Archive for the ‘Spirit’ Category

Heat of the night

Wednesday, October 20th, 2010

Literary humanists have always believed that stories are what we trade and tell to make sense of the world. I would like to relate a powerful story that has a memorable message and has served as fodder for much personal introspection. It is sad, unfortunate, and perhaps unbelievable, yet true. It applies specifically to physicians and health care workers who may overlook the imperative to do no harm. It delves into how we can dangerously “disconnect” from anyone under our care, be it physical, emotional, or spiritual.

My story begins in my early days as a physician. On a night on call, my superior took me aside and explained the theory behind an experiment that was about to take place.  Simply put, it was hoped that if an asymptomatic HIV-positive patient could be warmed to an extremely high body temperature, the HIV virus in his body might be killed in vivo and the patient cured of AIDS. In those years we did not have some of the powerful anti-viral agents we use today in the treatment of HIV disease.

The experiment began with a young, well-looking man walking through the hospital doors. Members of his family accompanied him and sat supportively while a consent form was completed. With little melodrama, they quietly said their farewells. Blood work was taken, IV’s started, and a central line inserted. Then he donned a wetsuit.

For the entire night, this patient wore the wetsuit. Since his skin pores were unable to drain, his body temperature began to rise. Each hour we took blood tests to monitor his progress chemically. As monitors flashed and beeped, his proteins denatured in the hot blood and he developed a dangerous bleeding disorder called disseminated intravascular coagulation. I transfused blood products in an effort to reverse the process but was unsuccessful. The man who had looked and felt fine a few hours earlier slowly exsanguinated in front of me. I was helpless, and by change of shift the next morning, he was dead.

My thoughts often return to the heat of that tragic night, when my sweat blended with his as I vainly tried to save a man who had trusted us. Many years later I am still trying to work out some of the answers. Recently I was inspired by a concept that sheds some light on the central dilemma of our story. It is the idea of “connectedness” or holiness in our lives.  To explain it, I must recount another much older story.

In the Book of Exodus, we read that as Moses prepared to ascend Mount Sinai, God revealed himself for the first time to the people of Israel. A Midrashic (allegorical) interpretation of this event by the early Jewish sages notes that God arrived in a chariot accompanied by lightning and thunder. This chariot bore four different images, including a calf, and was splendid and glorious. The people were awestruck by the fiery display, focusing not on God Himself, but rather on His wondrous vehicle. Later, when Moses ascended to fetch the Ten Commandments, people fashioned their own “god” from molten gold, in the form of a calf. Their focus on the “external” image of God and their idolatry is what ignited God’s fury.  The people were thus condemned to wander in the desert for forty years.

The importance and significance of this transgression is vital to an understanding of our everyday relationships. The Hebrew term “avodah zara” means “worship of the strange or disconnected part” and is commonly used to signify idolatry. In Judaism, avodah zara is one of only 3 cardinal commandments in relation to which a Jew should choose death rather than transgression. If applied more globally, it means there is danger when our attention is focused on superficialities instead of deeper realities and ethical responsibilities. One expression of this interpersonal imperative lies in the physician-patient relationship, which vests complete trust in life-and-death decisions.

There is an enormous challenge to resist the “strange or disconnected parts” in our modern world. How many of us own a TV, computer, cell phone, pager, access to the Internet, personal digital assistants, and the many other technological wonders of our era? In the race to apply incredible technology to our lives, we have undoubtedly left behind equally valuable moments in our every day. The phone calls us away from the book we are reading with our child. The pager distracts us from a conversation. TV is watched to an almost pathological degree, resulting in an epidemic of obesity. Multitudes are literally addicted to the Internet, a virtual surrogate for face-to-face interaction between humans. Family time around the kitchen table and “down time” when life just happens spontaneously are increasingly shortchanged.

How we connect with one another impacts us globally on every level. As a recent ad for the Toronto Star puts it: “You may have eyes to see, but do you have vision?” or “You may read, but do you communicate?” Human understanding and empathy, in addition to our clinical skills, are critical in the healing profession. At a more spiritual level, and for each of us, this connection with one another brings wholeness into our own lives.

