Transcript for Episode 39

Ryan:

In this episode, I get to sit down with my co-host Grant Martsolf. We take turns interviewing each other. Grant is a faculty fellow of Beatrice Institute and UPMC Health Systems chair in the School of Nursing at the University of Pittsburgh. In addition to co-hosting this podcast Grant directs Beatrice Institute's Personalism and Public Policy Research Initiative, which overlaps with his own research group at the nursing school. Grant is a statistics and health policy wonk who used to work at the Rand Corporation, so he understands our healthcare system and public policy research inside and out. Lately, Grant has worked to bring philosophical awareness to these technocratic fields, with publications such as "Integrating Political Philosophy into Health Policy Education."

Grant, this is the conversation we've been waiting to have.

Grant:

Yeah. I'm really looking forward to it

Ryan:

As Tyler Cowen says, "This is the conversation we want to have."

Grant:

That's right.

Ryan:

Not you,….

Grant:

That's right.

Ryan:

…listener.

Why should a nurse read Jeremy Bentham?

Grant:

So, that's a really good question. I actually have my undergraduates and my graduate students in my policy courses read a little bit of Bentham. I think it's good for them to understand within the context of ethics, the ethical principles and impulses that drive the way that we think about health policy.

And so much of the health policy work that we do is grounded in rights. We establish the rights that we think people should have within healthcare. And then the distribution, in many ways, is purely utilitarian. So, I think it's good for students to understand that. And then also, as nurses, to really bring their broader understanding of the good of the whole person that sort of transcends material utility to questions of health policy, which is central to educating nurses.

Ryan:

What did you learn from your mother, Donna Martsolf, about nursing education?

Grant:

I remember when I was a kid, there was a counted cross-stitch piece framed above our toilet, actually, growing up, that said nursing was the gentle art of caring. And I always found that really compelling. That first and foremost, what we're trying to do is teach people to care for the person. Right? And then, I think I also learned from her, recently, the importance of being an institutional person. Right? I think in many ways, my inclinations are very autonomous and self-expressive, and I think that she's been trying to instill in me, at least recently, the importance of being, serving the institution at which I exist and helping to advance its purposes while also doing things that I greatly enjoy. So, always fitting in the stuff that I'm trying to teach with the broader goals of the institution, to the extent that those exist.

Ryan:

Like you, I consider John Rawls's theory of justice to be a fantasy of the Enlightenment now come of age in the liberal technocracy.

Grant:

Yeah.

Ryan:

But why wouldn't Rawls's theory of justice work in a hospital? I mean, his veil of ignorance, where you should love your neighbor as yourself as if you didn't know your own identity as a social person, it would seem to fit in the operating room, where a surgeon might well not know the race, class, religion, or sexual orientation of the patient. And so, Rawls's justice is above all procedural. We assure that each person receives what's due her or him by following the same democratically determined procedures in each case. So, isn't the quality of healthcare delivery largely dependent on following empirically proven procedures? Can't Rawls, then, give us a complete account of what justice in the hospital might look like?

Grant:

Right. So, to a certain extent, I mean, I think that once... you're talking about surgery, so we'll talk about the surgical suite. I suspect once a patient is on the surgical table and the surgeon is cutting, obviously they can tell what race they are because their skin is exposed. But I get your point. I get your point. And so, the surgeon's not so overtly racist and changing their practices based on a person's race or their religious commitments, then, yeah, I guess so.

But one challenge is culture always invades the hospital, right? And the reason I say that is because very little of healthcare outcomes are driven by what happens in the hospital, specifically in the healthcare system more generally. I may get this number wrong, but I think something like maybe thirty percent of healthcare outcomes are driven by what happens in the medical system; seventy percent, the vast majority is genetics. People hate to say that, but vast majority of genetics and the rest is really culture, right? And so, you know, the person can get a good surgeon, can get a good surgery, get good nursing care in the hospital. And then, depending on where they go home to, that determines whether or not they're readmitted, whether or not they get a post-surgical infection. So, I think to a certain extent within an exceptionally institutional setting.

You know, my wife Christy, whom you know very well, is a home health nurse for a Christian, federally qualified health center, which is a clinic that sees primarily Medicaid patients and the uninsured. And she used to be in the hospital. And one thing she loved about the hospital is that it was a very controlled space. Patients had to take the medications when you told them to. They'd do what you told them to do. But now, in their homes, she realizes everything that was missing, and she finds it tremendously exciting that she has to negotiate with them. They don't have to take their medications when you tell them to. They don't have to do what you tell them to because you're entering their space. And I think that a substantial portion of what happens to the patients is driven by what happens after they're discharged, even their surgical outcomes themselves 'cause they're certainly not well when they leave the hospital after three days.

Ryan:

Do you want to switch?

Grant:

Yeah, we'll switch. I'll go ahead and ask some questions. So, one of the greatest aspects of my time at the University of Pittsburgh is participating in the Beatrice Institute. It's been so life-giving, both intellectually and socially. So, I want to ask a couple of questions about your take on the Beatrice Institute. I know the history, but one thing that really intrigues me is thinking about: What does the Christian academic have to offer at a major research university from within the university? Not from, not a scolding outside voice, but within the institution. So, I think, the sub-question is: Why Beatrice and what do we have to offer to our colleagues, particularly in this setting?

