It is our duty as physicians to estimate probabilities and to discipline expectations; but leading away from probabilities there are paths of possibility, towards which it is also our duty to hold aloft the light, and the name of that light is hope.
—KARL MENNINGER, The Vltal Balance
Statistics are the triumph of the quantitative method, and the quantitative method is the victory of sterility and death.
—HILAIRE BELLOC
I HAVE ALWAYS made a distinction between healing and curing. To me “healed” represents a condition of one’s life; “cured” relates strictly to one’s physical condition. In other words, there may be healed quadriplegics and AIDS patients, and cured cancer patients who are leading unhealthy lives. What this means to me is that neither my patients nor I need ever face the inevitability of failure, for no matter how life-threatening their disease or how unlikely a cure, healing is always possible.
Even the most mechanistic of today’s doctors may become interested in healing once they understand that a healed life may include as a by-product a physical cure—this was the original impetus for my own interest in healing lives. I find, however, that the healing has increasingly come to seem the most important aspect of my practice, which is why Bobbie describes it as a clergical practice. Recently a woman wrote and asked me to find her a clergiologist for her heart problems. Patients want to be seen as people. For me the person’s life comes first; the disease is simply one aspect of it, which I can guide my patients to use as a redirection in their lives.
When doctors look at their patients, however, they are trained to see only the disease. That is why so many of us need to be reminded that there is a human being in the room with us. One woman did this by placing a sign on her sick husband’s hospital room door saying “Danger, human being inside.” This sign (and the wife’s climbing into bed with her husband to rest with and comfort him) caused quite a disturbance at the major medical center where he was hospitalized. When they later had to go to a smaller local hospital in an acute emergency, the man’s wife again hung the sign on his door. This time a nurse noticed it and asked her where she had gotten it. Expecting the worst, the woman explained that she’d found it at a nearby store—to which the nurse replied, “Will you get me a dozen more?” Then there was my patient who wore an Egyptian belly dancer outfit to the oncology clinic one day. You can be sure the doctors didn’t treat her as just another case of breast cancer ever again.
A man who came to one of my workshops had his own methods of reminding everyone (including himself) that he was not just a disease. While hospitalized during diagnostic tests for what turned out to be a brain tumor, Jake wore his own clothes instead of hospital gowns, decorated his room with pictures of all his favorite sports figures, moved his bed next to a window so that he could see the sky, and in general just refused to act like a patient. These activities create a more active immune system—and a stir among the hospital staff!
During this same hospitalization Jake, who is a very powerful-looking man at six foot three, was on his way to the operating room prior to brain surgery. When the surgeon came down the hall Jake reached out to shake his hand but the surgeon pulled his hand back. Jake thought that the surgeon might be trying to protect his hands, so he then asked for a pat on the head instead. But the doctor again pulled back, saying that they were running late and needed to get into the o.r. At that point Jake roared, “I refuse to have this man work on me! If he won’t shake my hand or pat my head, I’m not letting him go into my brain.”
I have to admit that behavior like that can make a mess out of the operating room schedule. But it’s survival behavior. Jake knew intuitively that a man is not separate from his disease, and it was important to him to have a doctor who knew it too. Doctors who persist in thinking they can cure the disease without caring for the person may be excellent technicians, but they are incomplete doctors, because they have an incomplete understanding of illness.
The doctor I would want for myself or for anyone else I cared about would be one who understands that disease is more than just a clinical entity; it is an experience and a metaphor, with a message that must be listened to. Often the message will speak to us of our path and how we have strayed from it, so that our life is no longer a true expression of the inner self, or, as Larry LeShan would say, we are no longer singing our own song. Only by listening to that message can we mobilize all the healing powers that lie within, and that is what the doctor must help each patient to do. Psychiatrist Milton Erickson told a story he thought would shed light on how his own profession could assist patients in self-healing:
I was returning from high school one day and a runaway horse with a bridle on sped past a group of us into a farmer’s yard . . . looking for a drink of water. The horse was perspiring heavily. And the farmer didn’t recognize it, so we cornered it. I hopped on the horse’s back . . . [and] since it had a bridle on, I took hold of the reins and said, “Giddy-up” . . . [and] headed for the highway. I knew the horse would turn in the right direction . . . [but] I didn’t know what the right direction was. And the horse trotted and galloped along. Now and then he would forget he was on the highway and start into a field. So I would pull on him a bit and call his attention to the fact that the highway was where he was supposed to be. And finally about four miles from where I had boarded him, he turned into a farmyard, and the farmer said, “So, that’s how that critter came back, where’d you find him?”
I said, “About four miles from here.”
“How did you know he should come here?”
I said, “I didn’t know . . . the horse knew. All I did was keep his attention on the road.”
. . . I think that’s the way you do psychotherapy.
What I like about Erickson’s concept of therapy is that he knows that the doctor does not prescribe the patient’s path. The path is prescribed by the intrinsic awareness of the DNA in the fertilized egg that becomes you, and if you follow it you will become the best you possible. This approach to healing is as relevant to the body doctor as it is to the psyche doctor.
The physician is in a unique position, however, quite different from the psychotherapist’s, because people who come to our offices aren’t coming to change their lives. They’re coming because of physical problems. Some may even want to die. But if we are willing to treat more than their diseases, by being there for them, supporting them and loving them, in addition to caring for their physical problems, we may be able to redirect lives, not just treat illnesses.
Most of today’s doctors shun the informal psychotherapy that family doctors practiced routinely in the past. They takedown the facts of the patient’s medical history, without paying much attention to the patient. But we must never forget that the look on the patient’s face, the tremble in his hand, the falter in his speech, the lowering of his eyes, the dreams he has, the drawings he makes, are all potential signs of what really troubles him, and at least as important as anything he may say about his symptoms. In fact, so much of the important communication that takes place between doctor and patient is nonverbal that I’ve even had the experience of being able to treat a man from Greece who spoke no English. When this man was brought to my office I spoke to him as if he could understand me, and the effect of my hope and my concern got through to him without words. When he needed surgery, I played Greek music for him—another nonverbal form of communication.
It was common knowledge among doctors from Hippocrates on that we need to tend to the patient as well as the disease, “for some patients,” as Hippocrates said, “though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.” In the last hundred years, however, the role of the physician has changed drastically, for both better and worse. It used to be that doctors were ill equipped even to diagnose, much less to cure, most ailments. Practically all they had going for them besides the occasional herbal remedy and painkiller was their understanding of human nature.
During the final decades of the nineteenth century, however, the practice of medicine was changed dramatically by advances in the doctor’s ability both to diagnose and treat disease. Then, in the first half of the twentieth century, the introduction of the sulfa drugs in the thirties and antibiotics in the forties made this the age of the medical miracle. The doctor-mediated placebo effect no longer seemed needed.
