November 30, 2010 / Theology
This essay is neither for nor against Glenn Beck. The philosopher Michel Foucault warns us …
September 18, 2018
I knew nothing of how doctors think about and practice medicine when not long ago I found myself obtaining employment as a patient advocate at Mount Sinai Health System’s Head and Neck Institute in New York City. That I, a recent graduate with a master’s degree in theology, would have much to learn about the statistics and studies of thyroid cancer was obvious from the outset. What was unexpected was the way in which learning about thyroidology would inform my ecclesiological and pastoral reflections in the years to come.
One of the first lessons I learned on the job concerned the proper procedures for diagnosing and treating patients. This process always begins with a physical examination and a review of patient medical histories. Next, a radiologist or an endocrinologist performs an ultrasound radiographic examination of the thyroid and the lymph-node bearing tissues of the neck. Finally, a pathologist or thyroid specialist may biopsy any concerning nodules or lymph nodes. If the biopsy reveals something unusual but not definitively malignant, pathologists screen the biopsy samples for genetic mutations that can provide further information related to the patient-specific risks for the various treatment options. From there, doctors and patients consider the cumulative evidence to determine whether active surveillance, conservative surgery—such as the removal of only part of the thyroid—or complete removal of the thyroid and other affected tissues or lymph nodes is most appropriate.
While familiarizing myself with this tidy regimen, I discovered that theessential nature of health care is hard to articulate in medical terms: though doctors rely on standardized procedures, quantitative data, and technical catchall phrases like quality of life, curative, ablative, rehabilitative, these do not capture the weight of what doctors, nurses, social workers, and other clinical professionals do. Health care is all about creating and maintaining profound doctor-patient relationships and about pursuing healing and restoration of right relationship with others and with oneself.
The late doctor and bioethicist Edmund Pellegrino argued that the Hippocratic oath makes medicine a covenant relationship in which the primary goal is always to care for another person and to treat medical knowledge as nonproprietary. Daniel Sulmasy offers a similar assessment, arguing that medicine is an intrinsically moral affair that can be understood as a “dialectic” of healing. To render care, the clinician, along with the patient, must navigate particularity and universality, subjectivity and objectivity, art and science. Eric Cassell likewise notes that clinical thinking is “the whole process of acquiring information from diverse sources, calling up appropriate knowledge, applying various thought processes (conscious and unconscious) to the information, examining the conclusions and checking them against tests of validity, applicability, and importance, and finally, turning them inside out to see where they could be wrong.”1 Sources of information in this process include patients and their feelings and perceptions, diagnostic testing of various types, the assessment of other treating physicians, and the doctors’ own senses. Because medical reasoning requires the doctor to discern with the patient what is going on in that patient’s body, medical knowledge is always intersubjective.
Such shared subjectivity finds powerful expression in the medical laying on of hands, that is, the tracing of the skin of the neck to examine the thyroid.Though the diagnostic process as a whole is clinical and methodical, Paul Stepansky observes that it is still all about this healing touch: “Our doctors do things to us with their hands, and we welcome their hands because we have placed ourselves in their hands. And it is the doctor’s touch, which can be either direct, or, as we shall see, mediated through instruments and even exotic technologies, that justifies our initial leap of faith and provides one important basis for a trusting doctor-patient relationship.”2 This medical laying on of hands is often a communal affair, incorporating two or more other specialists and their unique expertise. That multiple doctors participate in the laying on of hands communicates how comprehensive and thoughtful patient care can be.
Even tools—the ultrasound probe, the laryngoscope, the surgical loupe—are extensions of a physician’s presence. Stepansky invites us to recognize “the physician’s own ears that hear us through the stethoscope” and the doctor’s eyes “on us through the ophthalmoscope, the laryngoscope.”3 Danielle Ofri gives profound testimony to this in recounting her final moment with a patient named Julia who was removed from life support due to severe complications from heart transplant surgery. Knowing that time was short, Ofri spent time at Julia’s bedside in the intensive care unit and performed one last heart exam with her stethoscope. She recounts,
Just as I’d done countless times over the years, I slipped the flat diaphragm of the stethoscope through the opening of Julia’s gown. Without my even having to direct it, the metal disk settled into the comfortable parasternal concavity where I always begin my cardiac exams. Feeling unrushed and oddly at ease, I glided the diaphragm along the familiar planes of the heart, pausing at the aortic, pulmonic, tricuspid, and mitral landmarks. I dwelled longer at each spot than I normally did, as though compelled to bid farewell to each voice in the quartet.4
This helps demonstrate an often understated or unstated reality: there is an erotics of care at work in medicine. Ofri came to care so much about Julia’s heart and life that it is as if she were treating her own heart, as if their bodies and senses were united.
