Mrs. Roman needs her lung removed. It has become severely damaged, is chronically infected, does not aerate her blood, and is spilling bacteria into her good lung, causing life threatening pneumonia. However, she will not undergo the lung resection surgery because she believes God told her he will heal her. So she lays in her ICU bed, trusting that God (plus antibiotics) will cure abscess and empyema.
This is (to put it mildly) ill-advised. So much so that it makes me angry to think about it. Without realizing it, I have become the person I feared.
Back in medical school, we had a class on the "human context of medicine." It was our first year, we were still figuring out how to do the whole medical school thing, and for three hours every Thursday morning we sat in small groups and discussed the papers we had been required to write about a variety of topics. Death, end of life care, sexuality, culture, religion. Pretty much we talked about everything your mother told you was bad manners to discuss with strangers. The teacher for this class, who gave us weekly lectures on top of our discussion, was a militantly atheist Reform Jew, and one of his pet projects was to ensure we all kept our religious convictions out of our practice of medicine. At the time, I thought this impossible. I resented his depiction of a strictly empirical physician, admitting the presence of more than flesh and blood only when necessary to gain the trust of a patient. It was an odd, soulless compassion he taught.
But I realized today, standing next to Mrs. Roman's bed, that I have become more like that person than I knew. Through the next three years of medical school, and the first few months of internship, I have come to believe in the power of medicine. I've seen medicine heal the sick and make the lame walk. If we haven't made the blind see yet, we're working on it. More effective than any lecture or any crazy triple-board certified medical school teacher was merely living this life. And standing by that bedside, my first reaction was anger, or at least irritation, that this woman held to a ridiculous conviction that is going to kill her. I was angry that this pleasantly deluded woman didn't share my near-religious conviction in the power of medicine.
At the same time, I share her convictions, at least in part. I am a Christian, but I've never been the "let go and let God" type. I'm more a "praise the Lord and pass the ammunition" type. I figure that no matter what you think about the controversial questions in life, God has given us all a brain and hands, which we ought to put to good use. Because of faith, I allow that God could heal her. But I believe in medicine the way I believe in gravity: it just works. Of course, it works based on principles which are either impossibly serendipitous or intentionally designed, but then that truly is the religious question. Whatever the answer, it is not germane to Mrs. Roman's condition. She is waiting for a miracle, and if she does get better, that's what she'll call it, but I'm intensely skeptical of miracle claims. Remissions happen in many diseases, and we don't always have an explanation for them. It is only when they happen to religious people that they are called miracles.
So the focus on pathology and on biology has made me a skeptic and maybe a bit of an empiricist. Where that breaks down, and where I retain my faith and humanity, is in the big picture. Certainly, the only way Mrs. Roman is going to be cured is with cold steel. But if there is any point in curing her, it is more than molecular; she is more than a broken machine, and the only way to understand that is not found in Robbin's Pathology.
10 comments:
I have to say that out of everything that has challenged my faith, medical school has done the most damage to it. The routine, the stress, the staying unpleasant most of the time - it's not like it makes God unlikely, it just makes it hard to think about things like that. I'm sure I still believe, but I am nowhere near where I was in college when I had time and a social network to support reflection on spiritual topics.
I went to a Bible college, and discussions such as these were common dinnertime banter. While most of my friends were believers in "miracles," it was apparent to a few of us that within Christian circles, looking for miracles and giving up autonomy to the ubiquitous "will of God" was likely a form of Christian mysticism-- but more likely, it was a way to lose accountability.
For people hard-pressed to make a decision (medical or otherwise), "letting God" takes the place of careful thought and deliberation-- and reduces the guilt of screwing up royally on their own.
I don't think that your faith is lessened by your belief in medicine, but that medicine has become a tool of your faith, rendering you capable of healing the sick. Great blog. Good luck with your patient.
Nathan - Trusting your skills is not entirely contrary to faith. After all, science is based on faith in the laws that God has created in nature. When we prescribe a beta-blocker, it's in the confidence that God, who created the beta-adrenergic receptors and ordained their function in the sympathetic nervous system, is not going to turn that set of relationships upside down suddenly. We can use scientific principles because the one who created those principles is reliable. All practice and theory of science is an act of faith in the Creator; some scientists just act in that faith, but deny it with their words.
Nathan,
I sympathize with your struggle, but open your eyes. You write of the power of medicine and ignore both the harm that medicine inflicts (chief of which is abortion and the hubris that kills) and the unreality of your training world. In real life, medicine does only a little good.
Part of the problem is the Christianity that really amounts to hypocrisy, a faith in a thing, rather than in Jesus, who lives and reigns.
Though Marian has a good point, that "mystery" (not mysticism- which is not commendable) which some people have retained, though they express it in objectionable, even grotesque ways, is essential to a balanced life. Jesus is a real person, whom you cannot see, who reigns in heaven and on earth. If that isn't mystery, what is?
Flannery O'Connor centered her stories on this reality, exposing the incipient nihilism in the view that you are toying with. Take a break from pathology for ten minutes and read "Good Country People" or "Greenleaf" and abandon the hubris.
Matthew - It is tough, isn't it? However, in the midst of such trials, I find it useful to remember the proverb "smooth seas do not make strong sailors." It is only through trial that we grow, and I'm hoping (and praying) that you find the opportunity to do so. Heaven knows I need the same.