There is no question at all that the curative powers of the physician are vastly greater today than ever before. And I certainly wouldn’t give up any of the medical miracles that we twentieth-century doctors have available to us. That’s why I’ve remained a surgeon. But I can’t help noticing that our power to heal people and their lives seems to have diminished as dramatically as our power to cure diseases has increased. This is because the knowledge of human nature that used to be the doctor’s principal resource has been abandoned as irrelevant in an age of science. Science has become God, and separated itself from the patient. Recently I visited a woman who had undergone a heart-lung transplant. Think of the enormity of it: Her blue fingers were now pink; she was alive. She told me that she had asked for psychiatric help because of the many issues she was having to deal with, including whether to thank the family of the individual whose death had made it possible for her to receive these organs. When she brought the subject up, the basic advice she received from her surgeon was to get on her exercise bike and work it off.
What has been lost is the human dimension. To recover a sense of what medicine used to be, when doctors relied on their inspirational powers because these were the only real powers they had, we must look to cultures where traditional medicine still plays a role. Ernie Benedict, a Mohawk Indian elder, is quoted in Jeanne Achterberg’s Imagery in Healing as saying that the difference between the white doctor and the shaman is that “the White doctor’s medicines tend to be very mechanical. The patient is repaired, but he is not a better person than he was before. It is possible in the Indian way to be a better person after going through a sickness followed by the proper medicine.” I think this is what the shaman knows and the Western doctor, alas, has forgotten.
But what do I mean by trying to reclaim the shamanistic role for the doctor? Those of you who are already suspicious of the medical establishment’s authoritarian impulses may be justifiably wary of a doctor trying to reclaim the moral and even spiritual authority that his profession has lost (some would say abandoned). However, I believe there is no disease whose treatment cannot be enhanced by a doctor who knows how to inspire and guide patients and so to bring into play the body’s internal healers. It is when I can help my patients find what Schweitzer called the doctor within—when I play coach, as one of my patients put it—that I am most fulfilled in my role as doctor and I serve my patients best. We become a team with joint participation and responsibility.
In a wonderful letter that a couple wrote to their doctor after he diagnosed the wife’s recurrence of cancer, they ask him to play this role with her and to support them in their struggle:
We need your skills as an oncologist, but we also need your faith as a human being that exceptional people can do exceptional things, and that Isabel is one such exceptional person. . . . It’s important for you to know that neither of us believes that cancer can be stopped by using medical techniques alone. It also involves keeping joy in your daily life, exuberance in your outlook, determination in your soul and unbridled faith in your heart. These things are not possible if your doctor adopts an attitude that you are “incurable.” We need you to treat Isabel medically, but we also need you to root for her and believe in her. We ask you to be patient and loving.
The doctor who truly believes in the uniqueness and specialness of each patient can have an effect that transcends the mechanical. I read a story recently that New Frontier Magazine columnist Alan Cohen told about a chiropractor who had an opportunity to change a patient’s life. One day a man who was an utter mess came into his office. The chiropractor was repelled by the man, but since he had been taught (by Indian healers, in fact) to find something lovable in each of his patients, he looked him over, searching for something he could appreciate. He saw that the man had new and very neatly tied shoelaces, so he got himself to relate to the man through his shoelaces and treated him in a loving way.
A few days later the man came back to his office, clean, well dressed, and looking much better, and he explained that on the day of his previous visit he had been headed to a nearby bridge to commit suicide when he decided he would give one more person a chance to change his mind. “The first place I saw was your office, and so I came to you. I must thank you for being so kind to me. I felt your acceptance and your love. You encouraged me to continue living, doctor, and I want you to know what a difference your kindness made.”
We as physicians have the opportunity to do this with every patient we see. Some come to us so filled with pain and self-loathing because of the negative voices in their past that they expect and even want to be abused and punished. But we have the ability, through loving our patients, to help them to love themselves. My painful lesson was learning how difficult my patients’ lives are. Not all of them want to live. Some of them will find the will to live only if their doctors do as the one in Alan Cohen’s story did.
There are also patients who do want to live but don’t know how. I think that’s who is referred to in Ecclesiastes where it says, “He who sins before his maker, may he fall into the care of a physician.” The issue here is not sin as we usually interpret it, but living an unhealed life. Only if we help to heal lives can we develop the kind of patient who is more likely to be cured of diseases.
As part of my clergical practice, one day I walked into my examining room and asked a lady sitting there with a staph abscess, “Why do you have difficulty saying no without guilt?” When she responded, “Who called you from my family before I got here?” I could honestly say, “No one, I’m reading your body.” Because I have learned that diseases are often signs, and that if I can read the message the disease is communicating, I may be able to help patients change not just their physical condition, but their lives. When one does that, one can indeed have patients come up and say, “The disease was the best thing that ever happened to me. Thank you for being on my path and guiding me.”
On my desk is a letter from a patient who had come to me for counseling as well as medical care. At the time she wrote, her ovarian cancer had disappeared, in response to her program of hope, meditation, visualization, autohypnosis, chemotherapy, psychotherapy and inspirational self-healing exercises. She says, “You have saved my life, enriched it and taught me to love.” What she is talking about is not the recovery she made from her disease, but the change that came about in her because of the disease, a change I was able to help her to make.
I have a dream, and the dream is to help my patients find their dream. Often the factor that motivates them to live and to find their dream is their disease. (Again we remember Arnold Mindell’s words: “A terrifying symptom is usually your greatest dream trying to come true.”) One woman whom I had operated on a number of years before wrote me a letter about the effect I had on her life:
During the first years after surgery, I kept a journal detailing my thoughts and feelings—it was a journal—ultimately—of growth and renewal. I have turned it into a book entitled The Uses of Adversity. Of course, you figure quite definitely in the book—from first considering you my savior, to blaming and hating you, to finally making peace with you in my mind. You didn’t know you had so many “uses,” did you!
No I didn’t, but I’m grateful to her for telling me I did. When we can help people transform affliction into a challenge and a gift, then we have reclaimed everyone’s dream.
Like most doctors, I have to try to remember that I am merely a facilitator of healing, not the healer himself—a frequent source of confusion for doctors! That’s why I’ve asked my patients to call me by my first name. As Bernie, I’m a human being whom my patients and the people I work with can relate to; they will accept my being perfectly imperfect. When no one expects the impossible of me, including me, that’s an immense burden off my shoulders. But “Dr. Siegel” is a label that assigns me a fixed role and means I’m supposed to be perfect. I will inevitably be a failure at being perfect.
Because there is always the danger that I will revert to the old doctor roles, Gwen, one of the nurses in the o.r., often greets me by asking “Who’s here today, Bernie or Dr. Siegel?” One day when I was Bernie, a nurse who was changing shifts in the middle of a long, arduous operation leaned over and kissed me on the back of the neck as she was leaving. That was an incredible gift to me. It gave me strength to go on, because it said so much about the pain and the love we had shared in that operating room. M.edical D.eities don’t get gifts like that, because they’re so aloof from everyone around them that they don’t share anything. So now I try always to be Bernie.
