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The Yale Journal for Humanities in Medicine |
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Spirituality, Religious Wisdom, and the Care of the PatientApathy in the Context of Illness: A Buddhist/Catholic Dialogue Introduction Alan B. Astrow, M.D. Our second inter-faith dialogue was held on March 8, 2004 at Memorial Sloan-Kettering Cancer Center. Our two speakers were Venerable Yifa, Ph.D., Director of the Greater Boston Buddhist Cultural Center and Myles Sheehan, S.J., M.D., Senior Associate Dean, Stritch School of Medicine, Loyola University School of Medicine. Anyone who works in oncology is immersed in intense life and death struggles. Often, there is hardly the time to think or even breathe, but in our few spare moments, who can avoid wondering about the significance of our work and the meaning of the experiences that our patients go through? And once those questions manage to insinuate themselves, who could not be at least mildly curious about the attempts of the great religious traditions, one's own and others, to make some sense of it all? But what place does this sort of speculation have in an academic medical center that is focused on the treatment of disease? Does spiritual inquiry have anything to do with our work with our patients? Isn't it self indulgent to reflect on life's mysteries when there is so much suffering to attend to in the here and now? To respond to those concerns, I would like to reference two thinkers: one a secular physician, Dr. Eric Cassell, and his dense but perceptive volume, The Nature of Suffering and the Goals of Medicine; the second the great religious thinker and spirit, Martin Buber, and his often obscure masterpiece, I and Thou. To illustrate what I mean by obscure, allow me to quote a representive passage from Buber: "The basic word I-You can be spoken only with one's whole being. . . All actual life is encounter. The relation to the You is unmediated. Nothing conceptual intervenes between I and You, no prior knowledge and no imagination. No purpose intervenes between I and You, no greed and no anticipation. Every means is an obstacle. Only where all means have disappeared encounters occur." Yes, from our perspective it sounds somewhat like a parody the early Woody Allen might have written. But stepping back for a minute into the atmosphere of the early 20th century, there is something deeply beautiful and romantic about this conception of human relations. It's a description of absolutely pure, uncorrupted, unmediated mutality, selfless unbounded love. But who could live that way? Who could get out of the house in the morning? Who is thinking about pure love when they have to get through office hours? In the real world, with a pure I thou encounter, a physician or nurse would not get past the first patient. Now coming closer to hand compare Eric Cassell: "one cannot avoid involvement with the patient and at the same time effectively deal with suffering . . . Every physician has the same fear-becoming closer to suffering patients, many of whom will die, surely promises pain, sorrow, and loss. Why would we not want to hold back, cover our feelings with a white coat, and hide behind incomprehensible technical language? "Because," he argues, "as understandable as self-protection may be, it renders useless the tools necessary for the care of the very sick and the suffering. . . Seasoned doctors and others who care for the dying can only say what experience will teach; the more completely open and unconcerned with self-protection the physician is, the less the emotional price of caring for the suffering and the greater the reward." Here, Cassell speaks in realistic terms of just the sort of open, undefensive, mutual relationship Buber seeks. This is Buber through the lens of someone who has actually lived a little and has some practical experience with the world. What then, do you get from Buber that you don't get from Cassell? Who needs Buber and his poetical descriptions of human relationships, his flowery romanticism? What you get from Buber, or from any serious religious thinker for that matter, is the perspective of a person who grapples with central issues of living and dying from a very long view. In Buber's case, human life is viewed through the prism a divine other in relationship to human kind. With non-theistic traditions life is viewed from the standpoint of an ultimate truth or reality. In either case, the hope is to restore three-dimensionality to what is otherwise a flat, disenchanted world. "In truth," Buber writes "the pure relation can only be built upon by becoming embodied in the whole stuff of life. It cannot be preserved but only put to the proof in action; it can only be done, poured into life." In the spirit of "proof in action", we asked our speakers to consider the apathetic patient or health care professional. The discouragement of chronic illness may lead patients to no longer care about themselves, their loved ones, and the world about them. Health care professionals may at times experience similar feelings of loss of meaning and purpose. We asked our speakers: what resources does your tradition offer to restore a patient to a state of caring and connectedness toward self and others? How does your tradition speak to the emotionally fatigued health care professional? Does your tradition offer insights that may be helpful to those who follow differing spiritual traditions? Myles Sheehan, "Apathy in the Context of
Illness - A Catholic Perspective" Published: September 17, 2004 |
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