Ryan:

Well, locally here in Pittsburgh one of the main things we have to offer is just the study of Christianity. So, there is that at the University of Pittsburgh. We have a great religious studies department, but it's small. We only have one tenure-stream position and another full-time non-tenure position that are dedicated to Christianity. At Carnegie Mellon University, there is no religious studies department. There are some great faculty who study Christianity, but how do the students get in touch with them? Right? So, one thing that we're doing is just offering the subjects.

But, I think that when it comes down to the interests of the university, a university that still wants to have some kind of liberal arts core, some kind of encounter with the humanities among its students, is going to need, especially in this day and age, to attract students some other way than the way that most courses of study attract students, which is by promising them jobs, right? And the humanities, as well as we do in preparing students for a wide range of careers, that's not intelligible to the parents and is not immediately intelligible to the students. So, what else is going to attract them to the humanities?

Often it is some kind of tertiary interest coming from the outside. And we have the numbers to prove that Beatrice Institute, by creating an intellectual community in which students feel like Christian studies is plausible, it's interesting, it's a way to connect with their peers and with faculty, by doing that, we are actually getting engineers, nursing majors, preprofessional degree majors to enroll in humanities courses and Christian studies courses or in courses that I teach in the English department, like Bible as Literature, which isn't explicitly Christian. But, you know, in the philosophy department, we've got students taking Plato because they encountered the great classics professor who also studies Augustine. So, really, one of the ways that an institute like Beatrice Institute serves a big research university is by putting butts in seats in the humanities courses. And then, we've got fantastic humanity faculty who can take it from there.

And then, there's a kind of loop, a feedback loop, where they take Christina Hoenig's Plato class and then they come back, and in Beatrice Institute seminars, they're able to engage at a higher level. They might end up doing a double major. And they're better equipped even beyond college to pursue whatever it is that they're doing in life. Because, you know, recent longitudinal studies have shown that the number one indicator for whether a student is going to pass from their high school years in a faithful family through college into their adult years still practicing a religion—their religion—is whether they have learned more about it in college. And so, that's a, that's a really virtuous feedback loop that we get there. And it really feeds into, as we know through these longitudinal sociology studies, into widespread metrics of life satisfaction, no matter what career you're in.

Grant:

What about to our colleagues? What do we have to offer them in terms of the research that we do? What you just talked about was very student centric. What about research and faculty centric?

Ryan:

The humanities have been in crisis for a long time, but within a liberal arts core, I think there's a broad, dawning consensus that critique–critical thinking—is not enough. Right? It's not what is going to change the world.

Grant:

Right.

Ryan:

You know, if there's anything that universities profess that they want to do, it's to change the world. Right? And in the humanities, which have become very activist—and I say that not disparagingly—but you are forming your soul—humanities as a kind of soul craft—that will enable you to go out and seek the good in the world. I think there's a broad understanding that that is a purpose of humanities, but you need more than critique. And and you need these visions of the good, and you need a sense that there is a possibility for reparation, there's a possibility for reconciliation. How do we go about doing that? So, Christianity, while it has its critical side, it has its secularizing side—driving all of the fairies from the land, driving the snakes from the island. Right. It has that kind of rationalizing side to it, but it also profoundly generates visions of the good and generates narratives of reconciliation and recovery. And it's never really stopped doing that, in the way that certain aspects of the social sciences have ceased to generate visions of the good and have turned purely to critique.

Grant:

So, one thing you talk about—and this is a part of the introduction, people will have just heard this—that part of our role is to promote intellectual friendship within the academy. What's your vision of intellectual friendship within the modern university? What, what are you hoping for? We have a friendship, but in many ways... it's intellectual, but it's also, you know, we have kids that are friends and we share a faith and we share, just, a friendship. But what's an intellectual friendship look like in the academy? What are you hoping to accomplish?

Ryan:

I think it looks, it looks a lot like, I mean, it can be friendship based on affinity, right. For me, most of my intellectual friendships in the university are not based on affinity. In terms of, you know, I'm certainly in the minority as someone who is a practicing Christian.

And so, it's not a kind of cultural affinity necessarily, but it is a shared—I would say interest is the way it begins. Interestingness is this vacuous concept that, nevertheless, we all feel and are driven by, especially in the humanities. So, it begins with common interests. But really, where interests take on content and direction and drive is in a search for truth, beauty, and goodness. And intellectual friendship—to go back to the Aristotelian definition of friendship as wanting the good of the other—to want the good of the other is to want the other to succeed in their pursuit of truth, beauty, and goodness. And I think that right now, especially in the humanities academy, there's a real hunger for goodness, for justice. What does it look like? How can we achieve it? And to come together across differences of experience of background is one of the most beautiful ways to pursue the good.

Grant:

Do you think there's a shared telos within the university, either generally or at the University of Pittsburgh, that we're about the pursuit of truth, goodness, and beauty?