Being human means you get to share a lot of laughter as well as hugs and kisses. One of my partners, Bill McCullough, who is a human being as well as a surgeon, was doing some rectal surgery and asked Maureen, the nurse, to shine the light on the asshole. She replied, “Which one?” Nurses like that are really an enormous help to us. They help us to deal with our pain as surgeons, they let us know they care, and, in case we forget, they remind us that we’re human. I heard a story about a nurse who discovered that a patient had died and called a young resident into the room to pronounce him dead. He went through his various procedures, postures and pontifications, and finally with great ceremony pronounced, “The patient is dead.” “No shit,” was her reply! The physician later described that experience as a turning point for him, which helped him to change and grow up. It’s the physicians whom the nurses say they can’t hug or laugh with (and sometimes at) who are the problems, both to themselves and to others.
What is it about us physicians that makes us want to play God? Woody Allen says it’s because we have to model ourselves after someone. Studies that have been done on the psychology of doctors suggest that we’re trying to deny our mortality, for people who choose medicine as a career are often motivated by a fear of death. Every victory over death confirms such doctors in their feeling of power, and conversely, every patient they lose represents a profound failure, a dread reminder of personal inadequacy. Curing becomes an addiction for them—one that is just as destructive as any other addiction. Since all doctors are bound to lose some of their patients, you can imagine how their sense of failure grows as every year adds to the tally of losses.
That’s why I call medicine a failure-oriented profession, with its emphasis on disease rather than people. Attend any medical convention and take a look at the doctors to see what I mean: Gone is the glowing optimism of the medical school student, and with it that aura of healing, of healers being sent into the world, that is palpable to everyone in the audience on graduation day. When you see them gathered together not so many years later at one of their professional meetings, worn out by their collective feelings of failure, you can sense the change they’ve made from a life-oriented to a death-oriented profession. This is not an inevitable result of dealing on a daily basis with serious diseases, as is evident when you attend a convention of other types of health care providers. No less concerned about their patients, they tend to talk about quality-of-life issues rather than disease, defeat and death. When they treat patients, they often have their families and office staff present so that they function as a healing team.
If doctors would do the same, they would not feel so isolated, and they would find they could succeed even when they are unable to cure. That’s why I sometimes receive beautiful letters of thanks from the families of patients who died, or am asked to deliver a eulogy at the funeral or attend weddings. These people know I did my best, and they know that death does not mean that either my patient or I was a failure. A letter that came recently said:
We can never thank you sufficiently for the wonderful care you gave my mother. Her name was Hope, and that was the precious gift which you alone among the many medical people involved in her case gave her.
My mother was truly an “exceptional patient,” to use your phrase. Such was her faith and fighting spirit that she refused to consider herself a statistic, insisting never to be told her prognosis, even during her final illness. Instead, her great trust in God, positive attitude, and involvement in her own healing, through the various techniques you suggested, allowed her to do marvelously well, living considerably longer [and] more actively than she should have, from a strict medical perspective. In our greed and deep sorrow we long to have had a complete miracle, however recognize with thanks the limited miracle we truly received.
We are indebted to you for providing my mother with the most effective medicine she received: vigorous encouragement, sincere care, and love.
God bless you and thank you for your kindness, concern, and above all, for being my mother’s friend.
And indeed I feel blessed, and healed, when I read such a letter, or am invited to the funeral of someone I cared for.
In years past I would feel the weight of loss and failure in the face of death, but then I would receive a message to remind me that none of us down here is capable of filling God’s shoes. A number of years ago a patient of mine died on the operating table. Although he had been critically ill and the family and I knew even before I started to operate that his chances of survival were small, nonetheless I was much affected by the loss. After he died, I phoned the family from the operating room and shared with them that I had tried to keep the death as spiritual as possible under the circumstances, which I think was some comfort to them. But they found a way to comfort me too. I received a poem in the mail from a member of the gentleman’s family, which restored me. When I read parts of it at the medical conference that always follows a patient’s death, there was total silence, as every physician in the room recalled his own pain and his own losses. The poem begins by saying:
This man the surgeon who with his hands
Works hard to mend where he can
Works hard he does this man the healer
Works hard yet at times he’ll fail.
and ends this way:
Carry on physician, do what you can,
Your common sense surely does the job
No one expects any miracles from you,
No one expects the impossible.
No one, that is, except everyone at medical school and in house staff training, as well as the individual physician. I know what those expectations are, and I too have been a victim of them. But I say we only fail if we are trying to keep people from being dead. Then we will inevitably fail, since life has a 100 percent mortality rate. I’ve done the research, and I hate to tell you, but everybody dies—lovers, joggers, vegetarians and nonsmokers. I’m telling you this so that some of you who jog at 5:00 A.M. and eat vegetables will occasionally sleep late and have an ice cream cone.
If we doctors would admit our mortality, then we would find a way to succeed with even the sickest of our patients, sometimes simply holding their hands when they are frightened and in pain, other times helping them understand the meaning of their illness and how they can use it to experience life and love. It is my patients, out of their kindness and their wisdom, who have taught me this, and it seems to me that whenever I am in danger of forgetting it, another patient helps me return to that knowledge.
One evening as I made rounds I came into the room of a woman with diabetes. She had lost her sight, her kidney function, her leg and several fingers. A patient like this can destroy a doctor in “cure mode,” and I felt the pain and weight in my stomach that I always get when I’m walking around trying to cure everyone. Not knowing what else to do, I simply went up to her and held her hand and spoke from my heart: “I wish I could help you.” And she said: “You are helping me.”
She didn’t ask me to cure her. She didn’t ask me to take away her diabetes or give her back her sight. She only asked me to hold her hand. And then I kept her company as she wrestled with the issue of stopping her dialysis and whether that meant she was committing suicide and would therefore go to hell, which was a concern of hers because of her religious beliefs. We talked a long time that night about her options and choices, until she seemed to me to be more at peace. I hope that I in some way helped to heal her, for I know that she helped heal me. She reminded me that I can never know all the answers, but I can help all my patients if I can just know their pain.
As is so often the case, it’s a psychotherapist, talking about his own profession, who has come up with the metaphor that best describes what doctors can do for their patients at times like the one just described. Comparing Virgil and Dante in The Divine Comedy to therapist and patient, Rollo May quotes Dante’s cry as he wanders through hell:
O my beloved Master, my Guide in peril, . . .
. . . stand by me now . . . in my heart’s fright.
“I hear in those words the cry of the patient who asks the physician to stand by and care,” says May. “Virgil responds as we should”:
Like Dante, patients must ultimately take responsibility for their own journeys, but like Virgil, the physician must not desert the patient, even the patient for whom it might at first appear that “nothing can be done.” Every patient can use what May describes as a “guide, friend and interpreter” through the private hells and purgatories of illness, and every doctor has the opportunity to play that role, to lead the way from the crucifixion to the resurrection.
Franz Kafka said, “To write a prescription is easy, but to come to an understanding with people is hard.” Medical school teaches everything we need to know about writing prescriptions, but nothing about understanding people. In fact, it teaches students to keep their distance so as not to be overwhelmed by the suffering of their patients. Better not to know them too well. The prescribed attitude is called “detached concern.”
What is detached concern? Do you think you could use detached concern with your family? What you would do is destroy them—and yourself, because estrangement from your own feelings is ultimately deadly. We need to show rational concern, not detached concern. With rational concern I’ve even been able to operate on people in my own family. And it was not an inappropriate act, but a caring act, a loving act.
