinois 60153

Text of an address presented to the Federation of Christian Fellowship, FASEB, April 12,1983.

I deeply appreciate the sharing of these moments, since we hold much more in common than scientific doctorates, or mutual interests in teaching and research. When your chairman called, I was struggling with the Physiological Society's proper role in combating the onslaughts of the animal rights groups, President Reagan and his Administration's severe curtailment of education and research dollars, the progressively increasing divergence of approved and funded research applications, and the apparent dearth of truly bright students applying for graduate study in Physiology. Tonight I will present a few isolated vignettes in light of our commitments, both as Christians, and as scientists.

Before exploring these concerns, I would like to share some personal reflections during the six weeks or so that I dropped out of the daily round of research and teaching for aortocoronary bypass surgery just one year ago. God has given me an additional year, and I want all that I say to be understood in that light and to His Glory.

I had presented a seminar before our Cardiology Department describing our results in the chronic dog model with intrapericardial cardiac denervation, and how this procedure might be applicable to selected heart patients. I was really trying to sell the Cardiologists on selective cardiac denervation as a potential therapeutic regimen. I felt I could make a case for denervation in situations in which: (1) there is evidence for neurally induced coronary vasospasm, (2) where intractable ventricular tachycardia is life threatening, (3) when there is danger of severe ventricular dysrhythmia, particularly fibrillation, (4) in cases of profound, uncontrolled anginal pain, and (5) where there is hope for sparing of functional myocardium in occlusive coronary arterial disease. Some surgeons around the world are now combining denervation with bypass surgery, and the intrapericardial approach should provide an ideal setting for selective denervation.

I presented this seminar on a Tuesday evening, and on Wednesday morning, mentioned to the Chief of Cardiology that I wanted him to check me over when I returned from an out of town lecture trip that I was starting that afternoon. I explained that I had experienced some "walk-through" angina and wondered how serious it was. He insisted he take an EKG right then and there, and I simply never got away from him. I was admitted to the hospital within the hour, catheterized the next morning, and sustained aorto-coronary bypass that same afternoon. It all happened pretty fast.

Research: An Investment of Tax Money

This personal encounter with the dramatic advancements in recognition and treatment of cardiovascular diseases undoubtedly sensitized my perception of the Federal government's vacillations in support of Biomedical research. You and I apply for research grants, and afew may still actually be funded. We perform the research and see it published (our promotion and our future research funding depends upon it). But how often do we feed back effectively to the tax-paying public or to our representatives in government just how useful and how essential that Federal funding is? Do we go out of our way to remonstrate with our congressman when he doesn't pay attention to us? Equally important, how often do we acknowledge the insights and guidance of the Holy Spirit in our ideation and orientation?

To illustrate my point more poignantly, imagine yourself to be side by side with me in the following situations: first, you are lying with me on the catheterization table, a bit later we're in thoracic surgery, still later in the intensive care recovery room, and finally we find ourselves in the pharmacological aftermath dealing with anticoagulant therapy, concern for cholesterol, triglyceride, and fatty acid metabolism, adrenergic receptor physiology, antihypertensive medication, and concern that the bypass vessels remain patent. Look around you; how much the scenery has changed in the past 5-10-15 years. All because of research, yours, mine, that of our FASEB associates, and colleagues around the world.

During the angiography, I asked to be positioned so that I could see the monitor, and during the dye injection, I thought I saw evidence of extensive collateralization. The cardiologists agreed and said that I was undoubtedly living off the collateral vessels since the native coronary arteries were pretty well occluded. I had been systematically exercising for the past 12 years, and I have come to believe in a functional relationship between exercise and coronary collateral vessels. In fact, if my view of the angiogram was accurate, I represented a better model than the dogs in a series of experiments that one of our cardiologists had designed to test this relationship. One group of dogs was subjected to carefully controlled partial occlusion of LAD and compared with another group without such occlusion. Both groups systematically performed identical treadmill exercise over a period of several weeks, after which all were subjected to radioactive microsphere injections to determine levels and distribution patterns of coronary blood flow in both normal and ischernic heart muscle. Unfortunately. he couldn't demonstrate clear differences in the two experimental populations, and the data did not merit publication. Thus, it occur-red to me that perhaps I was a better study model than were the dogs.

During catheterization, I listened to the conversations between the resident who did the cutdown and his mentor who was one of our former physiology students and also one of Dr. Mason Sones' early trainees. That was of considerable interest to me because I had sat with Dr. Sones on an NIH Study Section during the period in which he was pioneering the first therapeutic angiographic catheterizations. Furthermore, as the resident inserted the Swan-Ganz catheter, it also occurred to me that I had sat on the NIH Committee, and chaired the Site Visit, that had evaluated the original application from Drs. Swan and Ganz for development of this instrument as a research and clinical tool. I began to realize what a good investment of taxpayers money those NIH grants had been. Do you have any idea how many patients have benefitted from that little device? Did you know that the original idea and prototype for the flotation catheter was developed in totally unrelated dog experiments in Herman Rahn's respiration physiology laboratories?

During the catheterization procedure I recognized some degree of consternation among the physicians making the study, and I learned that my coronary vasculaturc had undergone intense vasospasm during the procedure. Most of those present had heard my presentation the evening before, and recognized the direct applicability of selective cardiac denervation, probably for the first time.

