In the first post of this series, I was ruminatingÂ about a patient who had a rapid decline in health and social circumstances, culminating in a recent scan that showed the possibility of cancer even while he was struggling with homelessness. It was a bleak situation that caught me off guard because I was not expecting it and was grieved to think of what it would be like for him to die alone.
He has since died.
There is a picture and a story making rounds on the internet about the grief of physicians. An EMT snapped a photo of a young ERÂ doctor who lostÂ a 19 year old patient. The photographer states that shortly after, the physician walked straight back into the ER. Â The picture is a moment of isolation in grief by a caretaker, and the original forum for the imageÂ is filled with thousands of commentsÂ that range from encouragement toÂ echoes of similar moments by healthcare professionals and family members whoÂ continue to grieve death.
The picture struck me because it was a reflection of countless momentsÂ of grief in my own training:Â informing parents about a devastating brain injury to their child; telling a husband that his wife’s neurodegeneration is from Huntington’s; giving a wife of fifty years the permission to let her husband with cancer go;Â watching dozens of “train wreck” ICU patients die despite heroic resuscitation efforts; hugging healthcare professionals as they watched their own husbands and parents and children die.
Even though these patients and families are strangers to me, I feelÂ bound to their suffering withÂ the most intimate of responsibilities and emotions. In the most acute of such moments, I often revolve back to a series of nihilistic questions: If medicine is about the alleviation of suffering and the postponement of death, is not all of our work ultimately futile? In a society that idolizes success and hides the dying and dead away from full view, what message can physicians give?
I posed these questions and others to Dr. Justin Denholm, the author of aÂ chapter on “Failing Faithfully: Christian Reflections on Ambition, Influence, and Success.” (InÂ Faithful is Successful: Notes to the Driven Pilgrim. Nathan Grills, David E. Lewis, and S. Joshua Swamidass, eds. Denver, Colorado: Outskirts Press, 2014. 95-108.) He answered with a gentle and refreshing word of wisdom:
…yes, all our work is futile, but that doesnâ€™t mean itâ€™s meaningless. Itâ€™s futile in the sense that you mean â€“ everyone will die, and we canâ€™t change that. Thatâ€™s only a problem, though, if we understand our work to be aboutÂ halting death instead of participating in a vision of what the new Creation will be like. One day there will be no more death, and so our struggle against it here and now tells the world a little bit about that. One day there will be no pain and suffering, so we do what we can to alleviate them today. Our image of what the new Creation will be like gives us a vision for what human flourishing really looks like, and this is what we can work to bring about â€“ imperfectly, but faithfully.
In the book chapter, he writes with clarity and clairvoyance:
Our fallen condition does not mean that we will never take pleasure in our work, that we will never see it have a positive impact on the world around us, that we will never please God in our capacity as workers. These things are good gifts from Godâ€™s creation, and are part of our hope as we long for the world to come. It does mean, though, that our desires and aims are unreliable guides to how God would have us work, and that our satisfaction can never be its yardstick. It has been said, and frequently repeated, that our vocation is found when our â€˜great joy intersects with the worldâ€™s great needâ€™. My conviction, though, is that a properly biblical understanding of work should lead us to be suspicious of both the reliability of our emotions as guide and our ability to evaluate the true needs of the world around us. We are people who long for the time when our world will be restored, when we will be in harmony with God and the new creation; but that time is not yet fully come. For now, we continue to work and strive, but we also must be people who wait. We wait, secure that the hope we have will not be disappointed, and our struggles now will one day glorify God in ways we cannot imagine.