As doctors, many of us have cultivated our detachment so effectively that our patients find us completely inhuman. The truth without compassion is hostility. I had a patient come to my office the other day who had had a mammogram in Spain, and she told me that when the time came for her to get the results, both the technician and the physician walked out and embraced her before telling her the news that she would need surgery. When she came to this country for treatment, she was shocked by the difference in physicians. The first surgeon she was referred to talked to her with his back toward her as he completed a chart, and got angry at her for asking how her breast would look after surgery. She found a similar coldness in the radiology suite she visited. She felt so uncared for that she left and ultimately found her way to my office.
Some have criticized me for being too tough on the medical profession. But since I am a physician, I feel I have the right to be tough—more right than those who have not felt the pain of the physician. For I do know our pain, I do know our burdens, and certainly I also know that many doctors feel more than they reveal. (You try being an oncologist or a surgeon for a week!) A recent “Piece of My Mind” column in JAMA reminded me that the apparent indifference of such doctors may be a mask for their pain, and may also simply be a result of poor training for dealing with that pain. “Jailhouse Blues” recounts the anguished feelings of a prison doctor who must inform yet another prisoner that he has AIDS. “I can’t afford to get involved,” he writes, for “there is too much to be done,” too many patients requiring his care. He obviously fears that he will be overwhelmed and immobilized if he allows himself to feel his patients’ pain: “To be able to care for this man I must withdraw, to protect myself and my own drained emotions. I rise quickly and summon the security officer: ‘Next patient, please.’” Instead he could reach out to his patient and say “I need to hug you.” I did that for years, thinking I was helping the person with the disease. Eventually I realized that the need really was mine and that the hug restored me as much as it did the patient.
I used to go through the same pain whenever I had to tell a patient there was nothing that could be done. Once I realized there is always something I can do, however, I discovered the antidote to that pain. At a workshop we were both attending, a woman patient of mine with breast cancer who turned to me and said “Office visits are okay but I need to know how to live between office visits” gave me the clue I needed to create a success-oriented practice. No longer would I just keep people from dying. That was over ten years ago, and that remark was my inspiration for forming the first ECaP group. Now I understand that everyone, be they prison inmates or people of wealth and privilege, is looking for a way to live between office visits. That is the one thing I can always help my patients with, regardless of their physical condition.
Several years ago I was asked to visit a young nurse who was on a respirator, dying of pulmonary metastases. The family was hoping I could help her. I went into the intensive care unit with fear in my heart, not knowing what I was going to say or how I could possibly help. When I reached her cubicle, she saw me, sat up, respirator and all, and opened her arms to embrace me. There was no problem with visiting her. She healed me, by teaching me once again how beautiful and courageous people are, how basic their needs, how simple their demands.
The morning I was going to speak at the Cornell University Medical School commencement, I asked two critically ill patients what they wanted me to tell one hundred new doctors on their graduation day. Both patients were young, one with metastatic breast cancer, the other with liver failure secondary to cystic fibrosis, and both died within several months of the request. What message did they wish to give to these future caretakers? Did they want me to ask them to find a cure for cancer or cystic fibrosis? No. They had five simple requests. One patient said, “Tell them to let me talk first,” and the other, “Tell them to knock on my door, say hello and goodbye, and look me in the eye when they talk to me.” These simple lessons are never taught in medical school.
We doctors are totally unprepared by our education for what we are going to meet in our practice. While I don’t think most physicians are villains, I do think the training process of physicians is villainous. Students have their natural desire to help people drummed out of them by medical school training that, on the one hand, has warned them about maintaining a professional distance from their patients and, on the other, has not helped them with such difficult problems as how to tell someone they have AIDS or cancer or how to deal with the fears that arise within themselves as they treat the critically ill. I have known people whose doctors have given them a life-threatening diagnosis over the telephone, in the most abrupt, thoughtless way, and then ordered them to appear at the hospital the next day to have some part of their body removed.
A group of oncologists, psychiatrists and medical school workers at the University of California at Los Angeles have for this reason spent four years making a film called Cancer Disclosure: Communicating the Diagnosis. Using physicians in combination with actors coached by cancer patients, they are trying to help medical students and doctors avoid the kind of disastrous scenario described above.
Another training program I’ve read about was started over ten years ago by Professor Sandra L. Bertman at the University of Massachusetts. Her medical humanities program makes use of literature, art and pop culture to teach compassion and caring to medical students. For example, the students in her “Death, Dying and Dissection” course are helped to explore rather than ignore what they feel as they make their way through such rites of passage as the encounter with their first “patients”—the cadavers they will dissect in anatomy lab. Bertman has them read excerpts from Irving Stone’s book The Agony and the Ecstasy, a fictionalized biography of Michelangelo, which portrays the feelings of the young artist as he secretly dissects his own first cadaver as part of his anatomy studies. She also has them study Rembrandt’s painting The Anatomy Lesson, because the faces of the people standing around the body reveal so much about their reactions. Rather than stifling their inevitable feelings of pity, fear and excitement in the face of death, the students learn from Rembrandt and Michelangelo that these feelings are universal; they’re part of what makes us human, and must not be denied.
At the conclusion of the anatomy course, students in Bertman’s class hold a memorial service for the human beings who donated their bodies to the cause of medical education. Thus they come full circle, purging themselves of the desensitization they had to undergo in order to sink their knives into a human body. Other schools are starting similar courses in which it is safe and desirable to discuss feelings.
Recently I read about a hospital in California where first-year medical residents are admitted incognito as patients for a day so that they learn about hospitalization from the patient’s point of view. I myself fantasize starting every medical student’s training with a physical. The student would show up for a routine blood test, and I would call a few hours later to say, “I think there’s something a little peculiar about the results of your test. You’d better come in tomorrow.” The experience of sleeping on that uncertainty would be quite an education for most students. Then I’d hospitalize the student for a few days of tests so that the fear experienced by every patient in the hospital, the discomfort and depersonalization, the loss of control, would become part of the student’s experience too. After a few days I’d announce, “Sorry, we made a mistake. Your blood test got mixed up with someone else’s and you’re fine.” They would learn from this what it’s like to experience illness, and I hope would see that diseases cannot be treated separately from the people who have them.
I’d like to see medical school curricula with courses taught by patients, nurses and doctors who have been seriously ill, because that too would be a new experience for students. I’d like to see some teaching time devoted to the healing power of touch—a subject that only 12 out of 169 medical schools in the English-speaking world deal with at all, according to a survey reported a few years ago in JAMA, despite the fact that touch is one of the most basic forms of communication between people. I work with osteopathic students as well as medical students. The osteopathic students have been taught about touching and manipulating the body, and when they’re in my office and a patient who has some pain comes in, they know how to use manipulation and massage to help relieve that pain. The medical student is more prone to prescribe a pill. We need to teach medical students how to touch people. Perhaps this training could be part of a whole course on communication, which is almost completely neglected in medical school.
