THE HEALER'S CALLING

In an age when Medicine could so easily become a monster of technology, this little book of 130 pages is truly heartening. The author received his M.D. from Cornell University School of Medicine and trained as an intern at John Hopkins before going on to take his vows as a Franciscan friar. He is now associate professor of medicine and director of the Center for Clinical Bioethics at Georgetown University Medical Centre, Washington, D.C. Clearly Dr. Sulmasy can hold his own in the academic fraternity. But more importantly, he is a man of great humility and unwavering sincerity, who writes of his deepest desire to serve his patients with all at his disposal, mind, heart and soul. As Sulmasy says, 'this is not a book about spirituality in health care' (which would suggest a spiritual component to medical practice). It is concerned with medicine as nothing less than a sacred undertaking, one of the deepest trust and respect, between doctor and patient. I am reminded that when I was in hospital a while back, I was asked if some medical students could examine me. It was their first day on the wards and I was to be their very first patient. As they tentatively felt for liver, spleen and so on, their eyes were as big as saucers with the instinctive awareness of the privilege and honour of the task. I felt valued and acknowledged. They all did really well; when it was over, I could tell them so and they blushed with relief and pleasure. I recall another time when a young doctor I hadn't seen before rushed in hours late to put up a drip into my arm. Her manner was abrupt and her face wore an expression of irritation and fatigue. This had a terrible effect on me. An alarming existential abyss opened wide - I just felt I didn't exist any more! I reclaimed my personhood by playing the professional card and letting her know I was a doctor. She then looked at me for the first time - I think she felt a bit ashamed - and began apologising for being so late (six wards to cover etc.) As I commiserated with her, I became a human being once again but I knew, and I think she did too, that it should not have to be this way. Yet I must admit I have been that young doctor (the 'liver' in bed five, the 'heart' in bed six) just as I was once the new medical student filled with wonder. It took me many years to remember what I started out with, lost along the way and had to learn to find again. Would this book by Dan Sulmasy have helped me find it sooner? I probably wouldn't have had it on my reading list; so narrow and compelling was the world of hospital medicine I knew. But in recent years there is a new kind of enquiry going on in medicine, with a burgeoning of evidence-based literature in the area of spirituality and health care (see International Center for the Integration of Health and Spirituality '[email protected]'), with many medical schools in the USA, at least, offering educational programmes in the field. Dan Sulmasy's vision is no longer a lone voice in the wilderness. Sulmasy lives and breathes the Christian faith but in a private kind of way, for his own inspiration and redemption. As a physician, he explains that spirituality means a relationship of love, not to be confused with narcissism or getting 'high' on one's faith. He writes, 'reach for the transcendent. Find it in the pedestrian'. His starting point is that this is generally what moves us to work in healthcare in the first place, even though we may not have properly understood it to be so. It is the very principle of healing, which works unseen alongside all the many investigations, diagnoses and medications. Spiritual medicine means accompanying one's patients through uncertainty and doubt, knowing that life is precious and so looking for 'cure' where possible, yet knowing also that healing may take us to the threshold of death. Every pain, however small, is a reminder of our mortality, but without which we could see nothing of the big picture. As Sulmasy points out: 'to recognize any limit is to know that there is something beyond that limit. To know finitude is to know the infinite… Suffering is the experience that human beings have of knowing themselves as finite creatures who have been given the gift of a freedom that orients them to the infinite…' These are abstractions, however, set in a text that is unencumbered by preaching or spiritual prescription. 'A patient is not a problem to be solved, but a mystery in whose presence the clinician is privileged to dwell.' Another way of putting it is that while the physician has to know what to do, equally he needs to know how to be. 'Don't just do something, stand there!' A source of inspiration for Sulmasy is that he sees Christ mirrored in every patient who attends in pain or distress. 'Christ may roll into the emergency room in shock, suffering from a gunshot wound to the chest. Christ may be thirteen years old, unwed, pregnant and in labor. Christ may be ninety years old and slowly dying of congestive cardiac failure. Christ looks through suffering eyes, directly at the clinician. He says 'Whatever you did for one of these least brothers of mine, you did for me''. I found myself comfortable with this Christian exegesis, having been brought up in the tradition. There is an advantage in the intensity of spiritual passion that is kindled. It may be less to the liking of non-Christians. But then, there is no shortage of more secular spiritual writings, by Drs. Larry Dossey, Dean Ornish, Bernie Siegel and many others. In his role as a practising clinician, Sulmasy invites patients to explore their spiritual and religious beliefs with him if it seems right and appropriate. He privately prays for them, but not, he adds, by the bedside as attending physician. 'I leave that sort of praying to the chaplains'. (This is indeed a delicate line to tread; such intercessions, however well intended, can easily be felt as intrusive). But as to having a good bedside read, I'm glad to say that in this little gem of a book, Dan Sulmasy tells how it is for him with no holds barred, leaving me warmed by his eloquence, lambent passion and heartfelt sincerity.