Belief before Understanding

“Unless you believe, you will not understand.” Isaiah 7:9

Read that quote again. Notice that most of the world operates the other way around. We first seek to understand and then begin to believe. Indeed, absence of understanding serves as a stumbling block for so many of us in our faith journey. But the instruction above, the truth above, is to believe in order to begin understanding.

When I was a boy, my mother gave me a small bookmark with a picture of Jesus at the top. Below that she wrote, “Wes, Jesus loves you. May you know this and love and serve Him all the days of your life.” I knew immediately it was true, internalized what she had written, and never looked back. It was a Grace, clearly. As I told this story to a Vanderbilt medical student last week at the beginning of the year barbecue for the SSCD (Society of Saints Cosmas and Damian, the Catholic medical student association), she recounted how she had been similarly “gifted.” All of us who have made the choice to believe, to walk in faith, have been blessed with such a grace. Yet it must never be taken for granted, and we must nurture this faith daily.

Isaiah 7:9 is used to begin Chapter 2 of Pope Francis’s encyclical letter, Lumen Fidei. During this year of faith, we are called to dive deep into our own personal journey towards God. Fulton Sheen points out that this journey is our response to Him having initially reached down to us. Christianity, he says, is a religion in which God first reached down to man, as opposed to most other religions where man is reaching up towards God. Returning to this quote, then, what do we make of our own ability to believe even in the absence of full understanding?

St. Paul tells us, “One believes with the heart.” (Romans 10:10) and we know that ultimately our faith is a leap of the heart. It will depend not upon our understanding, or upon our “seeing” God, but rather upon whether or not we actually hear what we have been told happened 2000 years ago. Not vision, but “hearing” will be the key. Jesus cried to us, “Anyone who has ears for listening should listen!” (Mk 4:9 and Lk 8:8)

Later in the second chapter of Lumen Fidei, Popes Benedict XVI and Francis (since they co-wrote the encyclical), recount the story of St. Augustine from Confessions when he heard a voice telling him to “take and read.” He then took up the epistles of St. Paul and, having listened, began to read. Are we listening? His speaking to you won’t be a thunderbolt or an auditory exclamation that others around you can hear, but when we believe, even before we understand, we will be driven to pray and talk to our God. Such conversations, when coupled with adequate listening, will bring us a message of hope, happiness, and joy that should physically produce a smile.

Let me explore one other angle with the same ultimate point. It is known that Pope Francis loves Dostoevsky. For all of us in medicine, who understand physiology and the rheology of blood flow, Dostoevsky provides another side of belief, without understanding, in his 1869 novel The Idiot. In this story, the character Prince Myshkin, is obsessed with the painting of the body of the dead Christ in the tomb by Hans Holbein the younger, which was painted in the 1500s. The character mistakenly concludes that the visual of Christ on such a dilapidated path towards putrefaction could make one lose faith. Really?

Or is it the other way around?! Seeing that body in such a state, knowing the blood flow has clotted, the organs are filled with edematous fluid, and then believing, even before understanding, that this body was resurrected, alive, eating fish on a beach with friends… It is then, just following Apostle Thomas’s Divine declaration of our Lord (which was incidentally the first of any person in the New Testament), that the words of Christ make the most sense:
“You believe because you can see me. Blessed are those who have not seen and yet believe” (Jn 20:29)… even without understanding…

“Unless you believe, you will not understand.” Isaiah 7:9

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Marian Devotion: Praying WITH Mary TO Christ

The Blessed Virgin Mary is on the cover of Newsweek with the title, “What would Mary do?”  Good question.  In the past year I have been particularly focused on Mary and in developing a Marian devotion.  Due to poor catechism at my schools, my own poor understanding of what I was taught, or both, this is something that I always thought unnecessary. Listening to others rant and rave about how wrong it was for Catholics to “worship” her, I even at times felt it to be inappropriate. (I’m embarrassed now that I ever fell into that.) My thoughts about Mary changed when I received a special book, once “rare”, but now increasingly famous and easily available on Amazon; a book that “changed JPIIs life of faith.”  A Treatise on The True Devotion to the Blessed Virgin was written by Louis-Marie De Montfort in ~1715 and lost under dust until found by accident in 1842. Though I still have a long way to go, this “inerrant book” has helped me in all my relationships toward peace and understanding. It is so logical, balanced, and helpful regarding focus in prayer and in life. During my re-reading of it now, a couple of pages a day, I am noticing things that are so relevant and our wayward ways within the Church.  Due to her unparalleled humility and devotion to Jesus, Mary serves as a wonderful and peaceful source of guidance towards Him.  Unlike others who are at time very helpful in our lives, but who can also present us with sinfulness, Mary can never lead us astray. There is, of course, “false devotion,” seven types of which are well outlined by De Montfort. (By the way, there are even “false devotions” to Jesus, such as claiming to kill an abortion doctor in His name.) We lean on our own “strength” to the point of inevitable weakness and failure, but Mary is perfection in moving towards Christ.

I watched a news story about a married preacher whose “devotion” to his flock had “caused” his marriage to fail.  He and his wife drifted apart and eventually he convinced women in the church that, in order to guide his flock with greater devotion, he needed a more intimate understanding of their marriage woes to the point of affairs with those other women.  Priests and preachers – themselves ill, can often lead others astray.  Should we be surprised?  Not really.  They, like us, are prone to false devotion and to being preyed upon by our ills (Satan, inner demons, whatever you want to call them.)  I am writing about this to remind myself and you that some form of daily, even hourly, steering method and prayer are required for our journey.  That should include each of us praying for one another.  If I only pray for myself, then that is one person praying for me. As I expand that out, then I am now praying for dozens and those dozens are praying for me as well.  This is a better system of prayer, and something commented on by many Saints in mystical writing.  Thanks in advance for your prayers; I assure you I need them.  I can also assure you that you have mine as I pray for the guidance and growth of our guild collectively and its members.

“Wrinkle in Time”: Lastly, how does a Marian devotion help us in our journey to Jesus?  Having read and been blown away by True Devotion, I liken the immense Grace provided by the Blessed Virgin to the method of tethering time described in A Wrinkle in Time by Madeleine L’Engle.  In the original version, there is a drawing demonstrating how Meg and Charles Wallace learn to “wrinkle” or “tether” time.  A string represents the distance one has to travel.  While holding the string stretched out by two hands with Point A on the left and Point B on the right, your hands are then brought together so that the string dips down in the middle. The distance between the starting point A and destination B is shortened dramatically; one can essentially get from point A to point B faster and via shorter distance.  Mary helps us tether the distance to our Lord God. The effect is not subtle but dramatic. Same road to travel. Same goal. Fewer distractions.  It must be maintained by a true devotion and by averting false devotions (same as anything else in life).  Thus, a straighter, more narrow, more direct course than we would otherwise likely achieve is possible, likely, and predictable.  There are other ways to get there, and we each have our own route, as stated by Cardinal Ratzinger to Seawald, but having Mary as our Maternal guide to Christ keeps us on track.  Grace!

