Georgetown University School of Medicine
20 June 2007
In about twenty-four hours we will process into Constitution Hall wearing the dark green-trimmed black robes of Doctor of Medicine. Those of us seated on the stage will be wearing hoods lined with multiple colors; some of which will clash audibly if we stand too close to each other. You, the graduating class, will enter with your hoods hanging over your arms. You will exit the hall with the blue and gray lined Georgetown University School of Medicine hood draped over your shoulders. Doctors of Medicine. At last. Enjoy every minute of tomorrow. We will enjoy it with you and think back to our own graduations. On behalf of the four dozen or so Jesuit physicians throughout the world I want to say: Welcome. . . . Doctors.
The hoods have a substantial weight that is physical, affective, and spiritual. The burdens they impart are significant. They are the burdens of this gospel: The burden to notice. The burden to care. The burden to act. The burden to be an instrument of God’s justice. Thus, Luke’s familiar recounting of the Good Samaritan is particularly appropriate to celebrate your formal entry into the world of medicine as physicians.
The story of the Good Samaritan is more than familiar. It is overly familiar. The Good Samaritan—like the Prodigal Son—is a figure of speech, the meaning of which is sometimes diluted through overuse and misapplication. Agreeing to switch call at the last minute because a residency classmate has just been given tickets to the hottest concert of the year is admirable. Whether this action qualifies one to be called a Good Samaritan is debatable. A good friend? Yes. An example of treating others in the way you would hope to be treated? Also yes. A good Samaritan? Tough call.
What is distinct about the action of the Samaritan? Risk. The risk of stepping outside the script for the day and intervening in a way that bound him to another forever; in a way that added a quantum of justice to the world. The opposite of love is not hate, it is apathy. Apathy was the sin of the other passers-by: not caring enough to notice or get involved. Or, to notice but assume, “I can’t do anything to help.” Consider the reenactment of the Good Samaritan which I witnessed a few years ago.
The psychiatry department at Temple University Hospital was on the second floor of a building across from the busy Tioga Street entrance. I was standing at a window contemplating the scene below on the kind of perfect day that occurs only in May: Food trucks selling hot dogs and soft pretzels dotted the street. Patients, families, white-coated physicians, scrub suited staff, and pedestrians were passing by. It was a Friday lunch time. All was right with the world. Then the drama unfolded.
A young man and his mother were seated on a bench eating hot dogs they had just purchased from one of the food trucks. They were plainly dressed and both appeared to be developmentally disabled. Suddenly the woman began to choke. Her son was gesturing frantically and calling for help. Two ear, nose, and throat residents passed within fifteen feet of the frantic boy and continued walking as if they heard and saw nothing. Other people ambled by as well. Suddenly one of the psychiatry residents and a student, who were crossing the street to the hospital, raced up to the boy and his mother. The resident applied the Heimlich maneuver. The student disappeared into the hospital and, after a few moments, emerged with a wheelchair. They put the still coughing and agitated woman into the chair and raced into the ER with her son running behind.
Later I spoke with the still shaken resident and student. They were rattled not only by the ENT residents’ reaction—perhaps non-reaction is a better term—but were also unsettled by the response in the ER. The student initially went to get one of the physicians, but was told they could not go out of the ER to help a patient. The patient had to come in by ambulance. Thinking quickly, the student grabbed the wheelchair, which was apparently an ambulance equivalent, and flew back to the plaza.
What were the facts? Two ENT residents, experts in treating choking patients, ignored a woman with a piece of hot dog in her trachea. ER policy kept the doctors indoors, no more than 150 feet from the woman and her overwhelmed son. A psychiatry resident and a junior student, neither one of them particularly trained to deal with this sort of thing, intervened. Unlike the others, the resident and student got involved. They acted instinctively without weighing the risks: Could I be liable to a malpractice suit if things didn’t turn out well? Am I violating hospital or school policy? Am I going to look like an idiot doing the Heimlich in the middle of the Tioga Street Plaza?