Marian - Thanks for the comments. I think we're probably near the same page on this. I'm not denying that miracles may happen, but like you said, looking for them and giving up any will of our own is not faith, it's laziness and shirking responsibility.
Alice - That's sort of what I was trying to say where I talked about the principles medicine is based on. I do believe that God created the world, and he created the principles we exploit with our drugs and our surgeries. However, God did not create beta-blockers, he merely gave us the brains to invent them. They are part of our work in his world.
The way I look at this is based on Acts 27. An angel tells Paul he will be saved from shipwreck, but that doesn't mean that Paul breathes a sigh of relief and heads back to his cabin with a bottle of Chianti. He stay active in the actions the sailors take, in the course of their trade, to save the ship, and in verse 31, he prevents some from leaving, saying that if they left, everyone would be lost.
The point is, God may tell us something (though whether he still does so so personally is a huge debate I will avoid here) but we still have an obligation to work towards that purpose. My frustration with Mrs. Roman was with her lazy, irresponsible, responsibility-shirking approach to her faith. If she doesn't want the surgery because it scares her or whatever, then just say so. God uses means, and works today through the hands of those who work his will.
Rob - I reposted your comment since it didn't take the first time.
You're right, I was ignoring the other edge of the powerful sword that is medical science. I will defer to your greater experience in saying medicine does only a little good, but as you say, my environment, whether it is only because it is a training one, or because it is in a tertiary care center with level one trauma capability and any specialty under the sun, gives me a perspective on medicine that is mostly positive. We cannot make people live forever, and there are instances in which we vastly more capable of improving only the quality of a person's life, but I respectfully submit that these are not "little goods." However, the hubris in medicine in general and in my post in particular is probably deserving of your closing rebuke.
Thank you for the recommendation for reading. I actually have the day off today, and I'll get back to you.
Just so you know, I believe in miracles - I've even seen a few, but I have a favorite joke for situations like this one:
John knew his house was in a flood plain when he bought it. He wasn't worried. He knew God would keep him safe.
The weather report called for heavy rains with a significant possibility of flooding. They recommended evacuation. John wasn't worried. He knew God would keep him safe.
When the water started rising, the sheriff came by and asked if he needed a ride. John wasn't worried. He knew God would keep him safe.
As the water reached the front porch, a neighbor came by in a john-boat and asked if he wanted a lift. John wasn't worried. He knew God would keep him safe.
The water rose to the second floor windows and the man down the street came by in a rowboat asking if he wanted to be taken to safety. John wasn't worried. He knew that God would keep him safe.
As the water filled the attic, John broke through and climbed out onto the roof. The National Guard came by and demanded that he go with them. John refused. He knew God would keep him safe.
John's house was washed away and he drowned. As he stood before his Maker in judgment, he asked, "I'm a believer, Lord. Why didn't you save me from the flood?"
And God replied, "I did my best. You were warned by the weather forecaster. The sheriff offered you a ride. I sent three more people in boats. Wasn't that enough?"
Can you get someone to suggest to her that God often heals through the hands of surgeons? I've seen that happen far more often than I've seen miracles.
maybe the miracle she's looking for is a competent physician and the modern technology to heal her.
This reminds me of the old joke of the Christian on top of his house during a flood.
He is sitting on the roof of his house as the flood waters are rising quickly and calls out to God, "Save me before the waters rise and drown me."
Soon a man appears in a boat and asks the man on the roof if he needs helps. The man on the roof replies, "No, God will save me."
The waters grow higher and will soon drown the man, and a helicopter shows up and drops a rope to the man on the roof, but he will not climb up, in hopes that God will soon save him.
Soon the waters overcome the house and drown the man. He arrives in heaven and the first thing he asks God is, "why didn't you save me from the flood."
God replied, I sent you a boat and a helicopter, but you wouldn't get in.
The miracle is modern science and the ability to fight such a complex health problem. God has placed capable doctors and nurses in her path to help, she just needs to realize that God is working through them.
We don't offer much.
We cut, we throw away, we mutilate. I mean, after all that's her lung, not her toe-nail.
Eventually, we are surprised when someone feels like envisioning other alternatives, that after all aren't worst - many persons we saved from a disease, died of another disease we and maybe our chemio helped them to develop.
But when the best option we can offer is cut, mutilate, throw away, there is one thing we'd better avoid: sitting there with the idea in mind that we know it better.
We know NOTHING. Our medicine, in maybe 200 years, will be considered barbaric.
Cut, mutilate, throw to the dogs, implant iron, get from a dead body a nearly collapsed piece and put it inside that other body.
Barbaric. Simply, the barbaric age.
Religion has nothing to do with it - or if it does, we ought to admit that if God doesn't know better, we neither.
People die, and at times we haven't something so terrific as we think to offer - go on living, without a lung and with a broken ankle and then in a couple of years maybe you die of a stroke.
Alberto
Alberto - you are right, in many respects. Medicine as we practice it now is always essentially a struggle against natural selection.
As far as 200 years down the road is concerned, I can't practice then, so I must do so in the present with as much humanity as possible.
People die, our treatments are seldom benign, and in the end, sometimes all we have to offer are a few years of existence in exchange for considerable pain and suffering. But that's medicine sometimes, and physicians are uniquely equipped to help their patient understand the balance of issues at hand.
My frustration with this patient was based on two factors. One, the procedure she needed was relatively (given her current problems and level of pain) benign. And two, her justification of her course of action was based on what I saw as flawed reasoning.
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