Monday, March 07, 2011

Full Circle

The Lord is constantly moving in our lives, and He has made that evident to me once again.  This past Friday, I finished up my time on the inpatient general medicine service, I had an experience that I am still contemplating and praying about.  It concerns a patient that I saw, but Friday was not the first time I had encountered this individual.  Last November, when I was doing a general surgery rotation at a community hospital outside of Toledo, I encountered Mr. L during an office visit.  Several months prior, he had a neuroendocrine tumor removed from his left forearm.  It apparently was not very large and seemed to be the only spot of cancer.  When I saw him in the office, he was complaining of a very large mass in his left axilla.  The mass had developed rapidly over the course of a couple of days and he and his wife had become quite concerned.  The surgeon, being a surgeon, took a tissue sample and sent it off.  On the last day of my rotation with this doctor, we recieved the pathology report stating that mass was neuroendocrine tissue.  We were both very surprised because this was unusual behavior for this type of tumor.  In any case, the surgeon stated he would be referring the patient to the University Hospital due to its location, size, and type of tissue.  I thought nothing more of the case as I moved on to my next clerkship.  
Fast forward three full months.  I am now on my last day of inpatient general medicine at the local Catholic hospital (I will use the term Catholic loosely in this case), and we are just starting rounds with the attending.  He tells the team that he has a private patient in the neuro intesive care unit, and that we may either join him or meet him on the wing where our first teaching patient is residing.  We all decided to go ahead and follow our attending upstairs to the ICU.  A fateful decision this would be.  When we arrived in the unit, I followed the doctor to see his patient.  The brief history I gathered from our attending was that several days prior, the patient had gone to bed perfectly normal, and awoke the next morning unable to move his legs or his right arm.  The patient was understandably very distressed and he was taken to his local hospital where an MRI was done.  The MRI showed a mass in the cervical spine compressing the spinal cord.  He was rapidly transferred to the Catholic hospital, a major hospital in my city, for more specialized care.  As I come to discover, this was Mr. L whom I had seen 3 months prior for a mass in his axilla.  As it was related to me, Mr. L had the mass removed by a University physician shortly after I had seen him.  I do not know the interim history, but in the end the cancer had come back very aggressively.  
I was shocked by all of this.  I told my attending that I had seen this patient before, and he made the remark 'Now you have seen him full circle.'  It is this remark that I have been contemplating.  Through all of this I can see the Lord's hand at work, placing me in just the right place at just the right time in order for this series of events to occur.  But I ask myself, what is the Lord showing me?  Why does he want me to see this man go from being very functional to being confined to an ICU bed, scared and in pain?  The answer is one that I think will take a long time to fully realize, but I believe that the Lord has started to show me something very profound and important: Man will suffer and sometimes there is very little that we can do physically for him.  
This may seem like a 'Of course!' type of statement, but I think it is much more difficult to grasp than we realize.  For those who have been in situations of extreme physical or mental suffering, we can think of those moments where we wanted nothing else than for that pain to be gone.  For some, they would give anything for a moment of relief.  And for others, they have given everything, including their soul, seeking escape from suffering, yet only to find themselves in even more dire circumstances.
Suffering is the paramount problem of man’s existence.  “Illness and suffering have always been among the graves problems confronted in human life.  In illness, man experiences his powerlessness, his limitations, and his finitude.  Every illness can make us glimpse death." (CCC 1500)  It is through the action of Adam and Eve that sin was brought into the world, and with it, suffering and death.  The story of man’s attempt to evade both suffering and death is the stuff of ageless legends and the impetus to seek both the ancient and modern remedies that might stave off such a fate. 
And yet, what does suffering do for man? Consider the word's of St. Paul in his letter to the Colossians of the relationship of suffering and the Cross.  He says, “I fill up in my body what is wanting to the sufferings of Christ, for the sake of his body which is the Church.”1  This reflects the new meaning of the suffering of man.  No longer is it simply the curse, but now it is the blessing of God.  Just as the doctor takes part of the salvific mission of the Church through the ministry to the sick, those who are sick and suffering take part in the redeeming mission of Christ.  In the words of John Paul II, “On the cross, Christ made his own all the weight of evil and took away the sin of the world (Jn 1:29), of which sickness is but a consequence.  By his passion and death on the cross, Christ has given new meaning to suffering: now it can configure us to him and unit us with his redemptive passion.”2  By his death and resurrection, Christ has redeemed the world.  In that action he has allowed the suffering man to partake in that redemption and within this new meaning of suffering for the Christian, there is a threefold salvific attitude that exists:
an ‘awareness’ of its reality ‘without minimizing it or exaggerating it’; ‘acceptance,’ ‘not with a more or less blind resignation’ but in the serene knowledge that ‘the Lord can and wishes to draw a good from evil’; ‘the oblation,’ ‘made out of love for the Lord and one’s brothers and sisters.’3 
To consider these three points in another way, one can use the words knowledge, trust, and action.  In that awareness there is knowledge of the nature of the illness and suffering and of the cross which is to be borne.  This is critical, because as Pope John Paul II (from whom this threefold salvific attitude comes) said, the patient neither wants to minimize or exaggerate it, but rather embrace it as it truly is. Through the acceptance there must be a trust in the Lord.  The patient must realize that the Lord came “so that they might have life and have it more abundantly.”4  Suffering is not a cruel punishment but a means of salvation, and so the patient must rejoice in the opportunity to suffer because it is from the Lord, from whom all good things come.  The third part of this attitude is action.  The oblation of which John Paul speaks requires that action must be taken.  It may only be an interior movement of the will, but nonetheless it is essential for this suffering to be fruitful.  The patient needs to consciously make the decision to offer up this suffering on behalf of the body of Christ.  In this way, not only will the graces be obtained, but the psychological affect will be greater.  Through his suffering, the patient has entered into the redemptive act of Christ and it is the physician’s role to help orientate the patient towards this end.

1 Col 1:24
Discourse in Lourdes, August 15, 1983, n.4 found in The Charter for Health Care Workers, p. 59, also found in CCC 1505.
The Charter for Health Care Workers, 54.
4 John 10:10


  1. Brian, this was an excellent essay on a topic I think about a lot. Suffering--what an unspeakable gift Christ has imparted! How can you share this truth with patients?

  2. It is so difficult to truly share it with patients, but it is definitely possible. The first step is to be living a life that others will recognize as something different from the rest. The other step that can be taken is to actually ask patients about their spiritual life. Sometimes a question whether they would like you to contact any clergy or such can open the door to exploring their spiritual life. When this is done, it can be much easier to discuss with them suffering and the nature of suffering and its role in their lives.