Ryan:

Well, I mean, it's, it's in our motto, right? At least the veritas part of it. But no, not officially. I mean, officially, what a twenty-first-century research university is here to do is to maximize benefit as understood according to a liberal, capitalist order. And so, you'll see this in the recruitment materials. You hear it when the students, student leaders are leading groups around campus, trying to get them to come, right. It's, it's very much this consumer experience that's meant to convert into a job and a particular kind of career down the road.

But the university is made up of humans who are naturally inclined to pursue and to be attracted by goodness, beauty, and truth. And part of our job as teachers is to help students recognize that that's something that they're after.

All right, now for you.

Grant:

Yeah.

Ryan:

So, what role in today's healthcare system would correspond most closely to an American civilian doctor in 1900, circa 1900, so before specialization and the move of healthcare delivery from the home to the hospital. I mean, is a nurse more like a doctor in 1900 or physician's assistant or has everything just changed so much that they can't even be compared?

Grant:

Yeah. So, we don't have to go back all that far to think about what that doctor would look like. Even my own father was a primary care physician. So, you know, family doctor, and he did everything from delivering babies to relatively minor surgeries in his office. So, I would say the primary care physician is probably most close to the nineteenth-century doctor of being a deep generalist and also being entwined with the good of a particular community.

Now, with that being said, that's deeply fragile at this point. So, for example, my dad gave up delivering babies maybe thirty years ago; he stopped working in the emergency department maybe thirty years ago, mostly for liability reasons. And because there were so many OB-GYN specialists that he probably wasn't delivering enough babies to keep himself any good at it.

So, I'd say the primary care doc is similar to that. But, actually, returning to talking about Christy, my wife, in many ways I would say, yeah, I would say the community health nurse is actually in many ways much more closely connected to that nineteenth-century home-visiting physician with the black bag who was there—and he had a relatively limited repertoire of things that he or she could do—but was there to abide with the family in their joys and their sufferings. And I think, in many ways, the community health nurse works that way. Now they have an even bigger portfolio of things that they can do to help someone.

But I think that sense of being a part of the community and being about the flourishing of families and individuals, I think, is probably most closely associated with, in terms of physicians, the primary, the family doc. And there's still settings in which they can do that. Like, if you think of East Liberty Family Health Center, where Christy works, in the city of Pittsburgh, in East Liberty, doctors, like Dave Hall, who started that, and then Joe and Sima Weaver, are still in that vein. But again, they're very much constricted by the fact that they have to crank out what we call CPT codes, where they're the revenue generators for a health center that has a deep and virtuous mission but still needs to keep the doors open.

Ryan:

What are the prospects for the future of the community health nurse? I mean, is this a growing approach?

Grant:

No, no, no. In fact, it's exiting a lot of nursing programs. [Now it’s] just like physician specialization and a deep commitment to technology. Like the most exciting thing that we have at the University of Pittsburgh School of Nursing is the simulation lab, where there are simulated patients that they're actually like giant dolls, like giant real dolls that very much function like people and that's what's... And then also, it's almost expected that a nurse coming out of university will go, is expected to go to the hospital to a medical surgical job or to the critical care unit. And there's very little—and we still have a community health class in this university, but it's, it is very understated.

In fact, I was at a meeting in Bozeman, Montana, two years ago that we organized thinking about the future of nursing health services research. And that was a big push. There's so many people there, nursing deans and journal editors, that I wish we could return to this sense of the community health nurse, who goes in and helps people manage their conditions, helps them address the various social and cultural conditions that are keeping them from being healthy. But the money just is against it.

Ryan:

Suppose I'm a member of an Amish community in rural Pennsylvania, you know, sixty years old, I get colon cancer. How is my experience going to differ of both care and of how I'm going to pay for it than the real me who has University of Pittsburgh Medical Center insurance, and this luxury, basically, luxury package?

Grant:

North or south Lancaster? Because apparently there's a difference. I forget what direction it goes, but apparently the wealthy Amish live north and the more modest Amish live south.

Ryan:

Okay.

Grant:

And there's actually...

Ryan:

And there's going to be a difference in care there?

Grant:

Apparently, there's a big difference...

Ryan:

Yeah.

Grant:

...in how they understand their place in the broader Amish community, which is news to me. I was actually just reading about this the other day. So, the first thing—and I'll just talk generally, but recognizing this difference in different types of austerity, even within the Amish community—is they do not use health insurance. And the primary reason is that the Amish believe that it, it cuts against their commitment to mutuality and cooperation and charity, basically, charity between neighbor within the community. And so, the idea would be that if your barn burned down—and we all know the image of the Amish barn raisings—if your barn burned down, you don't call your insurance agent and say, "Can you send me some cash so I can rebuild my barn?" Your neighbors come and they build your barn with you.

And so, this notion of mutuality and cooperation is exceptionally important for the Amish community. They think the same way about health insurance. So, actually, they have I think it's called the hospital aid program, where if you have...the expectation is that if you or your family have a healthcare need, you'll pay for it on your own—you'll have some savings—but if it goes beyond what you can contribute to, there's a pool of money that they've collected from almsgiving that then they give on behalf of that person.

