Tag Archives: Healing

Learning How to be Human

I had my first interaction with a patient last week (I’ll call him John). He was a reticent and withdrawn teenager, who, when I first approached, was reclining on an arm chair with earbuds plugged, staring off into a corner of the sterile room. His grandfather, who had brought John to the hospital, looked equally disinterested. My task was to interview him, and my supervising physician would evaluate me on my interviewing skills – whether I asked the right questions, how well I was able to solicit answers, etc. I knew right away as I saw John that it was not going to be easy.

And it wasn’t. It felt like wading across a wide, swampy moat – a moat that John and his grandfather had dug even before I spoke a single word. John was at the hospital for a routine service, and as far as they were concerned, I was a disturber of their relative peace. As I introduced myself and explained to them why I wanted to talk to them, John’s grandfather sternly warned that our interaction better not last more than they needed to stay at the hospital for John’s visit. “No more than thirty minutes,” he said.

I began asking John questions about his illness, and the effect it’s had on his life. Yale’s patient interview curriculum – which prides itself in its radically patient-centered approach – had promised me that if I ask an open-ended question and shut up for 3 seconds, the patient would fill the silence with a lengthy response.  John, though, met all of my questions with a terse response and a sideways glance.

“How has having [your condition] been for you?”

“Just…normal. It’s just normal.”

After about 15 minutes, I started to ask about his family. I learned that he had previously lived with his mother, and visited his maternal grandmother every week (the grandfather he was with was his paternal grandfather). Nowadays, though, he lived with solely his grandmother. I asked him if he could tell me why. John’s grandfather, who had been listening the whole time, stepped in. “That’s getting personal.” I had crossed a boundary.

I gave up. There was no use in pursuing my agenda anymore, and as I let go, what surfaced was an apology. I told them that I was a first year medical student – naive, blundering, just learning to crawl in this medical profession; that I am sorry if I offended them. I was told by my teachers that I needed to treat patients as whole, and should ask about the lives they led beyond the hospital; I was just trying to understand who they were…

I asked John about the music he was listening to. He liked dubstep and electronic dance music.

“Dude, so you like beatdrops?”

And for the first time, he smiled.

We went on to chat about his schoolwork, and how he had starved himself of video games for 6 months for the sake of his grades. He had straight A’s. More smiles.

Donald Berwick, in his address to the graduating class of 2010 at Yale Medical School, noted that a good physician is not the one who readily dons the white coat (with its accompanying pedestal and power) but the one who readily gives it up.

Congratulations on your achievement today. Feel proud. You ought to. When you put on your white coat, my dear friends, you become a doctor.

But, now I will tell you a secret – a mystery. Those who suffer need you to be something more than a doctor; they need you to be a healer. And, to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off. You must recover, embrace, and treasure the memory of your shared, frail humanity – of the dignity in each and every soul.

I wrote before about the phenomenon of ‘the bridge’ in medicine – that to become a doctor is to enter a world from which there is no returning. The irony is that becoming a healer precisely requires this return. I must learn, no less, to become human again.

The finding is in the giving-up… It is a principle that harkens me to the poetry and truth of Christ’s paradox: “Whosoever wants to save his life will lose it; and whoever loses his life for me shall gain eternal life.” So I gladly seek the place in which I become nothing – the place where I unmask all that I’ve toiled to put on to find that I am, in the end, simply Christ’s beloved. And in that place of nothing (which is the place of everything) I gain the vision to see John for as he really is: not as “a difficult patient,” but as fellow man, deserving of love.

This is the place where medicine transforms from a “giving to” or “fixing,” to “walking with.” It is where true ministry and healing is possible.

Medicine and Seeing

Lord, give me eyes to see…

I’ve been praying this prayer a lot recently, in the first few weeks of medical school. Sight is a gift. To see our lives, the lives of others, and the events of our world in the lens of truth and love – that spirit is something we cannot conjure up on our own. The God of truth and love must gift it to us.

Each morning, I wrestle for this sight, as Jacob had wrestled God for His blessing. Jacob had spent his entire life crafting his own blessing. There is the time when he steals his brother’s birthright with a well-timed meal. And the time he tricks his blind father into blessing him instead of Esau with a clever scheme. He amasses a vast amount of wealth as Laban’s shepherd, taking the strong of the flock for himself, and leaving his uncle the weak ones. Jacob then runs away with Laban’s two daughters and his massive herd to begin his own life – to look for his own paradise. That is the picture of Jacob before his encounter with God: he is always running.