Justice. Social involvement. These do not necessarily require agendas, policy meetings, demonstrations and speeches. Sometimes meetings are necessary. But this shouldn’t come as a surprise. During the next few years you are not going to have the time or the energy to get involved with issues of justice and fairness in the way you may have been in college and med school. Eighty hour work-weeks and thirty-hour shifts every fourth night or so take a significant toll on time and energy—especially the latter.
When we think of peace and justice many of us tend to think macroscopically: Martin Luther King, Mother Teresa, Voter registration drives, and so on. But justice is—indeed it must be—microscopic as well as macroscopic. Perhaps it has to be microscopic before it can become macroscopic. Martin Luther King and Mother Teresa both started small, on the level of the individual
The action of the gospel Good Samaritan was a relatively simple event. Man gets mugged. Passers-by ignore him. Someone finally stops to offer aid. The Samaritan gave of himself, his time, and his treasure. So it was for the resident and student. Only a few people in the plaza bothered to notice what was going on. No one came over to help. It was microscopic justice when the resident and student intervened. It was a moment in time that would be forgotten by everyone except the primary actors. I often wonder what kind of difference this event made in the lives of the patient, her son, the resident and, particularly, the student.
Justice begins when one notices injustice. Injustice is corrected only by action. In time some of you may become involved in health care policy. You may work to change inequitable distribution and availability of health care for the poor. You may work to improve insurance coverage for those who currently do not have or cannot afford it. You are not going to do that as first-year residents. In reality, most of us will not be able to attack these issues on the macroscopic level. But, as we all learned in histology, the microscopic supports the macroscopic. Indeed, the microscopic determines the structure and function of the macroscopic.
Physically you will wear this hood for an hour or two tomorrow. In reality, however, the Georgetown University School of Medicine hood will be draped over your shoulders for the rest of your lives. The privileges and burdens implied and granted by this hood do not come off at 5:00 PM. You can’t fold your responsibilities as physicians neatly into a drawer when you’re on vacation. Tomorrow, and for the rest of your lives, you will wear the gospel on your shoulders.
The Good Samaritan helped one individual. The Good Samaritan made a commitment to care and thus became an instrument of justice. Go and do likewise.
The second oddity is the photos. I took them last week at the Carthusian Charterhouse in Pltereje. Using my iPhone. Have never used the phone to take photos but as I didn't have the real camera with me thought I would give it a try. The only reason they came out well was the light. It was great, first time in a while. I will be back there in a few weeks. As I will not need the computer will take the camera instead. Extraordinary place.
The entrance to the monastic church. The Carthusians are the most cloistered of all orders. The church is not open to the public at any time. They order has no external ministry. They are purely contemplative. This is the entrance within the garth. The monastery is not as old as the Cistercians in Stična. The order is older but the monastery had a very rough go of things and was destroyed several times over the centuries and rebuilt.
The view of the church from within the monastery.
The church with the monk's choir stalls along the well. The most characteristic aspect of Carthusian liturgy is that the office begins at midnight and ends at about 2:30 AM. It is chanted in the dark. There is a light above each stall for when needed.
A view of the choir from the gallery. The church is very large and thus, during the winter when it would be impossible to heat, the smaller brother's chapel is used for the liturgy and Mass.
One of the office books. I wish I'd thought to put my day planner next to it to give an idea of the scale. These books are very large and heavy. The studs on the cover makes them easier to close. When I am in the choir for vespers I do not touch the book or try to turn the pages. One book is shared by two men. I let the prior turn the pages. I can't imagine ripping one of them.
The chant. This book was up in the gallery and open. I felt a bit better about shooting it. Most of the liturgy is in Latin. Latin Gregorian chant has a mystical quality that cannot be captured in English.
The "bishop's room." It is not used and I do not nap on the bed when I use it. It is actually a small apartment with a living dining area on the other side of the wall. Carthusians live as hermits. The priests live in a two floor cell with outdoor garden that is accessible only through the cell and not from the outside. They take their meals alone in the cell, coming together only for the midnight office, Mass, and vespers in the early afternoon. All other prayer and work is done alone and in silence in the cell. The monastery has no central heat. The monks' cells are heated with a similar stove.
+Fr. Jack, SJ, MD