So many Amish communities are very...do a lot of traditional types of medicine. Apparently, there's a very robust herbal market in Intercourse, Pennsylvania, or one of those towns in Lancaster. But they're, they're not anti-technology. So, this person, I assume, probably gets surgery, but I think the big difference would be there wouldn't be the same sort of commitment to no-holds-barred care. It's also a very deeply communal decision. The elders would come into the hospital room, help the person make decisions—not in spite of their own wishes, but together—taking the person's wishes into account, but then also recognizing what the community has decided is a good life. And oftentimes that good life would be the agreement that the person's life has come to an end. And again, I think it's this balancing act; they're not against modern medicine, but also recognize its limitations.

Ryan:

So, the decision to go to hospice rather than to keep bombarding with radiation to, to add six months to the life or something like that.

Grant:

Right. That's right. I think there's also, and I don't know this for certain, but I suspect there would also be some consideration of the fact that their hospital aid program has limits. They can't give all the money to one particular family. I mean, I don't know that for certain, but I suspect that there's a board that oversees the hospital aid program that, I think, makes some of those hard decisions together.

So, I'm very interested in Genealogies of Modernity. I've been reading the blog, which is obviously your... the research endeavor that's housed in the Beatrice Institute, but it's sort of the epicenter of your intellectual life right now and also received a very large National Endowment of the Humanities grant, which is very exciting.

Again, it's called Genealogies of Modernity. So, what is a genealogy in the way that you talk about it? I know that we talk about genealogy, like who are your grandparents and who are their parents. I think it's related to that, but you're thinking more of the genealogy of ideas, or correct me if I'm wrong. What do you mean when you talk about genealogies? What's this project?

Ryan:

Yeah. Well, so my own individual project that I'm writing a book about right now is specifically, what are the literal forms of genealogy? Like, we have the family tree that we can look at. We have what Darwin called genealogy. He actually preferred the language of genealogy to evolution. So, the genealogy of a species. Right? So, so these are literal ways of understanding what Darwin called "descent with variation." So, descent with variation—lineages that grow and change and branch over time. So, that's what I think of as literal genealogies.

And then, the historical humanities, that is the humanities that are concerned with change over time, as opposed to, say, the branch of philosophy metaphysics, right. But most of the humanities have this historical bent to them. And what it is that they're doing, in terms of helping us understand what it is to be human and how we are human, is understanding the unfolding of human history across time. And it used to be that the primary analogy for this was story. So, it's there etymologically in the root history; in German, the same word, Geschichte, means short story and history. And so, when you have story as your analogy for history, you think in terms of beginning, middle, and an end, you think in terms of protagonists and antagonists, you think in terms of conflict.

But genealogy, since, I would say, the 1980s, has really taken on prominence as an alternative analogy to how we think about human history unfolding across time. Now, currently there are a bunch of, there's a lot of interest in nonlinear ways of conceiving of history, and those are fascinating too. But genealogy, in terms of thinking about history as unfolding across time, is, I would say, probably the primary analogy that's used now.

And so, what does that mean? So, think about, when I think about my own genealogy, I can think about my ancestors. And I've just been trying to do this on ancestry.com, and I can get back about five generations on various different branches. And then, either it disappears, I lose the trail, or I can keep going back so far by piecing together multiple family trees that other people have researched that pretty soon my origins are so many that they're basically meaningless, right? They're genetically meaningless, like in terms of what kind of genetic content I have, my predilections, my susceptibility to certain diseases, and they're also meaningless as my identity goes. They're so distant. And so, one way of thinking genealogically about history is to say that, oh, you went on ancestry.com to find monarchy in your family tree, and sure enough, you did. You traced it back to a minor king in Ireland. But that's not your origin, that's not your noble origin because look where he came from. He usurped his uncle's throne. And, besides that, you have a proliferation of origin. So, how can you say that that's the one?

So, part of the genealogical analogy is to debunk claims to noble origins. But if I think the other way, in terms of my descendants, they all proceed from me, from me and my wife. And we're the root of this family tree and everybody's growing out from there. And in that sense, I can say that I am the origin and cause of all of these people—Abraham, the father of many nations. And whether or not I'm of noble origin doesn't matter. But you can discover a lot by looking back to the particular origins of a family. Right? So, so there's also this other way of looking at it that historians talk about that's more positivistic. That, by doing a DNA test, I'm able to determine, and they would say "certain propensities" for medical problems.

So, those two ways of thinking about genealogy, the one obscuring causation and origins and the other one identifying and revealing causations and origins, actually push against each other in the way that the humanities think about things. And so, my wager in this book is that we can refresh the way that we're thinking about the historical humanities by digging into other kinds of literal genealogy, and that family tree is not the only way of thinking about genealogy.

Grant:

Is there a particularly common or taken-for-granted genealogy of modernity that's just plain wrong?

Ryan:

Yeah. I mean, there, there are a lot of them, right? So...

Grant:

Give me an example of one, particularly in the minds of the modern man.

Ryan:

A best-selling example is Steven Pinker's Enlightenment Now.