The course in communication would teach students how to tell patients their diagnoses, how to write a chemotherapy protocol, how to answer the questions of those dealing with life-threatening diseases—and would also help students understand what they themselves will be feeling during these communications, because doctors have feelings that must be dealt with.
I would have a course called “Why You Became a Doctor,” so that students can understand what motivated them at both a conscious and an unconscious level to choose the medical profession. This course would help students deal with their feelings as they face up to the fact that some of their patients are going to die, and that they themselves are mortal—which doctors don’t like to admit.
During the first year of medical school I would like to see every student assigned to a patient with a chronic illness. The students would remain involved with their assigned patients for the entire four years of medical school. They would be required to show up every time that patient came into the hospital and would visit the patient at home as well, so that they could see how the lives of both patient and family are affected over time by the experience of chronic illness.
Students would also be expected to attend a healing service at a shrine and told to go out and help one of the thousands of incurable people who show up for these events. “But how can I possibly help someone who is incurable?” they would ask. I know, because I too have gone to these services, and I remember my feelings of helplessness and frantic attempts to think of some medical solution that hadn’t yet been considered, even though many of these people had already had the best that the medical profession had to offer. But then one day I was at one of those services when a woman with a congenitally deformed grandchild in her lap reached out to me and said, “Please pray with us.” She taught me the one thing I could do, and reminded me that doctors are health care providers, not health cure providers. That saved me, and now I can be comfortable using what I learned from that grandmother.
In the absence of the kind of training I’m describing, however, it is not hard to understand why today’s young doctors, many of whom have never had to confront death or serious illness in their own lives, have no idea how to help their patients. Overwhelmed by the magnitude of what they must tell patients and families facing serious disease, they withdraw. The patient, however, sees only the detachment, not the concern. Too often, the result of maintaining our “professional distance” is that we build a wall around ourselves. When we do this, our patients are not the only ones who suffer. We hurt ourselves as well. (Look at the high suicide rate of physicians.)
The pain of the medical student and the doctor is very real. If you doubt it you have only to read more “Piece of My Mind” columns in JAMA. A recent contributor, a seventeen-year-old girl who intends to be a doctor, expresses her dismay at the despair she sees in most of the columns written by doctors. “Sad, heartwrenching or simply depressing” she calls them, as she wonders whether in twenty years she too will be speaking only of “frustration, anger, and a sense of defeat.” But if Joy Matthews can just keep wanting to “heal lives,” as she puts it, she may remain true to her name long after colleagues who seek only to cure disease have lost their own sense of joyfulness in the practice of medicine.
I receive hundreds of letters testifying to the pain of doctors who feel defeated by the demands of their profession because they have focused on diseases and not on the people who have them. One such letter was deeply gratifying to me because it described how Love, Medicine and Miracles was able to play a role in healing that pain. The woman who wrote it was just starting her fourth year of medical school, after three years of what she had found to be dehumanizing, soulless work.
My third year of medical school, although better than the first two years of sitting in class, was still about 80 percent drudgery. Rushing through admissions and orders, chasing down labs, endlessly arranging and rearranging x-rays, CT’s etc. and laboring over progress notes. Some patients I connected with and enjoyed, but most of my energy was spent in anxiety about presenting cases, knowing dosages, finding vacutainers, missing veins, and the day to day management of patients on almost a purely secretarial level.
Reading your book reminded me of why I was going to medical school in the first place. I’m thirty-six years old and switched from a career teaching literature to medicine after I had my first child. I switched because I liked taking care of people, I liked being around when they were in trouble and I liked being able to help them. . . .
I finished your book in July and started a rotation I was truly dreading in August—my subinternship in medicine. I was dreading the long hours and the complicated patients with multiple chronic diseases and mainly the feeling of being overwhelmed by all I didn’t know about diseases. . . . About halfway through the rotation I began to notice the curious sensation, heretofore not associated by me with ward medicine—I was enjoying myself. By the end of the rotation I was telling people I loved it.
What made the difference was the amount of time I spent with my patients. I ate lunch with them, arranged for their children to get HIV testing, listened to their family problems, compared prices of nursing homes with their wives. I realized I didn’t have to know a lot of medicine to help them out. I relaxed and learned as much as I could about the diseases as I went along. . . . I was thoroughly enjoying myself, simply because I was listening to my patients and getting to know them. I was helping them enormously by just being there.
This woman knows the secret I would have every medical student learn: If you withdraw you die; if you share your patients’ pain, you begin to live. Let your patients heal and teach you.
Once the shared humanity of doctor and patient is acknowledged, doctors can be relieved of the burden of thinking that the responsibility for life and death lies with them alone. I like George Bernard Shaw’s advice in The Doctor’s Dilemma. He thinks it should be compulsory for all doctors to have inscribed on their brass plates, in addition to the letters indicating their qualifications, the words “Remember that I too am mortal.” My version of this advice is to recommend that all doctors hang their own x-rays in their offices as reminders of their mortality, and move their desks against the wall so that they meet their patients face to face with nothing between them, as vulnerable mortals. I know what a shock it was the first time I looked at my x-rays and realized they looked like everyone else’s. That meant I could die too—no matter which side of the desk I was on.
Too often physicians learn the pain of their patients only by going through pain themselves. In another “Piece of My Mind” column, Dr. Marian Block described what she felt when she had to submit to procedures she’d been prescribing for years for her patients:
“I guess I have to say this, but you’re going to be all right. If this is breast cancer, it’s the earliest kind we know.”
His words are meant to reassure, but I almost burst into tears. I am a thirty-nine-year-old physician who has just had a screening mammogram, having waited to engage in the procedure about as long as a physician who recommends it to her patients can wait.
. . . Two days later the call comes recommending surgery. Only then do I experience an intense physiological reaction. This is really happening. Surgery. General anesthesia. Fear, a profound anorectic and as good as atropine for drying the mouth.
Over the next days and weeks I hear and process a lot of information, even though I am often being told facts it seems I must already know, facts with which I have an easy familiarity when they apply to others. But there are times when I am presented with information and hear almost nothing. I am like a deaf person, knowing that words are being said but unable to understand their meaning. I hear words that I have used with my own patients, like “fibrocystic disease,” and I am told it is really too common to be a “disease.” The surgeon uses another word I have used—“nuisance”—and I know how he means it. That word nuisance, I have used it myself. I think (but do not say), tell me about this nuisance, this nondisease that scares a person half to death and results in surgery.
In the context of having the best care for a minor surgical procedure, I marvel at what my patients must go through. How are my words understood? How many questions go unasked? . . .
Three days after the surgery there is another phone call. I hear the two words I need to hear, and to his credit (because I do not hear the rest), he says them first. “Totally benign.”
It’s always a surprise to doctors who find themselves or their family members on the receiving end of the health care system to discover how little in the nature of true healing their profession offers. I have read many moving letters as well as articles and books by doctors who have had this experience. No one has said it better than Dr. Hans H. Neumann, whose article “Why Have We Stopped Comforting Patients?” written shortly before his death, contains a lifetime’s worth of wisdom.