E Wesley Ely, MD MPH

CMA 2012

 

A Treatise on the True Devotion to the Blessed Virgin, by Louis-Marie Grignon de Montfort,

“All those who are likely to read this book love God, and lament that they do not love Him more; all desire something for His glory , -the spread of some good work, the success of some devotion, the coming of some good time. One man has been striving for years to overcome a particular fault, and has not succeeded. Another mourns, and almost wonders while he mourns, that so few of his relations and friends been converted to the faith. One grieves that he has not devotion enough; another that he has a cross to carry; which is a peculiarly impossible cross to him; while a third has domestic troubles and family unhappinesses, which feel almost incompatible with his salvation; and for all these things prayer appears to bring so little remedy. But what is the remedy that is wanted? what is the remedy indicated by God Himself? If we may rely on the disclosures of the Saints, it is an immense increase of devotion to our Blessed Lady; but, remember, nothing short of an immense one. Here, in England, Mary is not half enough preached. Devotion to her is low and thin and poor. It is frightened out of its wits by the sneers of heresy. It is always invoking human respect and carnal prudence, wishing to make Mary so little of a Mary that Protestants may feel at ease about her. Its ignorance of theology makes it unsubstantial and unworthy. It is not the prominent characteristic of our religion which it ought to be. It has no faith in itself. Hence it is that Jesus is not loved, that heretics are not converted, that the Church is not exalted; that souls, which might be saints, wither and dwindle; that the Sacraments are not rightly frequented, or souls enthusiastically evangelized. Jesus is obscured because Mary is kept in the background. Thousands of souls perish because Mary is withheld from them. It is the miserable unworthy shadow which we call our devotion to the Blessed Virgin that is the cause of all wants and blights, these evils and omissions and declines. Yet if we are to believe the revelations of the Saints, God is pressing for a greater, a wider, a stronger, quite another devotion to His Blessed Mother. I cannot think of a higher work or a broader vocation for any one than the simple spreading of this peculiar devotion of the Venerable Grignon de Montfort. Let a man but try it for himself, and his surprise at the graces it brings with it, and the transformations it causes in his soul, will soon convince him of its otherwise almost incredible efficacy as a means for the salvation of men, and for the coming of the kingdom of Christ. Oh, if Mary were but known, how how much more wonderful would be our faith, and how different would our Communions be! Oh if Mary were but known, how much happier, how much holier, how much less worldly should we be, and how much more should we living images of our sole Lord and Saviour, her dearest and most blessed Son!”

excerpt from Preface to True Devotion written by FW Faber in 1862…

 

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Noises in Haiti

Noise in Haiti is its own adventure. Usually there are no less than a dozen noises coming at you at any one time. Most of them are an ordinary array of yelping puppies, fowl, or spewing Creole (men yelling at a cock fight or the bedlam of a pick-up soccer game being played on a dirt and stone field with a taped-up rock as a makeshift “soccer ball”).

But night noises are an altogether different matter. The entire set changes. Right now, for example, I can count exactly 9 different animals or insects (mostly the latter though Kim would not like to discuss that). The sounds create a cacophony that is strangely mesmerizing. Some are long and building in character while others are short bursts of high pitched jolts. The one that really has my attention, though, is this bug that just won’t stop. He makes his cry over and over, with an extremely strange tapping noise that starts short and then gets longer and longer till it sounds like a wooden spoon scraping on an old worn and dented steel pot. It says, “look how proud and dominant I can become…don’t doubt my ability…I have developed this talent through grit and purpose to dress the night air and I will do this without tiring as long as my body will allow.”.

This reminds me of my Haitian friend Dr. Astride Jule and her 99 year old grandmother, Evianie Lapierre. Evianie was born on November 18th, which is an historical day for Haiti: “The battle of Vertieres” during the independence war. Astride says this is probably the reason why she was a fighter who survived 100 years in this mountainous terrain. When I saw her last, her small body was indeed tired of making the tapping noises, and other than a palpable pleural friction rub and a swooshing heart murmur, I never heard a peep or whimper from her. It is pleasant to know she watches and listens to the noises now from a place where no element of discomfort will ever be felt again.

And what of yesterday and today here on our dental program and vaccination trip? We have run so many children through our registration and stations of shots, drops, pills, brushes, and stickers (in that order) that i see an endless line in my mind of the beauty – fuller’s white teeth and eyes followed by prematurely rotted and nub-filled mouths and intrepid gazes. Most are quiet like Astride’s grandmother and prouf to allow the pain of a needle to wash over them, but others bring bounty of color into the “classroom now makeshift clinic.” These kids don’t know the harm that will be prevented via shortly endured pain (our familiar human plight, right? The easily missed or forgotten lesson of the long-standing benefit of transient suffering.)

As I lay awake, though, it is not the stalwart fighter, whose drop of blood on the deltoid is received without a flinch, that I worry about. It is the one who got away. Those devious few who snuck to the back of the line and managed to escape without his or her card being filled out. Who escaped the clutches of Taylor, Brooke, Blair, or James running them down and dragging them back to complete the public health mission of this crew from Tennessee.   Those few are still subject to die the miserable, frozen, arched, and frothing death of tetanus that became exposed as all too common here in the aftermath of the now-famous earthquake. Or the painful, pasty, and blood-caked swallow of unbridled diphtheria.   Despite our diligence and even the hawk-eyed glance of “Dr. Kim,” some of them got away and won’t be treated. Today, when the sun comes up, that will play out again… and tomorrow night I’m going to add to my “worry list” those unknowing souls and their journey into illness.

The balance of emotions will be achieved by other memories of this fabulous country. That of our arrival at one school yesterday and the 200 kids ranging from 6 to 16 watching our every move in their crisply ironed, checkered uniforms. Girls with bows and boys with scabs, called to the front to sing to us the songs prepared especially for our visit. My mental recording of the English teacher struggling through a written-out yet broken letter, more beautiful and powerful than anything penned in the Queen’s English. James getting up to tell them in French how thankful we are for their willingness to meet us and allow us into their lives. And then the presents brought to Kim and the kids through the loving hands of Father Guy, whose oversight of every child in this rural community of villages and its astonishing 62 schools, seems to have no bounds. The gifts are wrapped in beautiful paper and include a Haitian-made globe, various tediously grown produce (farmed on mountainsides in fields with more rock than soil), and robust eggs that are easier to come by yet no less valued.

And then there are three other memories that will stick with me alongside my worry list. The first occurred when we had finished at the Sisters’ school. After packing our wares into the jeep for the next school, the bell for recess rang and the girls we’d just vaccinated came flowing out onto the cement playground by the hundreds. They descended on our daughters like playful kittens. As if on cue, the black and white kids meshed and were one. The girls played with Brooke’s, Blair’s, and Taylor’s hair tirelessly. Amazed by their long pony tails and the previously unfelt silkiness, they girls fought to even touch the treasure. They braided, unbraided, and rebraided B, B, and T’s hair. Laughter as you have never heard. And then later the soccer game that Blair joined at the Broyher’s school, bringing her Coach Rico (from the D1 Brentwood Premier team) along with her. And lastly, I will never forget Brother Damien taking us to his self-brewed cellar of bier and then pouring us a golden chilled glass to round out the steamy day.

This is the stuff of life, regardless of the setting. God’s talents are on display right next ro you now. Look and see. Our view must be that of God’s example to us. Mine is in Jesus. His love and endurance, tangible beyond words and for the taking. Yesterday I thought of Him as my impatience brewed when a girl urinated all over us in irrational fear, and how patient He is with my daily foibles. Then I remembered the words of Mother Teresa when asked how she picked up the people of gutters. “I say to myself, this is Jesus Christ.” And I watched as miraculously the scene drifted into smiles at the absurdity of the scene. And I thought of His forgiveness as Kim was relentlessly patient with my shortness at times. I pondered the importance of the need to be forgiven and the solace it paradoxically brings to the forgiver (or the shackles to those unwilling to forgive). These lessons are catholic, that is, universal, and must be embraced at whatever spot we are along our journey.

Time to stop now. There is much to do today. From this ledge, I can see the sun rising over the next mountaintop. There are children to laugh with and to cry for. Sweat to be had. And the bug, the one with the building tap and stalwart message, he is now fading as the sound of distant crowing increases.

AMDG, Wes

 

 

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Kaleidoscope

As a boy, I was thankful for and humbled by the kaleidoscope.