Grant:

Right.

Ryan:

Right. Where he shows in something like sixty graphs how the Enlightenment discovery of autonomous reason has affected the world in only progressive ways, making humans less violent, less sick, and more happy.

Grant:

Yeah. I remember reading Steven Pinker's Enlightenment Now, and I realized that there was one graphic that was conspicuously absent was the abortion graphic. Where he...

Ryan:

Well, those would skew the numbers, just like he has a way of statistically dancing around the various totalitarian massacres and debacles of the middle of the twentieth century, as well.

Grant:

Right. And he also has a particular way of thinking about history, where he doesn't count the 1930s in now. Do you know what I mean by that? Where we've somehow moved beyond the 1930s, so we no longer have to think about it as a "present catastrophe."

So, actually, I was gonna wait for this next question, but this is very relevant that you bring up Pinker. So, I'm thinking about the fact about how many Catholic writers, authors, novelists that I love so much that interpret modernity apocalyptically with deep pessimism. I think particularly of Walker Percy, who we did a podcast about recently, Michael D. O'Brien, who we've talked about quite a bit. We both have affection for Michael D. O'Brien. Should they be cheerier, like Steven Pinker is cheerier?

Ryan:

Well, I don't know that they should be necessarily cheerier, but I think that, you know, there's, there are two kinds of apocalypse, really. There's a tragic apocalypse and there's a comic apocalypse. And we kind of get a glimpse of both in the Apocalypse of John in the book of Revelation. We've got the tragic side of Antichrist, but then, ultimately, it's subsumed into this marriage of Christ and the Church. So, like a Jane Austen novel that begins with a conflict and a breakdown of social relations but ends with their reconciliation and marriage. That's the basic plot of the Bible. And so, what, what does it take to look at human history with a comic historical imagination? And, and that's where I think this alternative vision of genealogy comes in.

Grant:

Interesting.

Ryan:

And this particularly... so, you know, forget about the family tree that begins with a couple and then branches out through their specific descendants, and think instead about the way that medieval people determined whether it was possible to marry your cousin. This is where we get the term “six degrees of separation.” And so, there's actually charts that enable you to determine whether you're within this six degrees of separation or, after Lateran IV in 1215, four degrees of separation was what was required in order to marry. This is also tree shaped, but it's like a Christmas tree made of a grid of boxes, and those boxes measure the degrees of separation. And as a new generation is born, it bumps the previous generation up into the next row of boxes. So, it's always in motion. As human history unfolds generationally, this tree of consanguinity it's called, of blood relations, this tree of consanguinity is unfolding and in motion. With each generation, it pushes individuals out of the proximity that is taboo and into a distance that renews marriageability. And so, what we need to be thinking about is as history changes, what new possibilities open up? As historical phenomena move out of this close proximity where there might be conflict and into a certain kind of distance—let's think even of patterns of secularization in the modern world—where does marriageability return? And it's that kind of thinking of possibility that, I think, is the comic historical imagination.

Grant:

Yeah. I think that's a really good point. At the end of Michael D. O'Brien's Children of the Last Days, the final scene is Father Andrei and Arrow walking through the cleft of the rock into this paradise where, really, Ratzinger's creative minority is existing and then a new, more beautiful culture is emerging. So, I've actually been thinking about that a lot as well, that we can look on our current time very pessimistically, but it also can be an exciting time. When we see the Church in such disarray, those are the very moments when the saints are created and there's new shoots coming out of the stump. I often have to remind myself of that. You always have to read Michael D. O'Brien to the end to get the last five pages of the hope.

Ryan:

Yeah. And you know, a similar analogy there is I was just at a retreat a couple of weeks ago, and in one of these meditations it really got me because I thought it was heading... it was about how amid the apparent devastation of secularization we need to focus on the little things, the small communities, and so on. And I was expecting kind of a Benedict Option argument. But then he took this turn that I'd never heard taken so explicitly before, which was not to go back to the wake of the fall of the Roman empire with Benedict in monastic communities. He said, "We've got to think of ourselves like the early Church when there was no system of episcopacy. There were no monasteries. There weren't even what today we would call churches. There were just lay people, a few priests, a few deacons, the occasional bishop, and families. And that's where we're at. And that's where we need to focus." So, different than the Benedict Option, it's the option of early Christianity.

Grant:

Yeah. And that's sort of the notion of the domestic church that I think is so powerful. I mean, I do agree that if the Church has a future—and it always does, right—that it will be grounded in parents and children carrying the fire of hope forward into the future. So, in my best days—and, and listeners should know that Ryan actually did send me that meditation from—it was St. Boniface, right?—that was related to that meditation.

Ryan:

Right, yes.

Grant:

Because Ryan knows that I can be prone to deep pessimism as I read Michael D. O'Brien and Walker Percy all day.

So, go ahead.

Ryan:

Well, that's a good transition to the “would you rather” series where you have to choose among alternatives that you would never want to have to choose among in real life.

Grant:

Okay.

Ryan:

So, first one, Walker Percy or Michael O'Brien?