He is still on the run when suddenly he is forced to account for his life. Esau, his long-estranged brother, is said to be approaching from the far side of the wilderness, likely to kill him. Jacob ‘runs’ one more time, trying to appease his brother with a series of gifts, and ultimately, dividing his camp into two so that if one is attacked, he is left with the other. As he sends his camps off, he is left by himself (Gen 32:24) – his first time in true solitude. Desperate, cornered, on the verge of calamity, and finally alone, he does what perhaps God had been trying to get him to do all along. He simply asks. “I will not let you go unless you bless me.

I will not let you go unless you bless me!” That is a holy prayer.

Lord, give me eyes to see…

‘Education’ is a misnomer for what happens in the four years of medical school. Becoming a doctor is about more than just the accumulation of medical knowledge. Medical school is assimilation – the inculcation of a set of values which is no less cultural because it’s scientific. Medical school is a foreign country, complete with its own language, and therefore, its own way of seeing.

Before anatomy class began, our professor told us his philosophy for teaching anatomy, which was to help us ‘see what doctors see.’ He told us that as we open our donors’ bodies and delve beneath their skin into their viscera, we will look, but not see, because we do not yet have the framework to make sense of what is in front of us. What is this intricate mesh of meat, fat, and bone? I do not know, and so the world of the body is still fresh. It is still sacred.

But when will that eternal light dim?

There’s a passage in Annie Dillard’s ‘Pilgrim at Tinker Creek’ that I often reread. Apparently, when physicians first discovered how to perform safe cataracts operations, patients who had been blind all their lives were suddenly able to see. Having never associated words and meaning to visual stimuli, they saw the world differently than the already-sighted. They didn’t see chairs, tables, books, food, shadow, form, or size – they saw patches of light and dark, blobs of color, brushes of unencumbered, freeform marks.

“A twenty-two-old girl was dazzled by the world’s brightness and kept her eyes shut for two weeks. When at the end of that time she opened her eyes again, she did not recognize the objects, but, ‘the more she now directed her gaze upon everything about her, the more it could be seen how an expression of gratification and astonishment overspread her features; she repeatedly exclaimed: ‘Oh God! How beautiful!’”

It will be a tragic day when I stop exclaiming ‘Oh God! How beautiful!’ When, instead of the intricate mesh, I only speak of mediastinum, costal cartilage, inferior vena cava, ad infinitum…the babble (Babel?) of those of who know, but do not see.

Not long after that anatomy class, Dr. Lisa Sanders, who had started the New York Times column that inspired House, M.D., led a session for first year students on the topic of observation. ‘Writing is observing,’ she said, ‘and you must practice writing in order to keep observing.’ She then showed us a picture of a scene in the wards, in which a medical student was leaning over a patient to observe something on her shoulder. Dr. Sanders asked our class, “What do you see? What do you notice about the patient and the student?” Our class spent 5 minutes sharing our observations. We talked about how the patient looked afraid and how the student’s posture seemed to belie a certain eagerness. We noticed emotions and facial expressions, and imagined movements from the stillness of the photograph. At the end of the exercise, Dr. Sander turned to our class and warned, “What you see now, you will no longer be able to see 10 years later. You, still being laymen, notice things I no longer care to notice as a doctor. Medicine is a bridge you cross; there is no turning back, even when you wish so much to be back on the other side.”

And that is why I pray for sight, with Jacob’s desperation. The battle for eternity happens in minutiae, and our souls soar or fall in trivialities we are prone to overlook amidst the comfortable humdrum of our lives. I pray before anatomy class that the God of healing may help me to know wholeness – that the ease with which the blade slits the skin does not dull me to the beauty of embodiment. I pray to see the weight of glory in people I pass by everyday. They are not merely ‘a nurse,’ or ‘a student,’ or ‘the person who takes care of your paperwork’; they are eternal, divine beings – imago dei – whom, as C.S. Lewis says, I’d be tempted to worship if I saw their true glory.

I pray, finally, that the Gospel would remain news. Too many times I let the Gospel become familiar, which also means that it becomes comfortable. It is not. I have to encounter the person of Christ daily and come to terms with its truth, and the demands and costs that truth makes on my life. There is no easy way out. He is calling for me (“Remember your first love!), and it means my death. The scales must daily be taken off from my eyes.