Wandering and bored while shopping with my mom, I’ll never forget the first time I saw one. A dusky brown, dented, cheap-looking metal tube. Deceptively simple and understated. What riches lay there with a mere gaze and rotation into the light? Turn the wheel and witness red shards, turn again and see orange flowering, next yellow explodes into view, then blue seeping into the scene. From then on, I asked all shop owners if they had kaleidoscopes.

So often now, we hear of physician burnout. My heart always sinks a bit when I hear doctors tell motivated and passionate young women and men not to go into medicine. “It’s not like it used to be when I started,” they groan. “Medicine was exciting and all about the patients. Now all I do is look at computer screens, talk to billing specialists, and try to figure out the new insurance system…” On and on the polluted advice proceeds. And I get it. The times and format of medicine have changed. An all-too-frequent modern day picture of interdisciplinary rounds in ICUs, for example, includes an attending physician on one side of the hall standing outside the patient’s room and a row of computers with heads behind them typing orders and researching answers on the other side. No eyes on the patient, perhaps not even venturing into the patient’s room during rounds.

Enter the kaleidoscope.

In that antique store, the owner sat me down and said, “Son, I know you think this looks humdrum, and most people pass it by, but stop what you are doing long enough to look inside for just four or five turns.” I never forgot his advice and began applying it to many things in my life, such as completing dull but required coursework in college or rote steps done repeatedly in scientific experiments. Most importantly, though, as a newly minted medical student at Charity Hospital in New Orleans, I carried the concept with me as I began discovering the fascinating Cajun and Creole cultures of the population we served. Evenings were spent reflecting back on the people I’d met that day, as if peering inquisitively through that vintage metal tube.

After my training and sub-specialization, this acquired mental habit stuck with me. As Osler counselled a century ago in his 1913 “A Way of Life” address to Yale medical students, “Shut close in hour-tight compartments, with the mind directed intensely upon the subject in hand, you will acquire the capacity to do more and more, you will get into training; and once the mental habit is established, you are safe for life.” This directive resonated with me. It was the ‘safety’ I was looking for – a way of protecting my love for the vocation that drew me into her embrace.

Twenty-five years sped by; I still practice this ritual. Recently after rounds, I looked through the kaleidoscope, as I often do, with just enough time for four quick turns. Immediately, I again saw flashes of color and light built on endless combinations of personal values, faiths, family structures, race, and life choices:

…A 24-year-old patient admitted for Gram negative sepsis complicating peritoneal dialysis. Quick answer (Rx): control the source of sepsis, provide antibiotics and fluids. Dive deeper. After his congenital heart defect was addressed by heart transplantation at only 15 days old (the state’s first newborn heart transplant recipient), he inexplicably endured years of being chained to a bed and starved. Weighing only 49 pounds at 15 years of age, his parents were incarcerated. He devoted himself to years of working diligently with the Tennessee Governor resulting in a law named after him (Josh Osborne law) to help prevent others from experiencing such abuse. Josh worked at Goodwill and won numerous awards for service, yet you’d never hear him or his doting aunt brag about those accomplishments.

…Only a few rooms away was a 46-year-old man admitted for recently diagnosed pulmonary fibrosis and suddenly worsening shortness of breath due to community acquired pneumonia. Obvious Rx: Oxygen, antibiotics, and consideration of newly approved medications. Not enough. The spectacular story of the person awaited. Staring at his ‘older than stated age’ wrinkles and graying hair cascading over his shoulders, I sensed he wanted to talk. With purpose he exclaimed, “I’m a Roadie, and I build and climb huge sets for bands like Widespread Panic and traveling productions like War Horse.” I told him about my daughter, Taylor, who loves music and drama, and he asked to meet her. The next day I brought Taylor to sit with him, and soon enough they were locked in the kind of deep conversation results from sharing rare and fascinating stories. I stood anxiously watching his oxygen saturations and instructing him when to let Taylor do the talking. As we left his room, this re-embattled Marine yelled, “Ruh Rah, Taylor.” His sister later told me that Taylor’s visit was the best medicine he ever had.

…In the adjacent hall of our ICU was a 62-year-old morbidly obese woman with non-alcoholic steatohepatitis, hepato-renal syndrome, and superimposed Staph sepsis. After addressing her immediate medical needs in the morning, I decided to discuss other things with her on afternoon rounds. This quickly led to a flood of tears, and as I handed her a tissue she said, “You know, the woman doctor last night, Erika, please thank her for me.” Choked up, she waited a moment to regain composure and finished, “Thank her for telling me that this illness is not my fault.” At that moment, the other aspects of her medical care faded and this element took on a humbling hue – I’d totally missed it.

…Lastly, I cared for an 85-year-old patient whom I knew was a bit feisty, helping her stave off recurring complications from colon cancer. Her face was gaunter and eyes deeper than several weeks earlier. Despite obvious suffering, there was a peace about her that was instantly evident in her desire to talk about end of life. Gazing at me, then cocking her head, Annmarie declared, “Doctor, I want to die a good death.” Though we often discuss “good deaths” in medicine, I asked to clarify what she meant. With just a few words came a ton of meaning: “A death not necessarily completely free of suffering, but control my pain as much as you can and please help decrease my awareness of trouble breathing.” She continued, “You know I like making decisions, but I trust you and Catherine (her daughter) to help me if I’m not thinking clearly. I guess, Doctor, dignity is the main thing.” Looking up from her bed, Annmarie moved on to what seemed to be her main point, “I imagine Heaven as a huge kaleidoscope of energy. We’ll see beauty beyond imagination.” Annmarie had soared right past all of the things that weigh us down—schedules, worries, regrets, and pettiness. She was completely focused on the main point, which as she put it was love from God to us and from us to each other.

Color my world…

The voices of my mentors remind me to take stock of this treasure trove of humanity I share as a physician. One day in class during my training at Tulane, I jotted down just one thought from a lecture given by such a mentor, and it rings as true today as it did then: “Medicine has as its means diagnosing, curing, and saving lives towards the end-goal of preserving and improving health, self-worth and personal dignity. Do not confuse the ‘means’ as the ‘end.’ To accomplish the means at the expense of the end is to fail.” (Irwin Cohen, 1989). That phrase “self-worth and personal dignity,” for me, is the entire key to the kaleidoscope. It’s where the conversation must take us, day-in and day-out. The depth of the complicated and mysteriously delicate lives of the men and women we approach lying in those hospital beds every day is where both our heartache and joy are anchored as medical professionals.

Acknowledgement: The author would like to acknowledge the generous editing of Hedy S. Wald, PhD.

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Cyanosis

Marcus and Danita first came to see me in North Carolina in the mid 1990s. He stood 6’1”, weighed in at 185 pounds, and had brown eyes and blue skin. Marcus’s first words to me set the tone for our visit: “Listen, Doctor Ely, I’m blue ‘cause I was born with holes in my heart, and I’ve had one foot in a casket since I was a lil’ boy. Many ‘all knowin’ doctors have told me I’m ‘bout to die. They’ve all been wrong so far, but now at 32, I’m wundrin’.” Marcus had cyanotic heart disease, and his skin told the tale. Lips blue as faded jeans, he lived his life deprived of oxygen, with sats in the death-defying range of 60% to 75%. He came to our nascent heart-lung disease program that day with his wife, Danita, to inquire about a new heart and lungs to enable him to help Danita raise their children¾Kristie, Ty, and Ariel¾whom he cherished above all else.

They told me about the scores of doctors who had pronounced his days on earth numbered, and how the family had completely lost confidence in “high-and-mighty” physicians. This made me nervous. Here were a man and woman who had descended that day from a mountain “holler” that bore the family’s name, bringing with them heaps of raw courage and a desire to fight for life. Seeking answers and hope, they had happened upon a green-behind-the-gills, newly-trained transplant pulmonologist. One main question hung palpably in the air: When, if ever, should Marcus have his chest opened and life-giving organs sewed in?