Doctors desire to care, to heal, to rehabilitate. Good doctors express this interpersonally through attentive, empathetic listening to patients and by viewing the doctor-patient relationship as that of coworkers, as equals.5 But that care also extends to their intellectual activity in the medical academic community. In both concrete patient encounters and in theoretical research, doctors deploy their senses and their being to keep vigil against disease, even for patients they will never see. At the same time, they also continuously evaluate the success of their efforts and participate in debate with the wider medical community so that all doctors can confront the insights, oversights, and implications of current practices and findings in delivering care. In other words, good doctors are always discerning, always ready to revise and change how they approach medicine. This drive to improve has led to striking refinements in thyroid cancer care.
Since returning to graduate school to pursue a career in academic theology, I have drawn on many of the surprising insights I garnered from my time in health care. This has been prompted in no small part by Pope Francis’s evocative and challenging vision of the church as a field hospital.6 With this image, Pope Francis calls for a Christian community that looks something like the medical world I inhabited—though his might be an even bolder vision of caretaking than what I witnessed firsthand. Field hospitals resemble emergency rooms in that their goal is to stabilize patients when they arrive, but the field hospital’s proximity to the front line conveys a greater risk and also involves severe and traumatic injuries. Pope Francis’s metaphor of a field hospital challenges the church to respond quickly and decisively, like health-care workers, but also to be near the front lines in order to promote healing.
I have found that the art and science of medicine offers several insights to the church as it strives to be both a field hospital and the body of Christ. First, medicine offers the lesson that the desire to care for another requires intensive, collaborative investigation. A well-functioning hospital or practice requires partnership. No physician acts alone. In cancer care, every doctor knows that it takes a village to render an accurate diagnosis and manage the complexities of care. One cannot forget as well that the decision-making process requires the full and free consent of the patient, so discernment is not exclusively left to physicians. This is what enables the medical world to model theologian Bernard Lonergan’s vision of human cognitional activity in community at work: in cancer care insights from doctors and patients alike give rise to further insights, finer distinctions in diagnoses, and improved standards for surgical care.7 Doctors never stop deliberating, and their practice invites church leaders, pastoral workers, and scholars to seek the same tenacity and comprehensive vision.
Again, Pope Francis offers the church a model of this in the construction of his ecological encyclical Laudato Si’. There, the pope promotes the healing of the whole community of creation by consulting scholars in science and economics and by frequently citing the pastoral letters and teaching of national and regional bishops’ conferences. In this way, he gathers together wisdom in a shared vision of care for our common home.8
Second, I learned from doctors that we must be willing to treat another’s body as if it were our own or even more important than our own. One witnesses self-sacrificial love in the doctors, nurses, and other specialists who, over extraordinarily long work days, read thousands of radiology scans and medical records as if they were sacred texts; they use their own embodiment to feel out and treat disease in another’s body.9 We can appreciate their care better by bringing their witness into dialogue with recent theological reflection on embodiment. Reflecting on the poetics of human flesh and embodiment, Mayra Rivera offers this invocation: “We pray that our bodies may keep us open to others, to sense the entanglements of our carnal relations.”10
Although most doctors would probably never describe their work this way, they also know that they owe their embodied existence to their patients, and they let their bodies keep them open to their patients’ bodies. Medicine, after all, revolves around senses: sight and smell to spot concerning signs of sickness or disease and to pore over all kinds of records and examinations; hearing to understand patient pain and experience; and touch to comfort, treat, heal, and coordinate. Doctors cannot render effective care if they fail to use their senses in a thoughtful and orderly way. They also know that patients expect and respond to caring hands, listening ears, discerning senses, and compassionate hearts. Despite the power differential in the doctor-patient relationship, the best doctors allow themselves to suffer and rejoice alongside their patients, just as Paul would have it in the body of Christ (see 1 Cor. 12:25–26).