First he tells about the callous treatment he himself received four years before, when he was recovering from a myocardial infarction. “You know, I feel remarkably well considering it’s been only forty-eight hours since my coronary,” he made the mistake of remarking to a young resident. “Don’t let that deceive you,” was the response, “you’re in serious danger.” The intern and the staff physician on duty echoed these dire messages—in marked contrast to Neumann’s own physician, whom he calls “a member of the older, more compassionate school of medicine.” Instead of alarming his patient unduly, his way of explaining the situation was to say, “Barring any unforeseen developments, your chances are excellent. Your ECG shows the expected evolution, and you’re making progress.”
Neumann tells an even more horrifying story about what happened to a member of his family. Given a diagnosis of inoperable liver cancer, she was treated with a brutality almost inconceivable unless one assumes the doctor reacted that way out of an inability to confront his own mortality and limitations.
Take the case of Mildred, a relative of mine. When exploratory surgery revealed her liver cancer, she was referred to an oncologist. She told me that after the doctor read her pathology report, he reached into his desk drawer and withdrew a slender stick.
“This is what you need,” he said, waving it in front of Mildred and her husband.
“What is it?” asked Mildred.
“It’s a magic wand,” the oncologist replied. “That’s the only thing that can help you now.”
When she recounted the incident to me, Mildred said, “The man actually grinned when he said this. Did he think I would find it funny?”
Since he kept the “wand” in his desk, the doctor apparently used this technique quite often. Yet he never mentioned—to Mildred anyway—that periods of remission were possible, even predictable, in cases like hers. The encounter had a devastating effect on her, doubling the burden of her disease with iatrogenic depression.
Stories like this and the one I told earlier about the doctor who wanted to prove to his former patient that laetrile is quackery can only be understood as expressions of the essential destructiveness and sickness of many doctors. In The Vital Balance, psychiatrist Karl Menninger quotes a British colleague as saying that “the need to cure is . . . nearly always a reaction-formation against destructive needs and wishes, and that is why the need to cure is so dangerous within psychiatry.” Then he goes on to say, “It does not matter in surgery; but in a mental hospital the patient may never react to what is on top in the doctor, but to what is underneath.” There I would have to disagree, however. The doctor’s underlying feelings are just as important in oncology and surgery as they are in psychiatry, because, as these stories show us, those feelings always end up being expressed, one way or another. If there is a compulsion to cure, which is frustrated, out come the destructive tendencies, and doctors destroy what they cannot cure. Doctors who treat their patients like this send them straight into the arms of the quacks. The medical profession needs to accept responsibility for its role in promoting quackery by removing hope.
As Neumann says later in his article, “a doctor who provides the patient only with textbook translations of lab reports is, at best, a competent scientist.” At worst such a doctor is a destroyer. If you’ve ever witnessed a patient’s reaction to his or her own pathology report, then you know what I mean. My friend Joe Kogel, who was diagnosed with malignant melanoma over five years ago, is a professional actor and writer. He has a one-man show in which he reads aloud from the pathology report that revealed his metastatic melanoma, letting us see the incredible emotional impact that medical terminology can have on a patient. Lab reports and statistics too often are used to take away hope. But I like what the receptionist in my office told the woman who announced that “statistically” she was supposed to die soon: “Statistics are for dead people. You’re not dead.” Wouldn’t it be nice if those two were teaching a communications course at medical school? I also liked the approach one of my patients took to statistics: When I told him he had cancer, he said, “I guess that means I have five or ten thousand miles left.” Don’t let statistics tell you when to die.
I’m not suggesting that we ignore lab reports and statistics, just that we recognize that they are only one aspect of the picture. I tell my patients who have illnesses for which the statistical outlook is poor that we will use statistics to help select the best treatment options for them. Then I try to complement the benefits of the medical, mechanistic approach with those of the symbolic and spiritual approach. It is important to realize that these approaches need not be mutually exclusive.
That’s the point of a course I teach called “Surgery: Mechanical or Healing Art,” in which I describe the techniques I use in my clergical practice. But nobody at medical school knows what to do with a course like that. It straddles too many boundaries of things they think should be kept separate. Words like “dreams” and “drawings” scare surgeons, as do certain four-letter words like “hope” and “love.”
The letter the associate dean for educational and student affairs sent me about the course states the dilemma very clearly: “As you know, all courses taught at the School of Medicine must be authorized by and become the responsibility of one of the established departments. Your course has been listed under your Department of Surgery. I recently received a letter from the Chairman of the Department of Surgery, indicating that he did not think that the course should be surgical. He suggested the Department of Psychiatry.”
I wrote back to them and enclosed several of the letters I have received from students who are crying out in despair at the mechanical nature of what they learn in medical school. I could also have quoted Lewis Thomas to them: “Medicine is no longer the laying on of hands. It is more likely the reading of signals from machines. If I were a medical student or an intern just getting ready to begin, I would be apprehensive that my real job, caring for sick people, might soon be taken away, leaving me with the quite different occupation of looking after machines.”
Yes, I react strongly when it’s suggested that my course be taken out of the surgical department. But it really makes very little difference whether they support what I do, because the students keep coming and the course will go on, whether it’s listed in the Yale Medical School Bulletin or not.
I love the Quaker statement “Speak truth to power.” The truth lies in people and their stories, not in statistics, which can be used to say whatever anyone wants them to say. If I continue to speak the truth and live it by example, my patients will do better and the establishment will eventually respond. Which they are both doing.
That my patients do well was most recently confirmed to me when an oncologist called to say “I want you to know that your patients live longer.” That the establishment is responding I know because I’ve been invited to speak at so many medical school graduations and hospitals that I can’t accept all the invitations. So perhaps the new medical students will not accept the old teachings any longer. Maybe in the future doctors will feel free to express their emotions, and won’t be embarrassed to be seen coming to my workshops or buying my books.
When I speak to physician groups they often sit quietly and rigidly. I used to think they were bored; but then I noticed that when I was done they all lined up single file to talk to me. ‘I realize now that they are in fact very interested, but uncomfortable about letting a roomful of their colleagues know. However, I am encouraged that more physicians are asking questions in these meetings and coming to workshops. My work is becoming better known and accepted, and therefore it is safe to speak openly about it. As one man said, “Even if I disagree with you, half of my patients have your book under their arms, so it’s important we talk.”
Love, Medicine and Miracles stirred the waters and created change. That’s why there is music in virtually every operating room in New Haven today, although when I first brought in my tape recorder I was considered an explosion hazard. And that’s why I expect hospitals will in the future use closed circuit television in patients’ rooms to provide preoperative preparation, meditation, healing imagery, music and laughter. Sooner or later they’ll see that this will help patients heal faster, and reduce hospitalization costs. Wellness is cost-effective.
The fact is, there seems to be a movement today to reintroduce medical students to their patients as human beings, not diseases, and I think that movement will spread, because it will be successful for both patient and doctor. If nothing else, today’s consumer-conscious patients will pass the word among themselves, and the doctors who have gotten the message will get their business.