Though normally cool under pressure, I noticed that my forehead had begun to perspire, and beads of sweat formed on my chin and neck. My stomach began to tighten and the room seemed too small for the three of us as I tried to remain poised. I considered Marcus and Danita in their mountain home, Ariel and her 1,050 Barbie dolls stuffed into their closets (a staggering collection), and thought about Ty and Kristie needing a dad during their teenage years. Then my head echoed the vacuum of confidence they had in physicians who had continually been wrong about his longevity. Having lost much of my internal composure, my external composure likewise crumbled. In a wave of flushed confusion, I began sweating as if I’d been sprayed by a hose. In an attempt to shut down this involuntary response, I sought a momentary escape from what seemed a suddenly collapsing examining room.

Upon my return, sporting a dripping wet shirt and mumbling something about the heat, I examined Marcus thoroughly and made some cursory comments: “Your profoundly swollen ankles call for adjustments of the diuretics.” And, “you need to continue the use of the oxygen even though it doesn’t change your sats, and you should avoid physically taxing activity.” These were boiler plate recommendations; they were not what the Cobbs were seeking when they trekked down the mountain that day. My shortcomings seemed so transparent that I was sure I’d added my name to the list of physicians who had failed this hopeful couple. Having convinced myself that our new transplant program needed to start with very straightforward “cases,” I suggested Marcus, whose disease was exceedingly complicated, see another transplant team. And with that, I thought I had successfully ended my awkward relationship with this brave man.

Not long after that fateful visit with Marcus and Danita in North Carolina, my family moved to Tennessee. I didn’t hear from the Cobbs for a couple of years until the day I walked into a clinic room and saw their uncharacteristically sad faces peering up at me. Marcus’s health had gone south, and his lungs and ankles were packed with intractable edema. I was grateful that for all of us this second visit was completely different from our first encounter because several items were resolved. Primarily, all of us knew that Marcus was now unequivocally qualified for and wanted to pursue heart-lung transplantation. Secondly, we were sitting in an established center that could handle someone of Marcus’s complexity. And finally, I had learned to be more comfortable with my limitations as a physician and therefore no longer felt like an imposter. But, one question loomed that I did not understand: Why had they gone to all the trouble of tracking down, across state lines, that bumbling, insecure, sweating doctor they had met in that suffocating exam room? It seemed illogical to me. Danita told me that they walked out that day in North Carolina believing that they’d found the right fit with me. Apparently, it was precisely because I had so candidly revealed (though at the time involuntarily and regretfully) that I did not know the answers to most of their questions. A friend recently told me that monks are taught to “not know” so that they might begin to learn. Certainly, I knew what I did not know, and in the very instance that I thought it had made me unfit to serve, it made the Cobbs want to stick by my side even years later.

After Marcus became my patient for the second time, months of waiting slowly ticked by until the night I called with the news for them to come to the hospital. They flew from Cobb Holler over the Smoky Mountains to our operating room. Following a bloody, 9-hour surgery with numerous predicaments due to collateral vessels as large as ropes, Marcus’s oxygen saturations were soon in the 90s on room air for the first time in anyone’s memory. His recovery was brisk, furious, and astounding. He and Danita soared with ease into the new life of immunosuppression. Marcus looked handsome and healthy yet caught me off guard when only several months post transplant he announced while beaming broadly, “Hey Wes, I want to go parachuting!” He did not pose it as a question.

Years after Marcus’s transplant and following his days of hiking through the mountains, toting kids, and who knows what else, Marcus developed chronic rejection that was recalcitrant to all modifications of his medical care. He slowly drifted back into a state of inexorable decline. Months into this demise, I was standing at a podium in San Diego waiting to speak to a large crowd when my cell phone rang. Danita sighed, “Wes, Marcus is dyin’ and askin’ for you at the bedside.” She had no idea that I was on the other side of the country. I was compelled to try¾the distance was unimportant. “Jesse,” I said to a colleague, “can you give my lecture for me? I need to get back to Vanderbilt.” Marcus had been admitted with a horrendous bout of pneumonia and septic shock, which rapidly progressed despite aggressive antibiotics and resuscitation. Since he had elected not to undergo life support, I felt sure he’d die quickly. I ran towards the airport, dragging a suitcase and tripping over curbs, hoping to catch an earlier-than-planned flight home to see Marcus Cobb alive just one last time.

After boarding the last airplane back to Nashville, I watched impatiently as the miles and states passed endlessly underneath, and I wondered if he could hold on long enough. Once on the ground, I hopped into a cab and sped toward the hospital, letting Danita know I was near. As I approached Marcus’s hospital room, I saw a huddle of people pressed closely around the bed; there was a single space between their shoulders near the door that was apparently being held just for me. I slid into the circle of nine other people and looked down at Marcus, whispering “thank you” for having been called. And that was it. Within just a few minutes, he sauntered quietly out of life right there in front of his beautiful children, his loving wife, and the rest of us fortunate enough to be there. Truly a lifetime later than every doctor had predicted, but it was finally time. His lips had returned to their previous pale blue, and this time there were no looming questions about what needed to be done for Marcus. As for me, more than any other patient in my career, Marcus Cobb continues to keep me grounded in the truth of the statement “when I am weak then I am strong.”

By E. Wesley Ely, MD, MPH
Professor of Medicine and Critical Care
Vanderbilt University, Nashville TN
wes.ely@vanderbilt.edu

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Ricky the Smiling Cab Driver and His Colt Revolver

I was running late and had a cab waiting outside my house for about 20 minutes. As I approached the car, I was profusely apologizing to the man as he stepped out of the car. Then I saw that it was Ricky. He had driven me before on many occasions and was always SO happy. Rain or shine, he smiles, speaks in a slow Southern drawl, and with his large frame and power, throws my suitcase in the trunk and gets the door. What a pleasure it was to have him there that day. I knew for sure that he’d understand and forgive me. True to form, Ricky said, “Hey Dr. Ely, it’s been too long and I’m glad to drive you today,” literally beaming a huge smile amidst his wrinkled and “older than stated age” 50-something skin. As if completely unaware that I’d made him wait, he quickly redirected and asked if I had any scripture or meditations to read him that day. I often do that on the way to the airport with the different cab drivers. Maddy, Soddy, Janie, and Ricky have all come to expect it. Then after I read to them, I get the payback, which is them teaching me what the passages really mean. You see, I started doing this specifically for selfish reasons: I knew that each of these people would be a key for me to learn about life. It paid off again that day.

How did I see Ricky? Simple, jovial, satisfied with driving this car around in pretty Nashville, tolerant, patient, and a pleasure to be with. As we ambled past houses on my street with only 15 minutes to get to the airport, I asked him how many kids he had. He smiled and said, “Three plus Mary who died when she was 4 years old.” “How?” I snapped back. “She was killed by a drunk driver in 1983.” Then Ricky went on to tell me the story. One day his wife was taking the kids out to an early dinner and when they came back home and were turning into their own gravel driveway, a 19-year-old boy slammed into their car. He got out at the same time that Ricky flew out of the front door towards the smashed up car. His brother-in-law, Jack, was on the floorboard with his neck twisted awkwardly, and Ricky scooped Mary out from below his legs, noticing her crushed skull. “Mary died the next day in the hospital, and Jack is still alive today. He’s been paralyzed from the neck down ever since that day 27 years ago,” Ricky chokingly whispered. It was the first time I had ever seen Ricky with anything other than a smile on his face. I was stunned.