And with this I plunge into this medical world. I will learn its language, but I refuse to let that language define what is real and what is true, for I am afraid to be in a world I can box, devoid of mystery and beauty, where everything I see I can shatter in a thousand classifiable, knowable shards, and piece them back together to fit my convenience. So I worship, pray, and wrestle.

Lord, give me eyes to see…

Then Elisha prayed and said, “O LORD, please open his eyes that he may see.” So the LORD opened the eyes of the young man, and he saw, and behold, the mountain was full of horses and chariots of fire all around Elisha.” (2 Kings 6:17)


The passage on ‘Seeing’ from Dillard’s ‘Pilgrim at Tinker Creek,’ which I quote from, and which I highly recommend, can be found here: http://dcrit.sva.edu/wp-content/uploads/1974/01/Seeing.pdf

What is healing?

//Because I have a short attention span, I assume others do, too, so I try to use a different color text for “main ideas.

—————

It’s probably a bit strange that after four years of medical school, I’m not sure what “healing” actually means, or that medicine (as a field) is even about healing. Treating a disease or pathology is not the same as healing a person. The absence of disease is…well, the absence of disease, not necessarily health. We don’t cure cancer– we usually just cut off the offending organ or treat it with radiation/chemo and hope it doesn’t come back elsewhere. Many, if not most, diseases can’t be cured (think of chronic conditions like COPD, heart failure, schizophrenia, diabetes, etc.) – even with the best medical treatments, their effects can only be slowed or minimized, though they all eventually result in the inevitable progression of disease. Even if the best medicine can “cure,” I would venture to say that only the mildest of infections can probably be “cured” completely, and that “curing” just means returning you to baseline.

Which makes it that much more astounding that Jesus healed the sick and in turn commanded his disciples in Matthew 10:8 to heal the sick.

What does it mean that He healed, that we are supposed to heal and be healers?

Though he was addressing seminary students in the excerpts below, Paul Tillich’s thoughts have also been helpful for me as a soon-to-be physician, as his reflections on health and sickness appropriately grasp the comprehensiveness and complexity inherent in disease and health.

1) Health is about unity – the wholeness and integration of body, mind, and spirit – and shalom (this comprehensive flourishing) is the ideal. Let’s not mistake the absence of disease for health, because its absence could just mean we’ve discarded the parts of us that have the potential for disease, which are also the parts of us that have the greatest potential for life. I see this as particularly true in mental health, when the best treatment can get rid of the problem without having addressed the root of the issue (e.g. antidepressants that make you not depressed, but is to the point to blunt emotions so that one is non-suicidal, or to work with the patient to understand how to deal with pain in a meaningful way and still find joy?)

Health is not the lack of divergent trends in our bodily or mental or spiritual life, but the power to keep them united. And healing is the act of reuniting them after the disruption of their unity. “Heal the sick” means — help them to regain their lost unity without depriving them of their abundance, without throwing them into a poverty of life perhaps by their own consent.

2) People in medicine often talk about how increasing specialization (to keep up with unmanageable amounts of information) creates “siloes” that compartmentalize providers into only being able to treat very specific problems.

Take, for example, diabetes, one of the most common problems in the US. If you have diabetes, you probably have an endocrinologist to manage your insulin schedule, an ophthalmologist to check out potential diabetic retinopathy, a nephrologist to make sure your kidneys aren’t failing, and a cardiologist and/or neurologist if you’ve experienced any heart attacks or strokes as a result of that diabetes. And a PCP (primary care provider) to coordinate all of that. Our very training implies that we are to stay within our areas of “expertise,” and that expertise is limited to only certain organs, which in turn can cause us to reduce our patients to organs.

But health means wholeness, and shalom is about individuals, communities, and systems – even (or especially) in medicine. And that ultimately sickness has a spiritual component in that all illness is a reflection of sin, or separation (maybe the sin of nature, but sin nonetheless.) That is why in the stories of healing in the Word, it is never just an individual’s physical healing alone, but a restoration to one’s community (as in Matthew 8, when the fever leaves, she prepares a meal for others) and spiritual healing (e.g. in Luke 5, when Jesus heals the paralytic, spiritual healing (“your sins are forgiven”) is closely linked with physical healing (“rise and walk”), and the response of the paralytic is not just physical (“he rose up before them and picked up what he had been lying on and went home,”) but also notably spiritual (“he went home glorifying God”)).

