Doctors

The Difference between Paternalism versus Love

Recently, I heard a doctor say, “The difference between paternalism and love? It’s trust.”

This made me think of a scene in the 2017 film The Upside in which Philip Lacasse, a billionaire who has become a quadriplegic, is seeking a live-in caregiver.

Philip’s executive assistant, Yvonne Pendleton, has lined up interviews with many candidates.

“So… what would you like to tell us,” Yvonne prompts the first woman applicant who looks stiff and uptight.

“I take my relationship with my clients very personally,” she stumbles. “And seriously, I mean. And professionally. As well. Of course,” she ends awkwardly.

The next applicant, a politically-correct gentleman, says, “I don’t hear disability. I hear this ability.”

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Creaturely Sovereignty

Today I came upon the Oath of Maimonides. Here is the short text written by the preeminent rabbi, physician, and philosopher of the medieval period:

The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.

May I never see in the patient anything but a fellow creature in pain.

Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.

Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.

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Treat someone as you would want your loved one treated

There is this general ethos in contemporary healthcare that physicians should remain neutral, impartial, objective, and detached. To some extent, this seems fitting so to prevent burnout and enable doctors to see so many patients with a plethora of dramatic conditions and circumstances.

However, sometimes this goes too far and is detrimental and dehumanizing not only for patients but even for the doctors themselves.

One thing a former patient shared with me in this regard struck me. She said it was greatly reassuring for her when her doctors would preface their medical judgment or recommendation with the words, “If you were my spouse…” or “If you were my daughter…”

This indicated to her that the doctor truly had her best interest at heart. If he was willing to advise something in the case of his own loved one, then it was clear that he was making his recommendation very sincerely and had considered it seriously.

And so, this leads me to reflect on how we really want to be treated by others not only as they want to be treated but also as they would want their own loved ones to be treated.

I think doctors extending this kind of empathetic imagination to their patients can be an excellent form of accompaniment and help in having crucial conversations in the meeting between doctor and patient.

Fighting for the Right to Suffer

The other day I was listening to a talk by author Rod Dreher who, in discussing the contempt for suffering in our contemporary culture, brought up this excerpt from chapter 17 of Aldous Huxley’s book Brave New World:

“But I like the inconveniences.”

“We don’t,” said the Controller. “We prefer to do things comfortably.”

“But I don’t want comfort. I want God, I want poetry, I want real danger, I want freedom, I want goodness. I want sin.”

“In fact,” said Mustapha Mond, “you’re claiming the right to be unhappy.”

“All right then,” said the Savage defiantly, “I’m claiming the right to be unhappy.”

“Not to mention the right to grow old and ugly and impotent; the right to have syphilis and cancer; the right to have too little to eat; the right to be lousy; the right to live in constant apprehension of what may happen to- morrow; the right to catch typhoid; the right to be tortured by unspeakable pains of every kind.” There was a long silence.

“I claim them all,” said the Savage at last.

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“Why hasn’t God taken me home yet?”

This evening my friend who is a doctor shared with me an anecdote from the past week.

She had a 90-year-old patient named Laurence who was admitted for recurrent falls and who may not be able to return to independent living in her own home because she lives alone.

Laurence never married and does not have any children, but her nieces and nephews help her out with cooking, shopping, and managing her finances and appointments.

During the hospitalization, my friend had a few conversations with Laurence and, many times, she would ask, “Why hasn’t God taken me home yet? I’m 90-years-old now. I’m sure I will go to heaven, and I don’t know what else to do here.”

My friend noted that Laurence had mentioned on a few occasions that one of her defects is impatience.

“All I do every day is pray the rosary again and again,” Laurence said.

My friend thought quickly about how to help Laurence to see the value in her continued days.

“Maybe God is not taking you home just yet, because there’s something in which you’re meant to still grow – your patience.”

She gave a smile of compliant recognition and replied, “Yeah, maybe.”

Later that afternoon, as Laurence was leaving the unit to be transferred to another hospital, she said goodbye to my friend and said, “I know what my mission is now – to work on my patience!”

What a beautiful encounter of helping another to discover a new mission, even in her old age.

“You need to have an accident…”

This evening I was having a phone visit with my friend Don, who recently celebrated his 90th birthday.

I always enjoy our weekly chats, and tonight he discussed something that I found particularly insightful.

“I have a 7-person health team,” Don told me. “I have a heart doctor, a GP, an ophthalmologist, a dentist, a foot/nails doctor, a personal trainer, and a Chinese massage therapist.”

He named each member of his health team with pride and appreciation.

Then Don told me, “I had some friends who were so successful, so smart, so rich and they’re all gone. I don’t think they had a health team.”

I asked Don why he thinks his affluent friends had not attended to their health like he does.

“They don’t know what they don’t know,” he suggested.

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At the End of Life, the Artist is Necessary

According to the Cambridge Dictionary, the word “clinical” may denote “expressing no emotion or feelings” or “showing no character and warmth.” The sentence that is given to illustrate its meaning is this: “We were going to paint our kitchen white, but we decided that would look too clinical.”

Do you ever wonder why hospitals and doctor’s offices are so drab? Why does there seem to be so little attention paid to aesthetics? What impact does this have on doctors, nurses, patients, and visitors?

One day, Cecily Saunders, the British pioneer of modern-day hospice care, was “magnetically drawn” to an oil painting in a gallery window. She was so taken by it that she parked her car and entered the gallery moments before they were closing on the last day of the exhibition. Cecily Saunders moved eagerly from painting to painting. The blue Crucifixion had been the piece to catch her eye from the window, but the piece she impulsively chose to purchase was of ‘Christ Calming the Waters.’

The following day, she wrote the following to the artist, Marian Bohusz-Szyszko:

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Do you have something you need to do?

This evening I heard a physician, who is also a Roman Catholic deacon, share a story about a dying woman to whom he would bring Communion.

The 50-year-old woman had uterine cancer that had metastasized into her spine and, understanding the gravity of her condition, he found himself surprised that she was still alive each time he went to visit her.

Eventually, he decided to ask her, “Do you have something you need to do?”

This question invited an response and she answered, “Yes, I do. I need to become a Canadian citizen.”

It turns out that this woman was very close to finalizing her citizenship and needed to do so in order for her children to receive their citizenship and avoid deportation back to Hong Kong.

On hearing this, the physician-deacon phoned a citizenship judge friend of his and explained the situation. When the citizenship judge heard the request, he agreed to meet the woman the next day so that she could swear the oath.

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