It turned out that the boy was the son of a district judge in the area (this did not happen in TN) where this accident occurred. At the scene, Ricky and the police discussed openly how drunk the boy obviously was and of the overt smell of alcohol on his breath and in the car. When it came to trial, however, the entire incident was billed as a freak accident and the boy was given 30 days of community service by another judge (one of his father’s longtime friends). In disbelief, Ricky erupted from his chair and ran to strangle the judge right there in the courtroom. With an even more youthful power than he uses now to throw heavy suitcases, Ricky jerked the judge up off his chair by his robes and was quickly arrested and tossed in the slammer. Everyday in jail, Ricky would watch as the judge came to his door and say, “Have you settled down yet?” From the front seat of his cab, Ricky turned to me and explained, “I always told him the same thing: ‘When I get out of here, I’m gonna kill that boy with my Colt revolver for crushing my baby.’ You see, Doc, I figured you have to protect your family.” He went on, “And then the judge would add more time to my sentence. I spent a total of 103 days in that prison, and when they let me out, I just went and built another prison. I spent every day going to work from 7 to 4 then sittin’ outside the Judge’s house (the childhood home of the boy where he’d been living according to Ricky’s sources) for 6 or 7 hours, looking through binoculars to see if the boy ever went in or out of the house.” Ricky was going to shoot him dead with that pistol if he ever saw the boy again. After over 200 days of this stake-out hidden in the trees distant the house (and somehow never arrested), Ricky faced his denial and realized that the judge who’d sent him to prison had tipped off the family and had shipped the boy permanently somewhere else to live. He gave up but was a shell of a person at that point. He stayed married but let his bitterness poison that relationship too for many years.

Ricky’s plight is not that different from many of ours. We want something that is either taken from us or was never ours to begin with. We disagree with the circumstances of how this “goes down” and through an unearned sense of entitlement and empowerment, we argue to the point of absurdity. Of course many would act just as Ricky did and vow revenge against the killer. To what end? Ruining our life? Becoming blind to what we have right in front of us every day in the way of gifts? Refusing the goodness of our Father? I argued that God had protected Ricky from himself. Without speaking, Ricky nodded yes.

Still somewhat in shock at these revelations about the life of the happiest person I thought I’d ever met, I sheepishly asked Ricky, “What now? How do you put it all together?” “Well, Doc, something like this: It breaks my heart when I picture Mary that day. I also think about Jack and how he’s had to live all these years. My anger has dulled and somewhere along the way I forgave the boy. He must be living in his Hell knowing what he did that day. I had to get out of the prison I’d put myself into. I’m not a very smart person, but I do know that God is in charge of my life. Once I gave in to Him and realized that my way was not His way, I was released from the bars that I’d put around myself. Now, Doc, how about that reading you were going to do for me?”

I opened the Magnificat to page 257 for the “Word of God” that the Church had chosen for Thursday, November 18th. I read the words there on the paper: “I will lead the blind on their journey; by paths unknown I will guide them. I will turn darkness into light before them, and make crooked ways straight. These things I do for them, and I will not forsake them.” Isaiah 42:16. As the tears streamed down our faces, we arrived at the airport. This time, instead of parting with our mainstay smiles, we just looked understandingly at each other through a bear hug.

1 Corinthians 13:12 – “For now we see through a glass, darkly; but then face to face: now I know in part; but then shall I know even as also I am known.”

Romans 8:28 – “All things work together for the good of those that love the Lord and are called according to his purpose.” NOTE: It does not say that all things are good but that all things work together for the good of those that love the Lord and are called according to his purpose.

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Elie Wiesel on Night

“Indifference, to me, is the epitome of evil. I decided to devote my life to telling the story because I felt that having survived I owe something to the dead, and anyone who does not remember betrays them again.” Elie Wiesel

 A white-haired, somewhat disheveled man in his 80s walked spryly onto the stage at Vanderbilt to a packed house on April 12, 2010. “I love the ‘otherness’ of others,” began Elie Wiesel. All of us in the audience rose to show our respect. In and of itself, his being here is an unlikely occurrence, considering that he, and the other 20,000 living prisoners at Buchenwald 65 years ago, had essentially been left for dead by the fleeing SS guards. In Night, his Nobel award-winning gut-wrenching masterwork that detailed the ethnic cleansing of Nazi Germany’s Holocaust, Professor Wiesel wrote of that April 10th 1945 day:

“Hunger was tormenting us; we had not eaten for nearly six days except for a few stalks of grass and some potato peels found on the grounds of the kitchens. Then the resistance movement decided to act. Armed men appeared everywhere. Bursts of gunshots. Grenades exploding. We, the children, remained flat on the floor of the block. The battle did not last long. Around noon, everything was calm again. The SS had fled and the resistance had taken charge of the camp. At six o’clock that afternoon, the first American tank stood at the gates of Buchenwald. Our first act as free men was to throw ourselves onto the provisions. That’s all we thought about. No thought of revenge or of parents. Only of bread. The next day, a few of the young men ran into Weimar to bring back some potatoes and clothes. But still no trace of revenge. I had not seen myself since before the ghetto. From the depths of the mirror, a corpse was contemplating me. The look in his eyes as he gazed at me has never left me.”

I have actually made that run myself, the same one Wiesel described above. The pictures at the end of this file are some that I took after running the miles to Buchenwald from Weimar, the nearby lovely German city (home to Goethe) where the town’s people claimed to have not even known about Buchenwald (most doubt the veracity of that claim). On the day I was there, it was very hard to reconcile the blueness of the sky and the peacefulness of the countryside with the horrific events that occurred there (see the numbers from the museum I went through in the pictures at the end). My most striking memory of walking the grounds was a place near the back where they apparently took women and children…won’t write details of that…but today it is a green forest where birds chirp and squirrels scurry. Next to that same area was a small fenced-in corral that was used by some guards to keep goats, deer, and rabbits. One day the lower-tiered guards were actually punished by supervising SS for cruelty to animals because they had tied them up without adequate water one afternoon (documented clearly in the camp records to demonstrate the humanity of guards). How is it possible that we humans can think that unclearly about the value of life?

So what did Elie Wiesel, one of the great humanitarians of our lifetime, decide to tell us on this visit to Vanderbilt? He first focused, as I wrote above, about how much he appreciates the differences in all people─our collective “otherness.” Then he went on to remind us that these differences in people can lead nations to develop errant laws that do the opposite of ensuring the safety and equality of all. “Laws can be wrong and evil, think of the Nazis, Russians, South Africans.” He told the story of the “judging of the judges,” when the actual judges from the Nazi era (who had first condemned innocents to death and later judged the SS guards as criminals) underwent trial themselves. The judges of these judges stated: “Your main mistake was sentencing the first innocent person; that opened the gates of evil.” On a lesser scale, I am reminded of the Enron accountant who admitted clearly that “it all began with 25 cent ledger changes that grew to tens of dollars and to billions and then to devastated lives and dreams.” This is why mystics decry the occasion of venial sin, which always leads to larger and larger miscalculations of conscience.

Wiesel was deliberate in telling us that the humiliations he and the other prisoners experienced never made him feel personally shameful. “The guards lost their humanity, we did not.” What a paradox and how true. The committer of the sin is the one becoming less human, not the other way around. In fact, he said that the first time he was truly ashamed in his life was many years later in the Deep South, when he witnessed oppression of Whites over Blacks and the sin of our prejudiced American society. “I was ashamed to be a White man in the bigoted southern U.S.”

He then went on to discuss the new fanaticism that is dominating the world – suicide killing. “Terrorism is not new, but suicide killing is our new peril. It started in Israel and then 911, London, Madrid, Moscow, and all over the middle East.” “They even kill children. The sovereign right of children over me is such that if I see a child fall, I don’t look in his/her pocket for ID. I pick the child up and serve. I take care of the child!”

