Sirach 15:15-20
Many of the novels, memoirs, and scripts written about the world of physicians, illness, and medicine are schlock. A small few, however, accurately capture the unvarnished reality of the demands, sacrifices, and pain that are part of a vocation to medicine. Among this small number is a novel with particular relevance today as the covid pandemic appears to be on the wane. It is relevant to all of us who have had to cope with the biological, psychological, social and spiritual crises emerging from the covid pandemic. Written seventy-six years ago it seems prophetic when read in the light of contemporary events.
Albert Camus’ novel, The Plague, should be required reading for anyone studying medicine, practicing medicine, or working in any form of ministry, vocations in which one must confront the most vexing problem in the universe, since Adam and Eve discovered Abel’s lifeless body.
Dr. Rieux, the book’s narrator, identified the mysterious infection spreading through Oran as bubonic plague. He approached it courageously and with unflinching commitment to his patients despite his own personal pain. In a scene midway through the book Rieux is speaking with Tarrou, an enigmatic character who became a friend.
At the end of the long conversation that cannot be summarized easily one reads:
“Tarrou, who was staring at the floor suddenly said, ‘Who taught you all this Doctor?’
The reply came promptly, ‘Suffering.’”
If we allow it,--and it is much too easy to run from it--suffering teaches the physician,
the priest, the patient, and all others. But, it takes time, demands courage, and requires a willingness to recognize and endure one’s own pain, feelings of impotence, and rage, so as to help the one who suffers. None of us, physician, priest, nor anyone else,
emerges unchanged from the confrontation with suffering, our own suffering and, most particularly, the suffering of our patients in whatever form they experience it. With time we learn the truth described by Aeschylus,
“He who learns must suffer,
and, even in our sleep, pain that cannot forget
falls drop by drop upon the heart,
and in our own despair, against our will,
comes wisdom to us
by the awful grace of God.”
Benedictine Basil Cardinal Hume, the late Archbishop of Westminster, England was the son of a physician. He accurately described the vocational overlap between priest and physician in a short meditation:
“The doctor and the priest have much in common. Both are concerned with people and their well-being. Our starting points are different but inevitably we discover that our interest converges. The experience of people tells us, priest and physician, that many are still bewildered, indeed haunted, by the perennial problems of pain, suffering, and death.”
So it was for the characters limned by Camus, and so it is for all of us today as we struggle with the same perennial problems in the aftermath of covid.
Jesuit Father Ned Cassem was Chief of Psychiatry at the Massachusetts General Hospital for thirteen years. He was the consummate physician. As he had been ill for several years his death on July 4, 2015 was not so much a shock, as it was an opportunity to remember and reflect on the wisdom he imparted through lecture and example.
He was a man with tremendous empathy for, and sensitivity to, the suffering of others,
Fortunately, throughout his career Ned kept reflections, meditations, and notes in journals as well as on random pieces of paper jammed into file drawers, The day after his death Barbara McManus, his long-time administrative assistant, thought to email several pages of Ned’s reflections in case I wanted them for the funeral homily. One page was titled CREED. Three tenets of creed flesh out Hume’s writing as if Ned were writing midrash:
"As clinicians our responsibility is to always protect the patient."
"The secret of care for the patient is caring for the patient."
"The core of the doctor's healing role is loving the patient as the doctor loves himself."
Cardinal Hume’s wisdom and Father Cassem’s insights reflect the reading from the Book of Sirach,
“If you choose you can keep the commandments, they will save you.”
“Before man are life and death, good and evil, whichever he chooses shall be given him.”
“No one does God command to act unjustly, to none does he give license to sin.”
Every physician is presented with the option to sin, the option to destroy life that should not be destroyed, and the ability to desecrate and mutilate the human body—surgically, endocrinologically, and psychiatrically—in ways and for reasons unimagined in the past.
In December the Massachusetts Supreme Court once again rejected legalization of physician-assisted suicide. It was not the first time the ban was upheld. Unfortunately, there will be other attempts to normalize the planned and intentional killing of the sick and elderly.
We all experience, however fleetingly, the thought of killing a suffering patient during our careers. Not all thoughts, however, should be put into action. Robert Twycross founder of Sir Michael Sobel House, a hospice in Oxford, England. strenuously opposed euthanasia. He wrote: “Any physician who has never considered killing a suffering patient is either very new to the profession or singularly lacking in empathy.” He then went on to explain why what is now being euphemistically called physician-prescribed death must not be an option for us.
Both priests and physicians suffer in concert with the patient, it cannot and must not be otherwise, unless, as suggested by Dr. Twycross they are totally devoid of empathy. Each must confront the awful and angry one-word protest “WHY?” A protest raised by the patient as well. Each may nurture the desire to end the perceived meaninglessness STAT. Each looks toward the heavens and screams that same WHY? But the answer never comes. The answer never will come. As physicians we can only slog away, trying to diminish suffering as much as we can, in whatever manner we can, and when we can, patient by individual patient.
In his 1984 encyclical, Salvifici Doloris St. John Paul II wrote that: “(suffering) is a universal theme that accompanies man at every point on earth: . . . it co-exists with him in the world, and thus demands to be constantly reconsidered.” He went on: “Man suffers in different ways, ways not always considered by medicine, . . . Suffering . . . is wider than sickness, more complex . . . more deeply rooted in humanity itself. A certain idea of this problem comes to us from the distinction between physical suffering and moral suffering.” Camus outlined and elaborated on that distinction throughout his novel in ways too complex to summarize.
Neither physician nor priest can answer the WHY? of suffering but each is obliged
to offer understanding and care rather than death to the one who suffers, each is obliged to share in the patient’s burden in whatever way possible. Hippocrates’ classic injunction is succinct: “To cure sometimes, to relieve often, to comfort always.” The ministerial and medical interlace at “to comfort.”
Just as the plague in Oran was being declared over and just before the city gates were set to open, Tarrou died of an atypical presentation of plague. Rather than send his friend to the hospital upon the appearance of the first symptoms, and knowing the inevitable outcome if it truly were plague, Rieux, with the help of his mother, kept him in his own home. The description of Tarrou’s death is a very difficult part of the book to read. In just a few words, Camus summarized the suffering that accompanies physicians throughout their lives, the suffering that returns, even deep into retirement, when memories arise unbidden. He wrote: “The doctor could not tell if Tarrou had found peace, now that all was over, but for himself he had a feeling that no peace was possible to him henceforth, any more than there can be an armistice for a mother bereaved of her son or for a man who buries his friend.”
Midway through a conversation with my consultation fellowship director a few weeks before he dropped me off at the novitiate in Boston, Jesuit Psychiatrist George B. Murray asked “What’s my favorite prayer?” I admitted I had no idea. He spun the chair around, reached into a file drawer, and pulled out a wrinkled paper. It was my first exposure to a prayer that I would come to say daily.
The Prayer for Generosity attributed to St. Ignatius of Loyola is a fitting and necessary prayer for physician, priest, and indeed, anyone in health care.
O Lord, teach me to be generous
To serve you as you deserve
To give and not to count the cost
To fight and not to heed the wounds
To toil and not to seek for rest
To labor and not to ask for reward
Save that of knowing I do your holy will
____________________________________________________
Gave this at the University of Chicago to physicians and med students. It was a good experience. Got to catch up with friends while there. Just back this AM and crashed. Thus the late post.
Fr. Jack, SJ, MD
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