With such a witness in mind, we can affirm Marcia Mount Shoop’s profound assertion that “Feeling binds us together with all that is and with God. Feeling is our imago Dei,the creativity of God that works through us. . . . We live in a shared world, and our cells are knit together with universal threads. Our universality is our relationality.” Therefore, she says, “The Body of Christ is diminished when feeling is thwarted.”11 The church need not experience such diminishment if it carefully attends to Pope Francis’s own embodiment of the church as a field hospital through his public engagement—his embrace of a man disfigured by facial boils, his generous encounters with children who wander onstage during events, his spontaneous stop at the checkpoint separating Palestinian Bethlehem from Israel. At that wall of division, for example, Francis provocatively prayed in the same posture as he did at the Western Wall by touching the checkpoint wall and bowing his head in prayer. With such actions, Francis invites the Christian faithful to restore our sense of feeling and our presence to wounded bodies, embracing them, washing their feet, and standing with them. Such closeness to the people bears some resemblance to Ofri’s final goodbye to her patient, Julia.
Third, and relatedly, clinicians offer a different and comprehensive way to show how we should care for the body of Christ by even striving to protect patients they will never see from bad medicine.12 This explains why they constantly publish and research. If our own research into church life and practice resembled the sober analysis of medical literature and its drive to examine every aspect of every step of medical care, perhaps it would sharpen our feeling for good or bad spiritual medicine, for disparities in access to care, for what is hurting or missing in the body of Christ. Francis’s emphasis on retrieving practices of dialogue in the church (what’s known as “synodality”) can help us appreciate and imitate medical practice. Consider, for example, how such dialogue and debate could help to address the malpractice of priests and bishops that has surfaced in the most recent string of sexual abuse and misconduct scandals afflicting the global Catholic Church. American Catholic bishops are now debating structures of oversight for episcopal misconduct or abuse, and it is heartening to see a small but growing number of prelates affirm the indispensable role that the laity play in structures of accountability.
Fourth, medicine can teach us about the need to attend to embodied difference within the body of Christ. There are billions of bodies within Christ’s body, each with unique flesh, capabilities, limitations, wounds, and stories. Over the last fifty years, the church is seeing that each body manifests itself in increasing particularity and diversity: female bodies, black bodies, queer bodies, migrant bodies, bodies scandalized by the sexual abuse crisis and by poor pastoral leadership—they all call out for safety and better care. We continue to encounter wounded bodies in the church, but knowing that people are hurting is different from knowing precisely what afflicts them. Like attending physicians, ecclesial leaders, such as theologians, pastoral workers, and pastors, must compassionately encounter wounded bodies and listen attentively to their histories. We can adopt physicians’ rigor and collaborative style by using every modality possible to diagnose what ails the body of Christ and by always striving for the best possible care. Doctors do not diagnose cancer without scrutinizing it microscopically, obtaining imaging to determine the extent of its presence, and discussing with other specialists and the patient what the best option is. Those who desire to bring healing to Christ’s body can fruitfully do the same.
Looking back on my time in health care and at the lessons it afforded for theology and Christian living, I must confess that although the surgeons I worked for might not all be religious, they modeled for me the tradition that sees Jesus as the divine physician. Their witness reminded me that Jesus also affirmed his own embodiment. He too extended his hands to restore sight, function, and relationship to others. He too grieved and rejoiced alongside those he cared for. He welcomed, affirmed, and incorporated radically diverse bodies into his own.13 When we learn to discern together, to attend carefully, to diagnose exhaustively, and to extend healing hands compassionately and collaboratively, we will more faithfully embody the Divine Physician himself.
Dave de la Fuente
Dave de la Fuente is a third-year doctoral student in systematic theology at Fordham University. He has particular research interests in pneumatology, ecclesiology, and the relationship between medicine and religion.