Wiesel went on, “we must do what we can to see in each other not enemy but companion.” The famous “nose” analogy made by GK Chesterton in Orthodoxy came immediately to mind. “All the world’s noses have more in common than they do differences.” How beautiful the colors and shapes of all those noses having a common purpose but uniquely crafted!

He then closed with a plea for Education. “Only through education can we respond to the Holocaust and combat our World’s ‘culture of death.’ Life is sacred!” he implored. In his preface to Night, Wiesel taught that the appropriate response to Auschwitz should be responsibility. “The witness has forced himself to testify. For the youth of today, for the children who will be born tomorrow. He (the witness) does not want his past to become their future.”

Question and Answer:

During the Q&A, the Boston University Professor was asked by an impassioned woman who works with ethnic cleansing in Eastern Europe, “How did you rebuild your life?” Wiesel, for the 4th time that night, brought up God and the Book of Job. “I have not lost faith in God. I have moments of anger and protest. Sometimes I’ve been closer to Him for that reason. Job is the only book in scripture that teaches us how to live after the trauma.” On that point, there are some points worthy of consideration:

  1. Job, as we all know from the book’s introduction and course, is the story of a just man allowed to suffer through an seemingly endless test of faith. He loses all his possessions, his sons and daughters, and finally suffers serious illness. His friends try to convince him that this “evil and suffering” are pay-back for some wrong he must have done. These friends justify a moral meaning of suffering. But as JP II wrote in “Salvifici Dolores” in 1984, “While it is true that suffering has a meaning as punishment, when it is connected with a fault, it is not true that all suffering is a consequence of a fault and has the nature of punishment. The figure of the just man Job is a special proof of this in the Old Testament. In this sense, the Book of Job poses, in an extremely acute way, the question of the ‘why’ of suffering; it also shows that suffering strikes the innocent, but it does not yet give the solution to the problem.”
  2. Suffering brings solidarity to those who are its victims. It joins them together. Therein lies strength that will teach us about love. It also creates in each of us the possibility of rebuilding goodness that we have lost along the way in our lives. It can serve for “conversion.” In this, I as a Christian (though 25% Jewish and with a special kinship to my Jewish family and heritage) kept thinking about how “unfinished” the statement that Wiesel made was about Job being the only book in scripture to direct our rebuild after life’s trauma. To me, the definitive suffering of Christ is the answer still waiting at the end of the Book of Job.
  3. Regarding the intense suffering of innocents of Auschwitz and Buchenwald, consider the Beatitudes and the Lord’s Passion. Jesus spoke in his Sermon on the Mount of the poor of spirit, the afflicted, those who hunger and thirst for justice, and those persecuted for justice sake. Luke explicitly mentions those “who hunger now” (like Wiesel at Buchenwald having eaten only grass for 5 days). During Christ’s public life, he was fatigued, homeless, persecuted, misunderstood even by those closest to him, and increasingly isolated in preparation for his death. He was then sold out, arrested, beaten, humiliated, spat on, sentenced unjustly, scourged, crowned with thorns, and made to carry and be hanged on a tree. Through this tale of love, and through His resurrection, all of suffering enters a new dimension. Only this new dimension of salvific love puts the suffering of the world into perspective for me. Perhaps this is what Job foresaw when he said, “I know that my Redeemer lives.”
  4. In this new way of thinking, Jews and Christians can say together, “Do not fear those who kill the body but cannot kill the soul.” It is that paradox of weakness and strength that really came across to me during the Wiesel speech. “For when I am weak, then I am strong” 2 Cor 12:10

 

Ultimately, Wiesel told of his invitation years ago to the German royalty and leadership. As they bestowed on him an award, he calmly retorted thanks for all that the country had done right following the war, and then he asked them, “But why have you never asked forgiveness from the Jewish people?” The next week those German leaders made a trip to Israel to ask for that forgiveness publically. He smiled at us and said, “I often doubt the power of my words, but sometimes they do work.” Indeed they do…and I hope I remember these lessons of forgiveness, solidarity, and survival through hope that I learned when the Nobel Laureate came to Nashville.

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Call to Holiness in the Here and Now: Lessons from Opus Dei, St. Paul, and William Law

On a recent trip to Austria for a medical meeting, I was surprisingly and thankfully “knocked over the head” three times by the Holy Spirit in a trio of Viennese churches called St. Peter’s, St. Stephen’s, and the JesuitenKirche. Presumably God wanted to emphasize a few points of his Gospel message that I, being slow-to-learn, had not integrated well enough into daily life. In the spirit of sharing, I offer the experience in brief divided into 3 separate encounters as they occurred, which could be read on separate occasions.

Encounter 1: St. Peter’s church, located on side streets of Vienna, is moving even at first glance due to its sheer beauty. However, what really struck me was the message of devotion to holiness for laity. The holy card most prominently displayed in stacks throughout this church showed Saint Josemaria Escriva. As the founder of Opus Dei, this saint’s movement, which was misrepresented in The DaVinci Code, calls simply for holiness in everyday life by everyday people. The prayer card read: “Grant that we may choose holiness through daily work and the ordinary duties as a Christian. Grant that we also may learn to turn all the circumstances and events of life into opportunities to love and serve the Church and all souls with joy and simplicity, lighting up paths of the Earth with faith and love.” As I left Mass and walked into the reality of everyday life, the sounds of pigeons, beggars, and vendors stood in stark contrast to the glitter and gold I had just witnessed. Here, right here, is where we are all called to make a difference. We know this, and we talk a good game and think ourselves somehow “adequately kind” because we act in a giving manner during easy days when comfort and satisfaction abound. For me, though, standards for my own behavior rapidly plummet when I am tired, stressed, inconvenienced, or rushed. What happens, for example, to our “lighting up paths” for Christ when we have to wait in a long line, get cut off in traffic, or don’t get a good night’s sleep? These are the moments through which holiness is tested, yet we persist in giving ourselves a “pass” because we did well “yesterday” or sanctimoniously judge ourselves doing “better than the next guy.” And how do we muster the audacity to doubt the ever-present goodness of the Father just because we witness suffering in the life of family or friends, loss of job, or an agonizing relationship? Shouldn’t we instead work daily to build reserves of faith that will allow us to retain clarity to praise Him even more for loving us enough to allow pain to mold our weakness and immaturity into more lovable creatures? And our service is to be measured by millions of tiny interactions that occur in the context of our everyday life, especially, as we are told so often, the actions seen only by God that we do intentionally because of our love of Him.

Encounter 2: My journey continued the next morning as the sun rose to reveal intense winds and dropping temperatures. Through narrow alleys and along the quiet streets of Vienna, I made my way to St. Stephen’s, a landmark built originally in 1160. This astounding medieval church extends well over a football field in length. No picture even begins to do it justice. Nevertheless, I pasted a shot of the exterior for you below. As in many European cathedrals, there were so many side altars that it took me a while to find the small corner where about 40 of us gathered to receive the Eucharist. The first reading was from Paul’s letter to the Romans 1:16-25. For brevity, I am shortening the passage and using italics to emphasize what struck me “19 since what may be known about God is plain to them, because God has made it plain to them. 20 For since the creation of the world God’s invisible qualities—his eternal power and divine nature—have been clearly seen, being understood from what has been made, so that men are without excuse. 21 For although they knew God, they neither glorified him as God nor gave thanks to him, but their thinking became futile and their foolish hearts were darkened. 22 Although they claimed to be wise, they became fools 2325 They exchanged the truth of God for a lie, and worshiped and served created things rather than the Creator.This struck me as if I’d never heard it before. We are always talking about the mystery of God’s ways and using this as an excuse for our blindness. We claim that “if we only understood God and His mystery,” that it would be easier to remain on task in the little things of daily life (emphasized over and over by Jesus and the specific point of devotion for married and single lay folks emphasized by Saint Escriva). Instead, we are either welcoming pride and self-love as strident companions, about to do so, or asking forgiveness for recently having fallen prey. The Swiss mystic, Fr. Maurice Zundel, wrote that our self-love is so tenacious that it will die about a quarter hour after we do. If we would but digest this reading, it would be apparent that God has revealed to us all we need to know. The truth has been made clear, and we are thus without excuse! So what is this truth? Why are we here? For an answer, let us revisit Saint Ignatius’s Principle and Foundation: “Human beings are created to praise, reverence, and serve God our Lord, and by means of doing this save their souls. Cut to me walking out of St. Stephen’s into the chill of the day. I looked up at a statue of St. Sebastian, riddled with a dozen arrows, and prayed to do a better job with the plain and clear duty of praising Him joyfully and in thanks for my vocation as a husband, father, and physician.