When I awakened after surgical anesthesia, I immediately found, among the accessory lines coming out of my chest, a pair of wires just like those protruding from chests of my chronic, experimental dogs. They were from implanted atrial electrodes permitting either recording or pacing, and of course I recognized their purposes. Here again, this technology had only recently been introduced (by a close friend) to human cardiology. Throughout these procedures I experienced a peculiar fascination with these technologies which were actually in transition, or had only recently been transferred from the experimental animal laboratory, many by close personal acquaintences, and many still being employed in research, even in my own chronic animal laboratory.

There was a period of two or three days during the early postoperative recovery period about which I have absolutely no recollections. Apparently one of the bypass vessels had sprung a leak at its point of insertion into the aorta, and I lost consciousness, along with considerable amounts of blood. It became necessary to reopen my chest in an emergency procedure and repair the damage, so I was kept sedated for a few days. During this time, the Intensive Care Unit, and the many hours I spent on the Ad Hoc NIH committee evaluating MIRU (myocardial infarction research unit) applications assumed a different perspective and a different level of importance to me. I began to think those NHLBI investments in clinically oriented research were also pretty well conceived.

It was during this period that your prayers, joined with those of my family and other Christian friends, reached out to touch the very hem of Christ's garment. He answered your prayers and I came out of the experience very well, considering. When I was able to put things together, I also received God's assurance that He still had things for me to do. I determined that I would try to do whatever He wanted and I think that accounts for my speaking to you tonight. I want to praise Him for a wonderfully rewarding career in Physiology teaching and research.

You and I hold numerous characteristics in common: First and foremost is our personal belief and commitment to Christ. Secondly, we are teachers, scientists, investigators, with common interests in teaching, development of new knowledge with practical implications for medicine, and a sense of making the world a bit better because we passed by. Probably most of us consider our professional career as a ministry to which we were specifically called. We enjoy a bond of kinship in this ministry, and we believe we are in His Will, A very good friend was disappointed in his teaching experiences in medical school because he felt he was not contributing much to the spiritual or philosophic aspects of the medical student's experience; he returned to a responsible post in undergraduate teaching where he was able to guide literally hundreds of undergrads into medicine with a clear Christian philosophy. Another close friend is a medical faculty colleague who daily lives a clear Christian testimony. He attracts many medical students to weekly Bible study sessions, and is respected as one of the best teachers on our faculty. My point is simply that each of use has daily opportunities to extend our Christian testimony to our colleagues and our students. Are we faithful to that mandate? If a stranger were to ask one of my students about me some years after he sat in my class, would he recall me as "that enthusiastic, committed Christian teacher" or as "just another member of the faculty in Physiology"?

Sydney J. Harris recently told about a University of Chicago Professor whose newspaper obituary ended with the bleak sentence, "He left no survivors." One of the Professor's former students protested that this was not true. While the Professor, a lifelong bachelor, died without next of kin, he left hundreds of student ,.survivors" all over the world. A great teacher, even if he writes not a word, may be survived by generations, even centuries. Jesus, like Socrates, wrote simply with a stick in the sand, but published not a word during their lifetimes. Still, their thoughts remain eternally fresh. They acquire new disciples (students) every day. I suspect the impact and power of a teacher's personality is far more decisive and more permanent than the facts he imparts. I think this is what Einstein meant when he defined education as "what is left after you have forgotten everything you learned in school." What is left is the indelible memory of a teacher's insight and spiritual commitment, his moral courage, his respect for reason, his excitement for learning, his desire to share his knowledge and know-how, his eagerness to learn from his students as much as he teaches. Unfortunately, there are not many teachers of this sort, not enough at any rate.

So that the practicing physician may acquire appreciation for a strong, enduring bridge between the research scientist in his laboratory, and his own successful application of new knowledge in his daily practice of medicine, we as teachers must work harder to make this relationship real. And I believe the best place to emphasize the contributions of biomedical research to the tax-paying public is by way of the practicing physician. Virtually every individual, either personally or through members of his family, at some time experiences critically important interactions with his physician. Therefore, it is the physician who is in a strategic position to communicate real appreciation for advances in medical knowledge through research. Such dissemination is probably the best, and perhaps the only, way to justify uninterrupted, ongoing Federal tax support of quality research. If the tax-paying public insists upon this, congressional legislators will be less inclined to indulge in wholly irresponsible and repeated disruptions in research funding. But the medical student and young physician no longer have opportunity to experience or to appreciate this relationship unless you and I in the Basic Medical Sciences crystallize it for him. Have we properly articulated this responsibility?, Haven't we told him by our decisions and our actions that the laboratory isn't even important enough to include in his physiology course any more? I am afraid the evidence is piling up against us.

In Conclusion

Thus, I hope you share with me the excitement and exhilaration of actively doing original research, passing along your sense of partnership with the Lord in teaching your rapidly advancing discipline, and on occasion perhaps even sampling the wares of the physician who dispenses the spectacularly new knowledge and technologies that come out of our research.

I leave you with Paul's admonition (I Timothy 6:20-21): "Timothy, keep safe what has been entrusted to your care. Avoid profane talk and foolish arguments of what some people wrongly call "knowledge" (some biblical versions translate this word as science). For some have claimed to possess it, and as a result have lost the way of faith."