In retrospect, I now recognize attributes which, had they not been lacking in that young and less assertive physician, might well have saved her trusting patient’s life. Courage would have propelled her to confront her superiors regarding the morality of the research study. Independent inquiry would have inspired new ways to solve the dilemma of this challenging clinical scenario either by ending the study prematurely or by exploring alternatives to the in vivo experiment. Finally, inner strength would have allowed her to reach out to her patient as he confronted death, even if there was nothing more that could have been done to save him.

Blind Trust

Wednesday, September 15th, 2010

Blind Trust

While on vacation and camping in Cape Breton National Park this summer, our family had the opportunity to take a unique and special hike: a night walk in the forest. The guided tour of about twenty of us was around a beautiful, small lake on a calm, cloudless evening that started at twilight. Our park guide was an enthusiastic, endearing woman who exuded calm and a maternal aura that enabled the group to follow her trustingly, like a troupe of little ducklings, through what would eventually be a nearly pitch black forest frequented by black bear, moose, and coyotes.

A brilliant half-moon lit the water’s surface like a beacon but along thicker patches of the path, the trees obliterated all light. How then did we manage to walk nearly 6 km without flashlights along a rocky path interrupted by serpentine tree roots? It was a matter of pure trust! Our fearless and experienced leader explained the route and marched ahead of us, stopping occasionally to check that no one was missing or to explain some interesting detail of nature.

The most fascinating aspect of our venture was learning about and experiencing “night vision”. Our retinas are supplied with a healthy dose of rods and cones that receive light, perceive colour, and shape our visual experience. The reason dusk appears in muted colours of blue (referred to as “l’heure bleue” in French) is because these are the tones of colour we are able to perceive in diminishing light. It takes nearly an hour to accommodate to fading light and to develop night vision, which improves our vision nearly a million times! Our pupils dilate and the retina adjusts so that eventually, even in the dark, we continue to perceive shapes, shades of light, and keen peripheral vision. Our other senses are also awakened. Sight, balance, hearing, and especially smell, are all keenly fine-tuned.

Bears have the same visual acuity in the dark as humans, so I felt some degree of reassurance that I was on the same footing as the forest creatures. When we stopped on occasion to just listen in silence, the sounds of the forest rose up in a muted but perceivable chorus: insects, small rodents, distant cars, a distant fog horn, and once even the collective howls of a pack of coyotes (fortunately far enough away not to cause any anxiety!). It was a magical and mystical experience that soon evolved into something greater. As the sensory information flowed in and the solitude of the forest settled around us, our quiet parade became a spiritual trek that inspired me to see it as a metaphor for trust in the Divine.

We march through life, feeling enlightened and empowered, enabled by the vast information afforded us by modern technology. By the “light” of day, we see what we want to see and make decisions accordingly. We are confident of our steps (real and metaphorical) as we watch where we are going, aided by ambitions and goals.  The divine element is often lacking because we feel it is not necessary and thus we go from day to day under the false impression that we are in control and “on track” when we may, in fact, be quite off course, in a spiritual context. When night falls, we turn on lights, full of trepidation of that which lurks in the dark. We don’t consider the possibility that darkness can be safe or revealing. A walk on the dark side forces us to leave our ego by the wayside, abandoning our everyday mask of assurance. We are forced to adopt an attitude of trust.

As I marched along that dark path, uncertain of where exactly to place my feet next, I had to let my natural senses take over and become someone more humble, more pliant. It required complete focus. As in life, we can be guided along the right path when we give up our arrogance and adopt an attitude of trust in a Divine source. Without regular vision, without our modern trappings, our Divine self guides us along our proper path in safety. Even as I walked carefully that beautiful night, I could hear the steps of those behind me and see, in vague outline, the person in front of me. Each of us had to make his or her own way, without fanfare and without handholding. Had we encountered danger, our guide would have guided us safely through. In Judaism, Torah is the path and God is our guide. In each religion or belief, there are similar metaphors. Our innate senses and spiritual selves are capable, without gadgetry or intervention, to make the grade on our own, although we can help one another if we stumble or fall. If we study the ways of the path and respect its laws, we will naturally be guided in safety. We must only trust and keep walking.