My friend Jake, whom I mentioned earlier, was a real champion among patients. He found inspiration to fight the overwhelming odds against him in what he had learned from years of participating in Outward Bound expeditions. Diagnosed in August 1985 with an inoperable malignant brain tumor, he took two days off to cry and then decided to “get off the pity pot,” as he put it. He remembered that he had mobilized the students he taught at a special school for dyslexics by sharing with them the philosophy of Outward Bound Movement founder Kurt Hahn: “Your disability is your opportunity.” Now he put that philosophy to work on his own disability.
Jake went through radiation, came to one of my workshops and embarked on a very active Strategy of Wellness that he devised for himself. Two years after his diagnosis he had a CAT scan that showed his tumor to be half the size it had been when it was first discovered.
But refusing to lie down and die quietly can make you unpopular. In a study done at Yale there was a direct correlation between an active immune system and a negative opinion of the patient by the head nurse on the ward. What that means is that if I come on the ward and say I’m going to draw a blood sample from Mr. Smith, and the nurse says, “That old s.o.b. won’t take his clothes off, is never in his room and probably won’t let you draw his blood without asking you five hundred questions about why you’re doing it,” then there is a 100 percent chance of an active immune system. Whereas, if I come on a ward and say to the nurse, “Today it’s Mr. Jones’s turn to have his blood drawn,” and the nurse says, “What an angel. Yesterday he had a barium enema by mistake because we have two Joneses on the floor and he never complained a minute”—well, you just know what that says about Mr. Jones’s immune system.
Other studies have verified these findings. Unfortunately, most doctors want their patients to be submissive. In fact, the word “patient” means submissive. To be a “good” patient means to be docile and fit in and do what the system wants. But that is not good for survival. We need to look to another word, “curious,” for survival techniques. “Curious” has the same root as “cure,” and that means that doctors should be glad when patients come in with a list of questions, a request for options and an insistence on knowing how they can participate in their own healing. But the patient who does that is not a good patient. I have created a new word for people like that—“respant”—which stands for “responsible participant.”
My prescription for becoming a respant requires people to ask themselves the five questions discussed earlier, in addition to sharing the symbolic and unconscious aspects of their true selves. I also ask them to undertake a five-part therapeutic program that you’ll read about in chapter 6.
Not exactly a “good patient,” a respant is what Bobbie calls a “good/bad patient.” Respants get emotional, make noise and may seem difficult to deal with. They fight the submissive role because they are fighting for their lives, so I naturally encourage them in that behavior. The result is that my patients tend to get reputations.
The other day a radiologist called to tell me that a patient had come in to see her with earphones on, a meditation recording on her tape player, a list of questions in one hand and a list of her many allergies in the other—and she knew right away that this lady was a Bernie Siegel patient. Sure, I get teased a lot by my colleagues, but I also get notes like the recent one from an oncologist who told me that my patient was doing beautifully and that he would be sure to provide her with her music and the room with a view of the sky I had requested for her, because he’s seen how these things can diminish side effects. I’m gradually making converts in the medical profession, or perhaps it would be more accurate to say that my patients make the converts with their success stories.
More and more patients are learning to participate in their own healing. It’s no longer uncommon to hear patients say, “I have interviewed several doctors and now have a team made up of people who passed the interview test.” One woman didn’t even grant a doctor an interview until she visited a number of different waiting rooms and finally found a cheerful one. Only then did she make an appointment to meet the doctor and evaluate him. So you might think about using waiting rooms as part of your selection process. I love to hear about people who do things like that, and I also love to deal with patients who are direct about their needs and preferences—like the woman who came into my office with two typewritten pages entitled “This Is What I’m Like,” and two more typed pages of questions. At this point, I enjoy these patients. Yes, they’re difficult, yes, they take time, but they are wonderful survivors.
Recently a preoperative patient who had a lot of questions for me found a nonconfrontational way of asking them. She began each of her requests for information by saying, “Tell me about. . . .” I recommend this technique to all of you when you are talking to your doctors, because it is so nonthreatening.
The following letter, written by a woman to her surgeon, is a perfect example of a patient taking responsibility for her life as I am suggesting, something most people won’t do.
I would like to tell you something about myself, what kind of person I am, what qualities I can bring to these rather unusual circumstances.
I bring you a strong, healthy body, equipped with a good heart and lungs and better than average endurance. I bring you someone who runs, swims, plays tennis and bikes. I bring you someone to whom the outdoors is terribly important. . . . I bring you someone who loves life.
Yesterday I felt as though I was being put in a box car and shipped to Auschwitz to rendezvous with the Mengele brothers. I felt as though all “these procedures or protocols” were going to be enacted on me, with my having no say in the matter. I need to be heard, to have you know my fears and expectations.
One of my many concerns is bodily impairment. I want to be able to use my legs as I have in the past. My small incision has been somewhat restrictive, although I feel today that I could go out and run, maybe a mile. To the point, I do NOT want a radical inguinal lymphadenectomy (if I understand it correctly). . . .
This is what I want from the surgeons who are in my hire: I want/need to be consulted if possible, to be in on any decisions that are to be made in my behalf. Once in the operating room, I want the most highly qualified and skilled professionals (surgeons and staff) operating (so to speak) on my behalf. I want someone who sees alternative solutions and is not thrown by the unexpected. I want someone who when making decisions keeps in mind the spirit and life-style of the woman lying helpless and inert on the table.
You are the right person for me. I bring to the situation my strong mind, a sturdy body and a fierce desire to continue my life.
P.S. I want to be sewn rather than stapled.
Some of you may be amazed at this woman’s willingness to confront authority and express such strong opinions about the kind of surgery she is willing to have. But she had researched her options, and was careful to leave the door open to further discussion if necessary (“if I understand it correctly,” she noted, in reference to the surgical procedure she was opposed to—thereby inviting the surgeon to remedy any possible misapprehension).
If I received a letter like this, but felt strongly that the procedure the patient was rejecting was the right one for her, I would explain my thinking, perhaps by telling her how I would treat the same condition in my wife or myself. But I would never make her feel that if she didn’t do what I said she couldn’t return to my office. If we were unable to reach an agreement about her treatment, I might say, “I care about you, so let’s see you again in two weeks and find out what progress you’ve made. If what you’ve chosen works, fine. If it doesn’t, maybe you will want to look at some other options.” No matter what happens, I don’t give ultimatums. I always think of one woman of my acquaintance who, when a doctor told her that he was “captain of the ship,” said, “Yes, but I have to decide if I want to get on your ship.”
My patients stay with me because I let them know that we are working together as a team. On the other hand, by the time they get to me, some of these people have an entire breast invaded by cancer, or a malignant melanoma as big as a melon, because in their past experience they’ve found doctors even worse to deal with than the disease. These are intelligent people whose response to physicians who screamed, yelled and tried to play God was to walk out on treatment. They had made the choice that they would literally rather die than return to the medical profession. I can only say to those of you who are having similar experiences—keep looking for the doctor who is right for you. Don’t walk away from the medical profession. It has too much to offer to be discarded. To doctors I would say, please accept these people and continue to see them no matter how much you may disagree with them. When you do, 100 percent will ultimately accept you and your therapy, because they will know that you care. It has worked for me with all the wide variety of patients I see.