Encounter 3: The final component of my Austrian schooling speaks to the adage that physical shape of the cross begets an outward expansion beyond self that will paradoxically return to us more than we ever give. A year ago, a friend of mine found out that his wife was cheating on him. He and their marriage quickly became unglued. I had the good fortune of serving as a confidant for him as they worked to save the marriage. He thinks I helped him, but I know that he helped me more. To extend my friend’s blessings to me, the morning after mass in St. Stephen’s, he texted me with the unsolicited message that the JesuitenKirche (Jesuit church) in Vienna was a “must see.” Although it is only a few blocks from St. Peter’s and St. Stephen’s, I would have missed it for sure had he not guided me there. On the map of Vienna, the other two churches are notably displayed, while the Jesuit church was signified by a mere cross on the paper. It is perhaps the most glorious of the three, if that is possible. As I entered the stunning church, a baby was being baptized, surrounded by family and friends. So as not to interrupt, I sat near the back, prayed, and eventually opened up a C.S. Lewis book I’d been reading. Lewis draws on the message of the Englishman William Law, whose book A Serious Call to a Devout and Holy Life (1728) was so influential to the likes of Lewis, Whitefield, and Wesley. He recounts this statement by Law, “If you will stop and ask yourself why you are not as pious as the primitive Christians were, your own heart will tell you that it is neither through ignorance nor inability, but purely because you never thoroughly intended it.” Wow. There it was again, stated clearly. Law’s point is beautifully complementary to that of both Escriva and Paul: we have the mental technology to get this right! Here is where over-thinking can get you in trouble. An excess of theologizing about Christ often leads to us getting things in life out of balance (i.e., ignoring the Martha for the Mary). Success as a Christian (turning oneself completely over to Him and disregarding self) is not predicted by age or intelligence. As Law says, and building on the others, we know what we need to know but lack sustainable intent. We can, if we so choose, live our lives joyfully in thanks for His grace to us regardless of today’s or tomorrow’s circumstances. If we are not resolute in this, then pride will take over, and bitterness and vanity will kill our progress.

There is only one answer for us in the pursuit of thoroughly intending to follow a more direct path in walking with Christ: prayer. Ravi Zacharias, in his “Let my people think” podcast recently made the comparison between prayer and a GPS device. As soon as we go off the “best route” towards our destination, the GPS device recalculates and directs us back to the correct road. Prayer does the same thing. In our approach to the day-in, day-out small events of life, prayer will help us remember to lose self-love and focus attention on all those around us whose halos we continually miss because of our self-gaze. Two remaining sayings from this Viennese journey keep echoing in my mind. The first from my Grandma Alice, who regularly told my Grandpa, “Ralph, you have to become small to be big.” The second is never to become angry or resentful about pain, for as CS Lewis wrote, “God whispers to us in our pleasures, speaks in our conscience, but shouts in our pain.” If He is bothering to shout, you can bet we need to listen. Only then will we consistently “light up paths” for Him in the here and now.

For any who reads this, let it be clear that you’ll frequently witness my public failings along these lines. I ask you, please, to call me to task. Perhaps you can merely whisper to me, “Vienna.”

Ad majorem Dei gloriam (for the greater glory of God),

Wesley Ely, MD, MPH
Vice-President of the Nashville Guild of the CMA
wes.ely@vanderbilt.edu

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Diving Bell and Butterfly

[This story is dedicated to my great uncle Dubba, who left medical school to answer “yes” to a voice he heard in a movie theater one nigh. He became a Benedictine monk. He took the name Brother Marion and lived for over 50 years in the idyllic St. Joseph’s Abbey of Convent, Louisiana. Dubba eventually suffered a massive stroke prior to his death, and the last time I sat with him at the Abbey, he told me about his life’s calling and recited the very words from his favorite poem that provide the answer to the question posed in the title of this story.]

Three events in a single 24 hour period gave me a great gift, or “key,” that I would like to share.

Imagine your being a paraplegic or a quadriplegic. How would this try your patience and your faith as you had to eat and talk without being able to move your limbs? And what if it was worse than that? Perhaps you have heard about the now famous book and movie The Diving Bell and the Butterfly written by Jean-Dominique Bauby, a “locked in” victim of a massive stroke. Bauby had been the editor-in-chief of Elle magazine. As have been my own patients with “locked-in” syndrome, he is absolutely lucid but completely unable to move except for his left eye blink. Once this is realized, he is able to carry out his previously arranged book deal contract via dictating each letter of every word with a certain number of ‘eye blinks.’

The first of the 3 events was that my sister decided to share Diving Bell with me for an upcoming trip she knew I was taking. I found it astounding what Bauby tells us as we are allowed to “see” through his eyes. At the end of the book, I read with a deep sense of emptiness his parting thoughts and his ultimate question. I shudder to think what I would feel like if left to wonder the question he posed. Come along and let me share this story with you…

Walking into our den the morning I was to depart on my trip, the second confluence of events took hold. I heard our 14-year-old daughter, Taylor, playing piano and singing as she worked out the kinks of “The Call” by Regina Spektor, which is the marvelous soundtrack from the latest movie of C.S. Lewis’s Chronicles of Narnia. I heard Taylor’s strong voice (biased father) belt out, “It started out as a feeling, which then grew into a hope, which then turned into a quiet thought, which then turned into a quiet Word, and then that Word grew louder and louder ‘till it was a battle cry, “I’ll come back…when you…call Me. No need to say goodbye.”

Indeed, there is no need to say goodbye to Him at all. If we take Lewis’s message in the Narnia tales and their background biblical inspiration, then the omnipresence of Christ in our lives must remain the source of our smile and resilient joy at never (ever) being left alone. And yet, we all know that we come up against this feeling regularly. This brings me to the next event.

Shortly after I watched Taylor play “The Call,” I started my sojourn to Helsinki, Finland. In the past, I would have felt lonely on such a trip, but these days I keep prayer as my constant companion and welcome His presence alongside me in planes and airports and distant lands. As I sat having a warm buttery croissant in the Amsterdam airport, amongst so many bustling partners in life from multitudes of countries, I focused on the daily readings in the Magnificat. There I found the third piece of my life’s lesson, a treasure in a meditation for the day from Father Francis Martin, who is director of Christian/Jewish Relations at the JP II Cultural Center in Washington D.C. In this missive Father Martin recounts a famous story apparently used in monastic teachings to advance depth in prayer life. The story goes like this:

 A young man goes to his master and says, “I want to find God.” “All right,” says the old man as he takes him down to the water. “Put your head under the water.” Once submerged, the old man dunks the young man’s head further under the water until he struggles and then finally lets him up as he gasps for a breath. Addressing the look of surprise on the young man’s face, the old man explains, “When you want to find God the way you just wanted that breath, then you’ll find him.”

