I’d like to speak up for making medicine (not just internal medicine, but any health care profession) a calling to take care of people. Patients are fellow travelers, different primarily because of their struggles with ill-health (disease, accidents, aging). They need our skills and compassion, and their conditions are premonitions of situations we will encounter soon enough. The care we’d like to receive then should be the type of care we provide them now.
Let me paraphrase Fr. Gregory Boyle’s statement about the poor: “Here is what we seek: a compassion that can stand in awe at what patients have to carry rather than stand in judgment at how they carry it.”§ How would health care change if we recognized that Loss underlies patients’ experiences? Rather than react to patients’ behaviors, could we seek to appreciate how those behaviors express efforts for coping with loss?
We carry many dimensions of personhood within ourselves – the wonderful and complicated nature of being human. There of course are our organ functions that work so beautifully in health, and provide such frustration when diseased. But our “self” also includes our personality, past history and life experiences, family ties, cultural background, economic, political and social roles, emotions, secret life and future dreams, and our spirituality or transcendent dimension (what we connect to outside and beyond ourselves)*.
Suffering, in this understanding, follows losses that cannot be supported by strengths in other dimensions – when the intactness of our personhood is threatened, when we run out of ways to cope. Thus, a patient bearing a terrible illness with grace and fortitude moves us because she is not broken by her hardship – she seems to have inexhaustible resilience. We could learn from her how to live.
Other suffering patients and families exhaust our compassion, even our wish to help. I would suggest that these latter ones have exhausted their own capacities for self-consolation, whether through past traumas, emotional or social deprivation, and/or lack of spiritual connections. As much as we’d wish, we cannot change them. But we could imagine that even they are likely doing their best with what they carry. We cannot undo their burdens, and we have to be careful not to exhaust ourselves carrying the loads for them.
But care providers who reflect on themselves and their work, and who support one another, can show up with grace and fortitude. And grow through it all.
§Gregory Boyle, Tattoos on the Heart: The Power of Boundless Compassion
* Eric Cassell. The nature of suffering and the goals of medicine. New Engl J Med 1982; 306: 639-645.