The Yale Journal for Humanities in Medicine

Spirituality, Religious Wisdom, and the Care of the Patient

Loneliness in the Context of Illness: Catholic and Jewish Perspectives

Introduction

Alan B. Astrow, M.D.
aastrow@maimonidesmed.org

This is our last conference of the series.  I'd like to thank my friend and colleague and co-director of this series, Dan Sulmasy and the conference co-ordinators Gina Garvin and Magda Correa for helping to make this whole effort happen.  Here at Columbia my thanks go to Ruth Fischbach and the Columbia Bioethics Center for hosting tonight's event and Elvira Paravacini for serving on the planning committee.  The Al Smith Foundation along with the Auxiliary of St. Vincent's Manhattan provided grant support.  Of course, this wouldn't be taking place here at all if it hadn't been for Steve Miller.  Steve was my good friend and loneliness has turned out to be too apt a topic with which to end the series.  Three years ago Dan, Gina, and I had run a similar inter-faith conference series at St. Vincent's.    Steve liked the idea and suggested that if we did something like it again it would be fun if we could work together.  

Those of you who attended the session in September over in the Children's Hospital know that it was Steve, with his openness and spontaneity who made that one come to life.

Let me read a few excerpt from letters that I received about Steve from our September speakers.  First, Marilyn Mecham of the Interchurch Ministries of Nebraska:

"I remember  Dr. Miller . . .for his warm welcome and the hospitality he extended to me and to all who gathered that evening . . .for his reason for leaving the dinner early.  (Steve needed to be home for a family meeting to discuss a planned family trip to Argentina.  The kids didn't want to go and Marilyn was amazed that Steve was going to hear his kids out.)   It made such an impact on me that I shared it with my staff and with my judicatory leaders upon my return.  Steve's commitment to his family was inspiring.  Hearing that he was handling the vacation conflict/decision-making in a family meeting was powerful."

And from Professor S.N. Sridhar, Chair of Asian-American Studies, Stony Brook University:  "I liked Steve immediately.  He was so friendly, genuine, and committed to what he was doing. I was struck by his openness. . . .Steve was so dedicated to doing good for humanity, even his last act was an act of service."   

Steve had devoted his career, and gave his life, to the promotion of humanism in medicine.  He liked the idea of this conference series because he believed that some degree of spiritual reflection on the part of physicians is a necessary prelude to the development of a genuinely humanistic medical practice.   The nature of that spiritual reflection varies between traditions, but among the sixth faiths we have surveyed over the past year, all share the sense that spirituality has something to do with awareness or mindfulness.  In Eastern traditions, it might be the mindfulness of larger truths, and our connection to an overarching whole.   Tonight we close our series we speakers from monotheistic faith traditions.   In both Judaism and Catholicism I suspect, spiritual awareness refers to our relationship in daily life with an unseen Presence, a Presence that creates the possibility for goodness in the world.  The same Presence gives meaning and purpose to our actions, and when we become aware of it has the potential of transforming our institutions, our experience of work, ourselves.  

Let me illustrate what this might imply for medical practice with a case that Barron Lerner from Columbia has related to me:  

"I think back many years ago to the daughter of a Rabbi who was in the ICU for several months with advanced heart disease, severe neurologic impairment and no realistic hope of recovery," Lerner writes.  "The case was futile but she would not let go.  While she had no medical background, she was so determined to try to save her father that she even read Harrison's textbook of internal medicine on his bed.  It struck me at the time that despite all of the activity in the ICU and the countless visitors to her father's room, the daughter was very lonely.  This feeling contributed to her difficulty in dealing with the reality of the situation."

Clearly the "unseen presence" at the patient's bedside here, often unremarked on but Dr. Lerner is an aware physician, is the daughter's profound sadness and perhaps anger and who knows what other anguished emotions, in addition to loneliness.  And also I think, there is the presence of love, love of this daughter for her father whom she is soon to lose.  But these would seem to represent, ordinary, while deeply felt, human emotions. No need, one might argue, to invoke a mysterious radically Other Presence.

Here I need to turn to Martin Buber, whose classic from the 1920's I and Thou served as inspiration for this conference series. For Buber, these fleeting moments of genuine encounter with another in all their frailty and humanness is as close to an intimation of the Divine as we are able to get in this life.  But Buber goes one step beyond awareness.  "God's address to us penetrates the events in all our lives and turns it into instruction, into demands for you and me," Buber wrote.  For Buber, once we become aware of the unseen Presence, we are called upon to act. So in the case of the rabbi's daughter, the situation calls for the physician to move from awareness to action, to ask the daughter how she is doing, to praise her for her devotion to her father, and to acknowledge how difficult this must be for her.  This may seem simple and obvious but I suspect that it doesn't happen very often.  A kind and concerned word from a physician may not ease this daughter's acute pain, but in the long run it may well be something that the daughter will recall and appreciate, may help her accept the inevitable and resume her life.

What might this all have to do with religion?  Buber himself had a radically subjective notion of what God's presence might mean-it was for each individual on his or her own to decide and apply.    "Revelation is not legislation," he argued.  Buber, one of the great Jewish thinkers of the 20^th century, emigrated to Israel from Germany in the 1930's but did not set foot in a synagogue in his adult life.  He never resolved the tension between spirituality and religiosity.  My friend Steve Miller hadn't fully resolved the tension either. He attended a yeshiva for elementary school and junior high and felt decidedly mixed emotions about the experience.   But he nevertheless held a positive assessment of the role of religious practice in our lives-he attended synagogue regularly, had a close relationship with the rabbis, and sent his children to a non-denominational Jewish school. 

In a pluralistic society can specific religious teachings and practices add meaning and purpose to our experiences as health care professionals?     That has been the underlying question that has motivated our series.  I'm sure that we each can propose our own answers.  We are looking forward to gaining the perspective of this evening's two distinguished speakers, Helen Alvaré, Associate Professor of Law at the Columbus Law School of the Catholic University of America and Rabbi Tsvi Blanchard, the Director of Organizational Development for CLAL, the Jewish Center for Learning a Leadership. As it turns out, this is an issue relevant not only to us in health care but of increasing political significance worldwide.  

Helen Alvare, "Loneliness in the Context of Illness and Dying- A Catholic Perspective"
Rabbi Tvsi Blanchard, "Visiting the Sick- Jewish Wisdom and Practice Speak to the Loneliness of Illness"
Ruth L. Fischbach, "Overview- Loneliness in the Context of Illness"
Table of Contents

Published: January 12, 2005