Do we seek God consistently with such passion and desire? Once found, can such a desire be maintained? I have been told not, yet in St. Faustina’s Revelations of the Divine Mercy diary, she demonstrates such passion daily for the Eucharist, feeling utterly empty and “starving” without His daily bread. As Christians, we must nurture the same hunger through prayer that the monastic lesson above demonstrates. Think of Jesus’ presence in our prayer life (constantly as mentioned in II Thes 5:16-19) as our next gulp of air. None of this need be or appear to be self-righteous or holier-than-thou, as this would be offensive to others. Rather, we should help others of all faiths with devotion through small, ordinary gestures and reminders throughout the day and in all circumstances. (And by the way, I need to be reminded of this lesson more than most.)

On the flight from Amsterdam to Helsinki, I returned to Jean-Dominique’s story (which has no surprise ending, by the way). As he closes The Diving Bell and the Butterfly, it is apparent that the diving bell represents the perils of his heavily weighted circumstances in life, so deep within an ocean of grief, and the butterfly a visual for his intact, vibrant mind. He is next to the woman who has diligently followed his eye blinks for the past few months in order to transcribe the book. Jean-Dominique peers into her purse with his lone left eye (the right lid is literally sewn shut) and sees keys to her car and hotel room. Pensive, he wonders (recorded by her through his blinks), “Does the cosmos contain a key for opening my diving bell?”

In no way would I ever presume to judge Jean-Dominque’s faith, which he did not reveal specifically in the book. Indeed, he may have been talking about a key to physical paralysis, though one gets the sense he sought much more. To Bauby’s question, I draw on the final lines Uncle Dubba’s favorite poem Hound of Heaven by Francis Thompson, and I can hear his wise voice crackle: “Ah, fondest, blindest, weakest, I am He Whom thou seekest! Thou dravest love from thee, who dravest Me.”

It would be a perilously lonely and deeply lost feeling for anyone without such a “key” on a spiritual level. Thankfully, just about 2,000 years ago, we were given the Key to the cosmos that will unlock all of our “diving bells,” no matter what they may be. We all have our burdens, some physical and some mental. But to each of these “diving bells,” we have one master Key provided in the Trinity, to which we never have to say goodbye.

Bringing these three events together for me within one 24 hour period was a gift of much grace by the Lord. My prayer for you, and for all of us, is that the very thought of our Lord brings you to tears of wonderful thanks for all that you have been given in life. All of the beautiful and not so beautiful aspects of our lives, none of which we deserve in the first place, make up the tone of our call to Heaven. We should pray that our very next breath depends on the realization that Jesus Christ’s goodness is so remarkable in our eyes that we are suffocating in its absence. I pray that we can maintain this same degree of closeness to Him through “all the sham and drudgery” (Desiderata) of this world. If we do, then we will be lucky enough to have transient moments of clarity that bring us to the tears.

Ad majorem Dei gloriam ─ E. Wesley Ely, MD, MPH (wes.ely@vanderbilt.edu)

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Mary Lou’s Voyage into the Kaleidoscope

As I left my bustling children at school today, I crossed a main thoroughfare in Nashville into the Windsor Tower of condominiums, surrounded by blooms of dogwoods, tulips, and newly bursting azaleas. All of this exuberance from kids and spring flowers was in stark juxtaposition to what I knew was about to be the scene in Mary Lou’s room, where Hospice had been set up the day before. And yet, just as with so many dying patients with whom I have visited both in and out of the hospital, I was absolutely certain that I would come away from this ‘house call’ with more personal value gained than imparted.

Mary Lou was laying in her new hospital bed, placed by her dutiful daughter, Vanessa, right in the smack dab middle of the living room, facing her huge “picture” window with a fabulous view of Nashville’s skyline. Blue was all you could see this day. As I turned to Mary Lou, her face was gaunter and her eyes deeper than just two weeks earlier when I had seen her last, and yet there was a peace about her that was instantly evident. Having been diagnosed with colon cancer earlier this year, I had visited her many times and found her to be a bit feisty, in a good way, and not at all willing to “call it quits” just yet. Honestly, it had worried me because I felt that this fatal illness was likely to progress pretty quickly, and I didn’t want to see any lack of resolution of relationships and love shared and so forth. Even more importantly, I didn’t want to see her suffer pain or discomfort because of a resistance to face the realities of dying. Thankfully, nothing could be further from the truth, because Mary Lou and all of those around her have scripted a virtually beautiful story over the past few weeks that warms my heart.

In medicine, we talk much these days about “good death,” and as an ICU physician, I actively seek to orchestrate “good death” for my patients. On the continuum of life, the reality of dying is to me a natural and beautiful part of all of our stories, and one that I firmly believe we should not attempt to delay when the time is obviously at hand. Thus, imagine my thankfulness when I saw the immense amount of acceptance and courage displayed by Mary Lou. Maybe we all wonder if we will have such courage when it is our time. Well, to help impart her own sense of wisdom, Mary Lou took it upon herself to teach us while she still could. And she left Vanessa and me with 3 main messages.

  1. When discussing the afterlife, Mary Lou said, “I imagine Heaven as a huge kaleidoscope of energy through which we’ll see beauty beyond imagination.” She clearly stated that she considered this day and all remaining for her on Earth as a voyage towards this kaleidoscope and she called it her “next big adventure.” Of this, she was absolutely accepting, and it was beautiful for me to see. None of us knows what Heaven will be like, but we pursue the Kaleidoscope with Faith and the knowledge that it will be a gift not earned and yet abundantly given only through God’s divine mercy if we, the sheep, follow our Good Shepherd.
  2. Next Mary Lou said, “Without pain there can be no strength.” She was reiterating what so many saints (Teresa of Avila, John of the Cross, etc) have said, which is that we should be thankful to receive pain and trials. This brings us closer to an understanding of God. In such trials, we will come to know that He is with us, carrying us in our reliance as it should be every day even in the absence of an immediate trial. Furthermore, in Teresa of Avila’s Mansions of Prayer, she states the Heroic Virtues, which are to say that we (you and I) should approach all trials in the following 5 ways: (1) Easily (2) Promptly (3) Joyously (4) Regardless of difficulty, and (5) Consistently. On this day, Mary Lou’s approach and comments reminded me of these saintly virtues. Her wisdom in this seemed larger than life. I was thankful.
  3. Lastly, she talked of how much she appreciated the time she’d had with her family. She valued each and every minute over her whole life with her children their families. We discussed how often it is that people fail to appreciate these times and end up with regret. Then Mary Lou whispered her third lesson: “Life is simple, really. It is just Love. It all revolves around Love. People make themselves miserable with the seven deadly sins instead. Please remember that.” I thought of them: lust, gluttony, greed, sloth, wrath, envy, and pride. I prayed then, as now, for discernment to avoid these and presence of mind to turn to Jesus as my light away from these ever present traps. And the words “Jesus must increase, I must decrease” (St. John the Baptist) echoed in my mind.

Then she stopped. Looked at me, then at Vanessa, and tears flowed out of her eyes. These, though, were tears of days well lived, lessons learned, and thankfulness for having completed her journey. It was obvious that in the final synthesis of her life, Mary Lou had soared right past all of the things that weigh one down (schedules, worries, regrets, pettiness). She was completely focused on the main point, which was Love from God to us and from us to each other. The Kaleidoscope was in view, and who would want to delay that voyage when you’ve prepared so well for the journey? Not Mary Lou!

Ad majorem Dei gloriam (AMDG, for the greater glory of God),

 

Wes
wes.ely@vanderbilt.edu

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