And you have learned that disease that seems bodily may be mental at root, and that a disease that seems individual may be social at the same time, and that you cannot heal individuals without liberating them from the social demons that have contributed to their sickness. Beyond this, you may have become aware of the fact that both physical and mental, individual and social, illness is a consequence of the estrangement of man’s spirit from the divine Spirit, and that no sickness can be healed nor any demon cast out without the reunion of the human spirit with the divine Spirit.

3) Though health and healing are huge concepts, ones that I still don’t fully understand, this at least is true: we know that our God is Jehovah-Rophi, the Lord who heals (Exodus 15:26), and that the real illness and diseases that we ought to fear (i.e. not the bodily ones) have been borne by Christ, who took them upon Himself.

 You have a glimpse of what can heal ultimately, of him in Whom God made manifest His power over demons and disease, of him who represents the healing power that is in the world, and sustains the world and lifts it up to God.

 

Reflection on Presence: Part 1

My parents moved back to Korea 5 years ago. They live now with my grandparents (on my dad’s side) on a farm in a dinky little down called Chuncheon that has nothing going for itself besides maybe the fact that it now boasts a subway stop leading to the capital city. So now people don’t have to move out of that town for good.

Anyway, my grandfather has something like Alzheimer’s disease. His debilitating stroke a few years back left him with such a compromised memory function that he can remember my name and not much else. Not being able to remember can be lonely. So when I go back home for vacations, and when my mom sees me doing nothing, she cuts up some fruit, puts it on a table and tells me go eat some fruit with my grandfather.

grandfather1

I sit there, talk about myself, eat some fruit. Silence for maybe 5 minutes, whereby my grandfather has forgot everything I just said. So I say it again, eat some fruit, and if I feel especially loving that day, maybe ask him a few questions about his life. He’ll mutter something – but nothing I don’t already know. I return the plates to my mom, and I ask myself, ‘what was the point of that?’ Nothing happened.

“When Job’s three friends, Eliphaz the Temanite, Bildad the Shuhite and Zophar the Naamathite, heard about all the troubles that had come upon him, they set out from their homes and met together by agreement to go and sympathize with him and comfort him. When they saw him from a distance, they could hardly recognize him; they began to weep aloud, and they tore their robes and sprinkled dust on their heads. Then they sat on the ground with him for seven days and seven nights. No one said a word to him, because they saw how great his suffering was.” (Job 2:11-13).

In ‘Salvation and Healing; why medicine needs the church,’ Hauerwas talks about the idea of presence, and how we have so little of it, both in medicine and the church. Consider Job’s friends, he says. You may think whatever you want about their well-meaning but vacuous consolations, but at least they stayed with Job for 7 days. And no one said a word.

That’s exactly what makes people uncomfortable. Everybody loves to help – everybody shows up when they have a chance to be a hero, no matter how small that heroism may be. But how many are willing to be present when not just the helped are helpless, but they are as well? Will you show up, even when there’s nothing you can actually do?

So then we return to my grandfather. Medically, the doctors have done everything in their power to fix him up, but where’s the healing? If what Wendell Berry says is true, then disease is not just the presence of a pathological condition; disease is fundamentally alienation – alienation from our bodies (we are no longer ourselves), alienation from other people (people don’t like to be around other people that might get them sick, or worse, remind them of their own mortality), and alienation from God (as in, Oh God, I’m sick as hell, where are you?).

If that is true, than healing is much more than what modern medicine is. If that is true, modern medicine is not only ‘missing the point,’ but predicated on an illusion, operating in a universe that lacks real moral meaning (which one can say is a universe that doesn’t exist). My grandfather can walk, talk, and live in ways he couldn’t in the days immediately following the stroke – and at that point modern medicine waves its banners high and declares success!, but I am left with a feeling that that is not all there is…

In the world of medical technology, the illusion of control prevails, and with that, the urge to fix. What if all of the medical shindig is but a cloud that blinds us from seeing the truth, which is simply that we belong to each other? And what if the greatest thing we could do (physicians and others) for sick people was simply to be present with them, rather than suggest a million cures for their physical and psychological condition. It’s hard to sit still when there’s all these toys we could tinker with.

In the end, though, being present is what we will all have to do. Because some day my grandfather will die. So will I. In death, we can do little but to hold the hands of the dying, and then, we no longer wear the masks of power, but become who we were meant to be: the recipients of a beautiful gift that we neither understand, or control.