Grant:

So, I'm a very loyal person when it comes to authors and, well, hopefully in my friendships too, but particularly in authors. So, I will say Walker Percy, 'cause he's been with me a lot longer. But I do tend to have this habit of I find an author I love, and I read everything that they've ever written. So, I'm in the midst of Michael D. O'Brien, currently reading Sophia House. In fact, it's through this podcast that I got turned on to Michael D. O'Brien from Jessica Hooten Wilson who recommended him as we were talking about Walker Percy. So, I will say Walker Percy, but maybe check back with me in two years.

Ryan:

Would you rather get rid of your tattoos or your beard, assuming neither could grow back?

Grant:

I would say my tattoos. You know, I have some unfortunate regrets. But I can't live without my beard. I mean, this thing, I just realized recently, my beard is old enough to drink. It's now over twenty-one years old. My beard no longer gets carded at the bar. Yeah, I would keep it. And it's the one thing that, you know, my tattoos, I hide, often, but I can't hide the beard.

Ryan:

Little League or Major League?

Grant:

So, my son plays Little League. He just finished up his season. I would say I get the most excited at Little League. Watching your son—I would say, I've never been more nervous than watching my son pitch. It's so exciting and so nerve wracking, I can almost not keep myself from throwing up. So, I'd say for the excitement factor. But Little League ends, right? I mean, are you saying permanently get rid of Little League as opposed to permanently get rid of Major League Baseball?

Ryan:

No, not necessarily. Just, would you rather?

Grant:

Right now, I'd rather watch Little League. Once my son is older, I'd rather go to PNC Park.

Ryan:

You're wounded on the battlefield. Would you rather be attended to by Florence Nightingale or Walt Whitman?

Grant:

Well, Florence Nightingale. So, actually, speaking of my tattoos, I have a tattoo of a, they're called Rose of No Man's Land, which was the nurses that took care of wounded soldiers, I believe in World War One. I don't, my time is not quite right here. I'm actually, she was the Crimean War. She's much more in line with what I see to be a nurse, even though I'm also a male nurse with a beard. But I'm going to say Florence Nightingale. I'm not going to take it any farther than that.

So, what are the biggest challenges trying to teach iGen how to write?

Ryan:

The students who get to the University of Pittsburgh are already pretty decent. I did teach freshmen comp last year. So, these are the students who didn't test out of writing. But I think, I think it's more on the argumentation side of things. Just to recognize that it's not mean to argue a position.

Grant:

Right.

Ryan:

It's not mean to assume that you have a different position from someone else and then to give reasons for it. And I think, I think that's, that's the most…

Grant:

That's interesting...

Ryan:

So that's the big challenge.

Grant:

It's almost like a temperamental challenge as opposed to a technical challenge. I don't know.

What have you learned about the Bible for your own devotion when you teach it as literature within a secular context?

Ryan:

One of the biggest things is that I just have come to see the Bible completely anew by having to prepare lectures about it that don't assume any prior knowledge and that don't assume faith. And so, I have the Jonah story figured very prominently in my first book, and I realized early on, I can't assume that students know the Jonah story. And so, to tell the Jonah story to someone for the first time, just to tell it a) it's a ton of fun, but b) it's just remarkable. There's something, you know, there's this alienation effect that you get when you're trying to tell someone the Jonah story for the first time. This is what our friend Peter Moe has been really good at is looking, meditating on the whale from all of these different perspectives. And then, through that meditation, coming back to the Jonah story and asking, "What does this mean about Christ? What does this mean about resurrection?" So, it's a kind of lectio divina.

Grant:

Interesting. As you mentioned this idea of biblical literacy, I took a group of students to Argentina two years ago for a study abroad trip, and we visited a hospice center called the Good Samaritan. And the person that ran the hospice center started to talk by saying, "Who's ever heard the story of the Good Samaritan?" I figured every student would put their hands up. Maybe forty percent had ever heard the story of the Good Samaritan, which was shocking to me. And there's a number of Catholic kids there that had never heard the story of the Good Samaritan. That was very clarifying, both discouraging, that we've lost this sort of storytelling within our popular culture, but at the same time also kind of exciting, to your point, that they hurt. It was fascinating to watch those kids hear the story. There's a number of students weeping as they were hearing the story of the Good Samaritan. It had become so common to me that I realized that that's actually a story that should draw us to tears. So yeah, that's really an interesting perspective that you bring on there.

What does incorruption tell us about the Christian understanding of the body?

Ryan:

Mm. So, the incorruptible flesh, my favorite incorruptible is Saint Catherine of Siena. Her head and her thumb are incorrupt, preserved in the Duomo of Siena. You can go there; you can stand feet away from her head. And one of the things that this demonstrates for us is that St. Catherine of Siena was a saint, right? Her body—or these parts of her body—behave in a way that nobody else's body does. But I don't know if I would want to take my six-year-old up and show it to her because it's ghastly. It doesn't look like St. Catherine is just sleeping there. It's decaying, but it's decaying at a different pace than the natural pace.