Surgery can be a healing experience, as can chemotherapy, radiation and other treatments, if you see them that way. They can be gifts from God—in fact the Greek word therapeia means “doing God’s work.” That’s what I wrote in answer to a letter from a lady who said, “I decided after reading your first book that I’d let God heal me. So I stopped taking my medicine for high blood pressure and dizzy spells, fell down in the bathtub, banged my head and spent a week in the hospital. Why is God slapping me around?” She had misunderstood what I was trying to say in Love, Medicine and Miracles. I told her in my letter that I thought God may have sent her the blood pressure pills. There’s no reason to reject God’s gifts and set oneself such stern tests of self-healing. To cite Ecclesiastes again, “Give the physician his place, for the Lord created him.” Medication can be a gift from God, as well, according to the Bible.
It is sad that so many doctors and patients now see each other as adversaries rather than as joint participants in a healing process to which each brings special qualities of mind and heart. In my desire to put a stop to the adversarial relationship, I have talked a great deal to medical students and other health care professionals about what they can do for their patients, and to patients about what they can do for themselves, but I’ve not given enough emphasis to what patients do for their doctors. However, I have been so continually renewed and healed by my patients that I do not think the doctor’s indebtedness can possibly be overstated. The letter that best summarizes what I am trying to say about how the healing flows back and forth—and beyond—is one a patient received from her surgeon. After hearing that her doctor had just been diagnosed with cancer, this woman and her husband had sent him a copy of my book. He responded by writing this letter:
I want you to know how deeply I appreciate Love, Medicine and Miracles. This book continues to be a source of strength and optimism for me, and I have been telling my patients about it, so others have also had the benefit of your thoughtfulness and generosity to me. . . . Siegel brings out the power of love and hope.
Indeed, getting a cancer that has metastasized already showed me the enormous importance of a family, with brilliant clarity. I also experienced some depths of pure love which was unbounded and unqualified, as I know you have, from what you have done together. Being a card-carrying cancer patient has also shown the caring and the ties among us all. Each of us finds out by ourselves how long a night can be at 3:00 A.M., and how shattering this experience is.
None of us knows where this is leading. I see my role as more or less of a medical ministry; I have the opportunity to share my patients’ experiences more than ever, and this is a rare privilege.
You and many other wonderful people have shared love and concern with me and I have felt humble and uplifted as a result. As you have reached out to me, I will reach out to others.
The longer I practice medicine, the less sure I am of the dividing line between healer and those in need of healing. Patients whose overwhelming physical problems made me feel useless have taught me volumes about the true nature of my calling, thereby restoring my faith in myself as a doctor. Patients who feel they owe their lives to me have returned the gift in full, enriching my life immeasurably by the wisdom they gained from their illness and passed on to me. As students who have worked with me can testify, whenever I am having a really hard day, one of those days that means I have gone into “cure mode” and am therefore feeling defeated by my own limitations, I go into the intensive care unit and sit with my sickest patient. Invariably that person will teach me again what I need to know—that patients ask only for my care, not my cure—and I leave feeling better, restored to my humanity, accepting of my limits.
I suggest to all physicians who are feeling the despair of being unable to cure that they too go to their sickest patient, perhaps with an excuse like “I’m waiting for a lab report, do you mind if I use the chair next to your bed while I wait?” and then sit there for half an hour. I guarantee that your patients will heal you in the time that you are sitting there, by their strength, their courage, and the fact that they don’t ask you for a cure but are healed by your care.
The healing I have done as a doctor has always come back to me, tenfold. So who is the healer, who the healed? This is not a question that ever gets looked at in medical school. Students therefore miss out on one of the fundamental truths of the doctor-patient relationship—the fact that their greatest resource will be the people they take care of. The physician who knows this can tap into a never-ending source of loving energy. I have learned that I can always be sure of receiving the gift of renewal at the hands of those who might seem to have the least to give.
In a way, I could even say that I owe many of the extraordinary blessings that have come to me in the last few years, during what I might call my own medical ministry, to the patients in ECaP, the cancer support group I organized over a decade ago. At that time I was so unhappy with the way I was practicing medicine that I was considering alternative careers as a psychiatrist or a veterinarian. However, I realized that becoming a psychiatrist would remove me from the hospital and the whole system I was hoping to change, and though veterinarians work with pets who can be hugged, a veterinarian friend reminded me that people bring the pets in, which would mean I’d still be facing the same problems. My ECaP patients taught me how to remain a doctor by letting me know how to have a success-oriented practice that would help people to live between office visits.
As people who are ministering to those facing life-and-death issues every day, we doctors are privileged to be in a position to benefit from the hard-won wisdom of our patients. The men and women—and children too—who have looked death in the face, are often those who know most about living. Their message is: “I learned I was going to die and so I decided to live until I died.” They interpret their diagnosis not as a sentence but as a message to live. Their mortality is accepted, not seen as a verdict. How few of us know how to do that!
Another lesson I learned from watching them is to live one day at a time, suffering and rejoicing for whatever that day brings. But then Evy McDonald taught me about living ten minutes at a time. I’ve written so much about Evy in this book because she is a veritable scholar and sage of suffering—and of the wonderful things that can come of it. This lady used her illness to turn her life around in such a way that there is nobody, sick or well, who could not learn from her story. Like all exceptional patients, she knows about living in the moment.
Patients really are our greatest resource, and when I think of the doctor I met once who told me that diseases are wonderful, but patients are a problem, I can only say that the loss is his. I feel sorry for him because he is missing out on the many gifts that always flow from the patient to the doctor who is prepared to receive them.
Neal Sutherland, an oncologist friend of mine in Hawaii, is eloquent about the nature of those gifts. In a recent letter he shared with me his thoughts about the spiritual healing and renewal he has experienced because of the people he has met in his practice:
Bernie, I have chosen being with cancer patients because I felt that if I were with them enough, I could find the secret of living one day at a time and why some cancer patients are able to find such phenomenal inner peace through their disease. . . . I think I now understand that inner peace and the transformation that leads to that inner peace. From my perspective it seems that it involves being willing to give up life as we normally perceive it and view life only as a moment by moment occurrence of opportunities to give love. In the giving of love, there is also the receiving of love, and this cycle grows endlessly and without bounds.
Again I would ask: Who is the healer, who the healed? In the chapters that follow, about exceptional patients who have confronted AIDS, multiple sclerosis, cancer and a whole host of other diseases, this is a question you may find yourself asking again and again.
The people who have chosen to take on those diseases and live as fully as possible in the face of them give a gift to all those whose lives they touch, whether it is their health care providers or their families. And from them we can learn not just how to fight illness, but how to live, and what healing really means.
Ten years ago I thought I knew something about living and offered to help others learn. I became the student and have been taught by these incredible and exceptional human beings. If you want to learn how to live, hang a sign in your living room window saying “I give lessons in how to live, 8–10:00 P.M., Wednesdays.” You can even charge for it. When the people come, you have one job. Don’t say a word; just listen. In three months they will thank you for your help and wisdom. In six months they will call you a genius for changing their lives. That’s what’s happened to me. I get a lot of credit for sharing what others have taught me.