What does it mean to believe that we are made in the image of God but to believe that our same bodies areÂ subject to corruption? The human body is intricate and glorious; when things work, they work with incredible precision and harmony and joy. The functional body enables us to participate in all that makes us human, from cognitiveÂ reasoning to love and poetry and procreation. But when the body decays and dies, we often can only see its limitations and futility. To be a healthcare worker is to be caught in between those two paradoxical truths: that the body is craftedÂ with divinityÂ butÂ is composed ofÂ dust. We are caught in a literal lifetime of transition and this means that we are suspendedÂ in a place ofÂ waiting. We areÂ waiting for the kidneys to fail; we areÂ waiting for the dementia to progress; we areÂ waiting for the breathing to stop. We are waiting for the antibiotics to respond, we areÂ waiting for the patient to follow up, we areÂ waiting for some results.
To wait with purpose is to exercise patience, a word whose definition meansÂ to engage inÂ long-suffering. As Henri Nouwen writes in Compassion: A Reflection on the Christian Life:
Patience is the discipline of compassion. This becomes obvious when we realize that the wordÂ compassion could be read asÂ com-patience. The words passion and patienceÂ Â both find their roots in the Latin wordÂ pati, which means “suffering.” The compassionate life could be described as a life patiently lived with others. . . .Â If we ourselves are unable to suffer, we cannot suffer with others. If we lack the strength to carry the burden of our own lives, we cannot accept the burden of our neighbors. Patience is the hard but fruitful discipline of the disciple of the compassionate God. [Nouwen 89-90]Â Â
In certain ways, patienceÂ is theÂ ultimate expression in “failing” faithfully. It means we endure the temporary pain of surgery for the benefits thatÂ follow recovery. It means that weÂ weep with a family because it brings healing inÂ the future. It can even mean delaying our own griefÂ for a periodÂ so that we mayÂ rescue someone else from harm. It means carefully givingÂ value to “hope for the moment,” as Nouwen describes; it means trusting inÂ God’s purposes for those hard moments:
. . .Â When the time had come to itsÂ fullness God sent the Son, born of a womanÂ . . .Â so that we might receive adoption as children (Ga 4:4-5) NRSV.
It is this full time, pregnant with new life, that can be found through the discipline of patience. As long as we are the slaves of the clock and the calendar, our time remains empty and nothing really happens. Thus, we miss the moment of grace and salvation. But when patience prevents us from running from the painful moment in the false hope of finding our treasure elsewhere, we can slowly begin to see that the fullness of time is already here and that salvation is already taking place. Then, too, we can discover that in and through Christ all human events can become divine events in which we discover the compassionate presence of God. [Nouwen 98]
We work toÂ purchase aÂ healthÂ that is existentiallyÂ temporary in order toÂ provide anÂ opportunity forÂ it toÂ yield an eternal return. The timing and nature of this is not always clear and is not meant for utilitarian calculations of risks and rewards. But we recognize that through this physical engagement of vocationalÂ labor, the Christian healthcare provider mayÂ workÂ to earn aÂ spiritual fruit, one that will last:
I consider that our present sufferings are not worth comparing with the glory that will be revealed in us.Â For the creation waits in eager expectation for the children of God to be revealed. For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hopeÂ thatÂ the creation itself will be liberated from its bondage to decay and brought into the freedom and glory of the children of God.Â We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. 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. For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what they already have? But if we hope for what we do not yet have, we wait for it patiently. — Romans 8:18-25
*Â McNeill, Donald P., Douglas A. Morrison, Henri J. M. Nouwen, and Joel FilÃ¡rtiga. Compassion, a Reflection on the Christian Life. N.p.: Doubleday, 1982. Print.
About the author:
David graduated from Princeton University with a degree in Electrical Engineering and received his medical degree from Rutgers - Robert Wood Johnson Medical School with a Masters in Public Health concentrated in health systems and policy. He completed a dual residency in Internal Medicine and Pediatrics at Christiana Care Health System in Delaware. He continues to work in Delaware as a dual Med-Peds hospitalist. Faith-wise, he is decidÂedly Christian, and regarding everything else he will gladly talk your ear off about health policy, the inner city, gadgets, and why Disneyâ€™s Frozen is actually a terrible movie.