And I think that's the key to understanding the doctrine of incorruptibility is that incorruptible bodies are participating already in the resurrection, even as they are also participating in this corruptible world that is passing away. And what they witness to, then, is both the hope of the resurrection and that this world is passing away. And this is going on in each of us, right? This is what exercised Luther's imagination so much. How does the old man and the new man live in us at the same time? And this is an image of it.

Grant:

So, they make explicit that spiritual reality that we all are experiencing.

Ryan:

Here's a genealogy of modernity for you. Ivan Illych, he laments the institutionalization of charity in the Christian tradition. So, he talks about how, in the High Middle Ages, you had wealthy people building on a wing of their house to provide beds for the sick so that they could conveniently care for the sick with their own hands and, therefore, carry out the corporal works of mercy. But that's a very inefficient way of doing things. And the Catholic Church in the High Middle Ages started to realize that we could pool our resources and we could make the hospital. But the triumph of the hospital as an institution has meant that there's now practically no way for the average Christian to minister to the sick.

Is that right? Or, I mean, I could go off and I could volunteer at hospice this afternoon and in a way I, I don't have the money to build on an addition to my house, but that is open to me. So, is it possible that, actually, we've kind of democratized the corporal works of mercy? Like, what's going on there?

Grant:

So, one thing that does—this doesn't exactly answer your question—but one thing I really do struggle with is how to think about distributive justice. So, this is a little bit different but similar to the point that you raise. Where, by creating this infrastructure of food stamps and Medicaid, we've made it nearly impossible for any individual person to do acts of mercy independent of the welfare state. To your point, we can certainly do it, and there are certainly opportunities for us to care for people. And it's very efficient.

You know, a woman Elizabeth Bradley in her book called Health Care Paradox makes the point that in Scandinavia they rely very extensively on government welfare, very much less on philanthropy. Which, in the United States, probably feels like we rely very heavily on the welfare state in United States, but actually, compared to other nations, we still have a heavy philanthropic bent within the nation. And it actually works out better—from a technocratic, efficiency perspective—it works out in Scandinavia. Like, they're able to target money at people and have direct transfers, all that stuff.

But I do wonder what it does to us in the exceptionally long term that we are so abstracted from acts of mercy and charity. That, really, the only thing we actually do, in many ways, as modern Americans do acts of mercy, is to have a direct withdrawal from our paycheck. And I wonder if in the long run that will degrade even our commitments to the common good, because the common good is so abstracted from our lives. Does that make sense?

Ryan:

Yeah.

Grant:

I know that didn't answer your question directly, but I struggle with the same sort of thing, where everybody now is participating in almsgiving in a weird way by having money directly withdrawn from their checking account. They're not relying on the beneficence of the king or the aristocrat. Like, we're all kind of participating in a certain sense, but at the same time, none of us are actually participating in acts of charity. And I don't know what to do with that.

It's funny. I thought about this, too, within the context of COVID—again, I'm launching from your question to pontificate on things that I've been thinking about. But COVID was such a strange, modern thing, right? Where, the greatest act of mercy you can do is sit at home, watch Netflix, and leave everybody alone. That is so modern. And I don't know what to do with that. Christy, again, I continue to talk about my wife because she's so wonderful and such an important part my life, but she really struggled with that. That, as a nurse, there's almost nothing that she could do. And the best thing she could do is leave her patients alone so she didn't infect them with COVID. At least that's what was the going understanding last April.

Ryan:

You and I both know a student who came to Pitt as a first year in the nursing track. And after the first semester of her nursing classes, she kind of took stock of her surroundings and what was to come and said, “This is really boring. Like, I want to care, I want to care for people. That's what brought me here. But I can't enter another three years of this curriculum when what I long for is to read the classics.” And now, she is transferring and probably going to go somewhere where she can study theology. But if you were given free reign by a confessional university, like Baylor or Duquesne, to build a nursing school from scratch, would it be able to retain that student?

Grant:

I hope so. So, it’s so funny that you say this. You're going to get me in trouble a little bit ’cause I think about this quite a bit. There is something desperately boring about nursing education. We're very much beholden to accreditation standards, national accreditation standards, that require us to have certain amount of clinical hours. And it's a liberal arts degree, but not really. And in some ways, it's like, that's really boring to teach in because it's, it's really, deeply practical and it's not always super intellectual. And we try to do that, but inherently, it's a trade. And I could get myself into so much trouble by saying this, because what I'm saying is very controversial in the nursing education world. And there's not a lot of room for contending with ideas while we're also trying to do, like, reams and reams of clinical classes that, in many ways, are very boring. I'm very sympathetic to the student.

So, I think that there's a way to construct nursing education—I mean, ultimately, nursing is a study of the human person in its very depths and core. If I was redoing a curriculum, I would very much have a normal liberal arts first X number of years. And that's historically how it used to be. You’d do like two years of liberal arts and then you’d apply to nursing schools. Some schools are still that way. And then I would very much make nursing programs apprenticeship model. And again, like, that's what we moved from. You know, Dorothy Day, she was a nurse. I mean, she was a nursing student. She was an apprentice—that's probably not the word that they used—but she was apprenticing at one of the hospitals in New York City. And that was sort of a nursing education.

I would actually ramp back the clinical hours substantially. I think that we, but, but that's like, that's like the modern world, right. Where we give people lots of technical skills, but we don't give them a vision of the good to which those technical skills serve. So, I'd love to see students emerge with a really robust sense of what is a human person. What is goodness, what is beauty? How, how can I be restoring the sick person to a good, beautiful, and true image of what it means to be human person? But the thing is, we just don't have enough time because the curriculum is so stuffed with requirements that we don't have a good chance to teach them what it means to be a person, I think, to our great, our deep detriment. But, ultimately, isn't that just the modern university in many ways? We're giving them technical skills to no end.

I was watching an interview with Jon Stewart that he was doing with Stephen Colbert and he said, “Here's going to be the end of the world”—I’m probably not going to tell the joke right, but—"It’ll be a scientist in a lab and they'll go, ‘Huh, that worked.’” You know, they got this, like, amazing thing to work, but it wasn't in reference is anything good, and then all of a sudden it destroys the world. It's like, what's the technique they used to charge up viruses in the Wuhan lab—or supposedly, anyway—gain a function, right?

We can do these amazing things, but we're not quite sure how they serve any particular good or truth or beauty. And I think that that's endemic to higher education. And I would like to see that change within nursing because we are “the gentle art of caring.” And what is caring? If it's not, at least, helping for the flourishing of the human person, I'm not quite sure what it is.

And so this is actually exactly what I'm trying to do with my work through Beatrice. I think my field is exceptionally good at assessing whether or not programs worked and figuring out how much we spend on things, and figuring out fancy ways to get people health insurance. But I've never had us step back and say, “Why are we doing any of this in the first place? What are we serving?” And that's actually what I'm trying to do. And I think the first step is with a robust theory of the person. I really, really do. And so, once we have the theory of the person and we know what the basic motivations are of the human person and what those basic goods are, that are both spiritual and material, then I think we can begin to hash out: what does a social order look like that produces human, a flourishing person? And it's not just passing out health insurance.

Ryan:

Well, and if that's the shape of the good, that it's to eliminate suffering—eliminate, eliminate suffering—to cure and eliminate diseases, then I think that this whole, what seems to be crazy Silicon Valley push for immortality, right? These, these startups that are actually, you know, what is it they're promising? Immortality. But that is, actually, just a logical conclusion of this view of health. If health is just not dying, not aging, then immortality is the telos.

Grant:

But that machine, as it moves forward to that end, leaves a lot of broken people in its path. And maybe that's, like, the job of us, as well, is to mend the wounds of those that have been scattered as we progress towards immortality, because there's gonna be a lot of people that don't quite make it to that immortal end as the machine moves forward.

Ryan:

There's a great Ken Liu sci-fi story about this, and it really brought the search for immortality into sharp focus for me. And the story goes that a spaceship of humans has to depart earth in search of a planet where they're going to be able to carry on the race. Halfway there, they get a message from earth. They've discovered the science of immortality, and they're given it. It's just this, you know, sequence that the DNA repairs itself. So, they're able to make themselves immortal on the spaceship during their transit. But they only have limited food resources, just enough to get to where they're going. If one becomes immortal, are they going to have to kill off the children? Seriously. This is what it turns into. And it's a zero-sum game when you have limited resources.

Grant:

Man, that's really fascinating, too. You know, that's actually exceptionally fascinating where we have both these simultaneous movements towards immortality and then a desperate fear of global warming. The people that always lose out are the weak, right. It's always going to be the children and those that can't quite keep up. That's really fascinating. In both of those forces, the victims are the young and the weak. Oh gosh. That's really, yeah, I hadn't thought about that. That's really, that's really fascinating.

Anyway, I don't know if you've been reading Paul Kingsnorth.

Ryan:

No.

Grant:

Have you seen his name floating around?

Ryan:

I have. Yeah.

Grant:

So, he's, he was a very long-time environmentalist and he was a Wiccan. And, you know, he was into sort of earth religions. And, recently, the big news is that he converted to Eastern Orthodoxy. But his whole thing is he, he totally believes that—and this is a little bit different than what we were just talking about—that this project to save the environment is over. It's already been decided. Our insatiable desire for progress makes it so we must exhaust the resources of this world. And what does it look like, then, to live once that game has been lost and we know that, in many ways, it's over? Yeah, that story reminds me of that way of thinking. And maybe that's another thing. What is the good within this sort of apocalyptic moment, to the extent that we're interpreting it that way? What goodness and beauty will flourish as what we knew collapses and something new is born? It's an exciting time.

Ryan:

Yeah. Yeah. I agree. Well, this has been really great.

Grant:

Yes, this is fun. When do we ever have an hour and a half to sit around without our children asking for things where we can just chat about ideas?

Ryan:

That's true. I mean, they probably have been texting us, and we've been ignoring them. And they're stranded on the baseball field or something like that.

Grant:

That's right. Well, hopefully not, but your kids have a bus pass, so they'll probably get themselves home.

Ryan:

Yeah. All right. Thanks, Grant.

Grant:

Thanks, Ryan.